Elevator Thoughts

[Scaramedic]

I have been reading On Call Cardiology by M. Gabriel Khan, MD and I found this paragraph on Elevator Thoughts...

"Elevator thoughts are entertained during the 3 to 10 minutes after the phone call before the student or intern reaches the bedside. During the time spent to reach the ward, it is advisable to consider a differential diagnosis of the problem and relevant causes of the underlying disease. This thinking should provoke a more relevant questioning at the bedside and a pertinent physical examination."

This got me thinking about, for the lack of a better term ambulance thoughts. When your dispatched to a call do you consider the case you are running on? I know that many times the call notes are entirely different than what you actually end up with, but is it a good thing to think about and prepare yourself for the call prior to arrival? Does it make your assessment easier when you have already run the case through your head prior to your arrival?

I would like to say I used to think about every call en-route, but I am going to be honest and admit sometimes my thoughts were not always on the job. Now that I look back though I can see the benefits of ambulance thoughts for me and my patients.

Peace,

Marty

:joker:

[MrSpykes]

I think " ambulance thoughts" can be a double edged sword. Yes, it is good to think about and prepare for a call based on dispatch information. At the same time this can contribute to tunnel vision. Not to mention if the patient is completely different from the dispatch info it can throw you off guard and make you seem unprepared.

Two calls come to mind.

1. I was told i was going to a psych facility for a ground level fall. Patient was reported to still be on the ground. So we went en route lights and siren. Dispatch told me the patients airway was patent. I thought that was a strange piece of info for a ground level fall unless there was a loss of consciousness and we were told there was not. U/A at the facility I get out a LSB, C-Collar, straps, towel rolls and tape. We get up to the floor and we find out the call is for a female whom swallowed her toothbrush after lubing it up with tooth paste. She also swallowed her razor in the past.

2. I heard it dispatched as a male with an injury to the wrist. Once the patient climbs in the back i look at his wrists and don't see any swelling, deformity or bruising to either. So I asked, "What seems to be the problem to day?" He responded with a story about how last night he and some friends were wrestling and he hit his chest. I was completely caught off guard because i was expecting an injury to the wrist.

[Imagine89]

Since I'm still relatively new, I like to go over things in my head before aos. Our dispatcher usually has the right info...

[AZCEP]

The toughest situations are the ones you happen upon. You don't have time to adjust your mindset, and change the plan that you made before arriving.

Even worse in the middle of the night.

[Ace844]

I have a huge black cloud syndrome, so pretty much from the moment I step through the door, I am as ready as I can be for it to go FUBAR. That being said I do also practice what the original poster mentioned.

ACE

[rocket]

Hrmm.. interesting topic!

I've not read On Call Cardiology so I may be in danger of mistaking the context of the section mentioned in this text...

..but the one difference between ambulance thoughts and elevator thoughts that seems to stick out in my mind is the is the setting of that provider-patient meeting.

If the student or intern is arriving at bedside then the meeting is in somewhat of a controlled environment. Although it might still be an acute care/stabilization type of visit chances are the provider came in through the doorway.

Whereas in a prehospital environment the provider might come come in through the back window of the demolished car.

IMHO scene survey (and in some cases control) is a big part of what we do in the field due to the uncontrolled nature of our environment. My ambulance thougts tend to include a review of stuff like what did I overlook on the last case that sounded like this? or what did I take too long to recognize the last time I had such a call?. This type of thing might be assessment-related or it might be as simple as eyeballing a path for the stretcher through a tight area of the patient's residence.

Certainly this type of thinking hooks into the information I receive from dispatch...but I try to limit the DDx to a few general ideas and focus on putting together a bigger picture just as soon as I arrive and get to see more of what is going on.

Then again there are some times when all I can do en route is keep asking myself if I am actually fully awake yet. :wink:

-Trevor

[jw-c152]

I suppose I might think about the 'what if's on the way to some calls... but for the most part I don't.

If i'm driving, I'm more worried about getting us their safely.

If i'm passenger, I'm more worried about finding the street in the map book.

Usually the extent of my trying to predict what a call will be like based upon Dispatch info is deciding which equipment I need to take with me right away.

Cheers.

[Star09]

I try to go through protocols and the like in my head on the way to the call, it's harder to do for me, I'm still trying to get used to it. My two partners are also trying to teach me to anticipate what is needed before they have to ask. Sometimes, if it's a long drive to the scene, my partner will ask me what the first, second, third, etc. thing I'm going to do when I get on scene. That particularly helped in a triage situation.

[northernmedic]

On call is a great series of books. The regular On Call was a required text for my paramedic course and it was probably the most useful book I used.

[Ridryder 911]

I have always praticed and suggest to prepare for the worst, and if it is not you will be pleasantly surprised.

R/r 911