Sunday, July 25, 2010

In Fire & EMS EVERYTHING is Relative.

I’m thinking a little more in advance this time about the assignment for the next edition of the Handover Blog Carnival, which is “Crisis Patients”. Hopefully I’ll do a bit better this time due in part to the fact that I have more time and also because the ‘assignment’ fits a little bit better inside my head.
“Crisis” is a relative term. It’s a lot like “really bad”. I frequently work jobs where I find a particular senior Fire Officer there when I arrive. He’s a good Officer and has seen a lot, but most of us know that he ‘doesn’t do blood’. It’s just not his thing and he gets excited at any medical call where things aren’t calm and under control. He will frequently warn me as I enter a scene that “It’s ugly in there man, be careful”. I know he means it, but invariably when I get in there and scope it all out, it’s just a routine low level job. No big deal.
It’s the same with “Crisis”. One person’s crisis is another person’s routine job. There is also the perspective of view, i.e.: are you the person addressing the ‘crisis’ or the person experiencing the ‘crisis’?
After you play in this game a little while you start to collect incidents that could fairly be categorized as “crisis patients” and I’m sure there will be some good writing about these types of jobs by the other contributing writers to the Carnival.
In the case of serious life threatening jobs, the crisis is pretty evident and we all go to work applying our assessment, treatment, and transport options to the best of our abilities and within our various scopes of practice. On occasion, some of us pull a rabbit out of a hat and come up with a solution to a critical problem which helps a patient get to the next stage of treatment where they otherwise might not have. I love these stories because they teach me much about creative thinking and make me better.
Sometimes though, the crisis is hidden and can be easily missed by providers or crews that are just doing the job. These are the calls that concern me. Let’s face it, 95% of what we do is very routine, boring, or even useless. Transporting the drug-seeker so he can take another shot at fooling the E/D Doc to get his fix, bringing in the stubbed toe, toothache, or “I’m sweating too much” is enough to make you consider other options, but that’s the job we work.
Many times the patient themselves do not realize they are in ‘crisis’. Take for example the overweight 59 year old male who has chest pains and the monitor reveals a severe MI. We know this guy needs attention now and he is insisting that he just “needs some rest” and “will be fine in a little while”. It’s our job to identify these types of crisis and do what we can to mitigate them.
It’s along these lines that I find the patients that cause me concern. The LOLFDGB (Little Old Lady, Fall Down, Go Boom) who calls us for lifting assistance to get back up to her walker. On first glance, it’s a routine call, check her out, help her up, get the signature, and be back in service. But we make a habit of having one person check around to make sure everything is cool. Is there food in the fridge? Is it fresh, edible, and appropriate? Is this house in decent order, or is it a mess with garbage on the floor and filth in the kitchen? Does the home have adequate heating or cooling? In short, how is this patient coping? Do they need other assistance? Would a call to the proper agency be in order to help this person move through the stages of life and degeneration? The elderly can be in crisis and lack the ability to recognize it. I see these too often. Sometimes they just need an outsider to tell them the things their family has been trying to tell them for a while, and sometimes they need more.
Sometimes the ‘patient in crisis’ is not even the person we were called to help. On occasion it’s a family member, friend, or neighbor. I am thinking about the unexpected cardiac arrest or the suicide that comes from out of the blue. There is little we can do for the long deceased, but what about the person who discovered them and called us. These people are experiencing a true Personal Crisis. It might just be the worst day of their life. What can and do we do for them? What do YOU do?
There is little to no training in the EMT-Basic classes, and just a tad more in most Paramedic program and I believe this is a real problem. The agencies would tell us that we ‘treat and transport the sick and injured, the long deceased are not our problem and neither are the neighbors’. But the fact remains that we, the providers, ARE on scene, and DO see the anguish and possible symptoms of those affected by the incident. For myself, I can’t walk away until I have done what I can for these folks and gotten them referrals which might give them peace. What do YOU do with your Personal Crisis patients?

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