This month I feel the need to stray away from all of the icky, sticky infection control stuff and talk about something just as important. As the title states, “Practice what you are taught”. What I mean by this goes back to the beginning of your initial EMT training, yes we are taught to look out for number 1, but we are also taught how to assess a patient. No matter where you first learned to be an EMT you were taught patient assessment. That is what I want to talk about this month is patient assessment, and not just what you see but what your patient tells you.

    How many times have you been on an incident and observed other providers treating the patient but not listening to the patient. In other words the provider goes off in another direction and blanks out the whole picture. Sure your patient might have chest pain, but what else is there, what is the cause of the chest pain. We are taught to treat signs and symptoms, to treat the patient, listen to what the patient tells you.

Here is your patient: Male in his upper forties complaining of some chest pain (3/10) with some breathing difficulty. The episode began with some breathing difficulty about six hours before going to the emergency department. Shortly after the episode began he used his inhaler and experienced slight relief. Prior to going to the ED the chest pain started and he used the inhaler again, this time with no relief. Upon arrival at the ED both the patient and his wife advised the staff that he was having breathing difficulty with some chest pain. During the triage process in the treatment room the patient advised the staff that he was having an “asthma attack”. He (the pt.) further advised the staff that “when he has an attack there is minimal wheezing, but tightness and pain” he described the pain as “bronchial pain”. The patient continued to tell the ED that this has happened before and all he needs is a “breathing treatment or two to take care of the problem”. The staff ignored the patient and decided to treat him for cardiac related chest pain even though the patient continually told the staff what the problem was. This patient was in the ED from 7:30pm until about 5:00am the next morning. After doing a complete cardiac work up which included treatment with nitro they finally treated him for his breathing at 3:00am. At that time he received a breathing treatment and solumedrol. The patient was able to go home shortly after treatment for the breathing problem.

    What did the ED staff do wrong? They did not listen to their patient, the patient has had these episodes in the past and knows his body. He actually gave up trying to convince the ED what the problem was since they would not listen to anything that was said. I know all of this because the patient was me. When you have an alert and oriented patient you listen to them. We have been taught that the patient (alert & oriented) is your best source of information. I have had these episodes before and know what is needed, I would know if this was different from past episodes. I know my body.

    Let me give you a little insight about myself. I have been involved in EMS for thirty years, starting as a Basic First Aid provider in a Cadillac Ambulance in the mid 1970’s. I have been an EMS Instructor since the mid nineties with BLS, ALS & CCT programs. One of my biggest problems are providers that do not properly assess their patients. We all know that the initial assessment (old primary) consist of ABC’s, general impression and prioritizing your patient. In this assessment you also talk to your patient which in turn leads you towards a treatment pathway. That is why BLS instruction and skills are my specialty. Just remember, you cannot and will not be a good ALS provider if you cannot adequately perform BLS skills and assessments. I give assessment the same priority as I give airway, you as a provider cannot fix one without the other.

    As you saw in my case the ED staff did not listen to me and went off in a completely different direction, a direction that was not needed. You also saw that after my breathing treatment and solumedrol I went home. That is what it took to “fix” my problem. You might be wondering why I let the treatment continue, the answer to that is simple. I got tired of arguing and trying to convince them what the problem was. I take this as a good learning experience that there are just those people out there that will not listen to anything but the little voice in their heads. We have all worked with that kind of person at least once, no matter what they are told they do not listen. Don’t be one of those people, sure what you see might say one thing, but what is your patient telling you. We are taught to explore all possibilities and paint a picture. Let the Rembrandt in you come out when you perform your assessments, take all of the information that you see, hear, feel and apply it to the canvas of your mind. If you do that your assessments will be the best you have ever seen and you will probably take the right path in your treatment.

    In closing, please do not forget your BLS skills. These are by far the most important skills you can possess in EMS. Without BLS skills we cannot function, the job will not get done properly and patients will suffer. Review the assessment section of your EMT book if you need to in order to make things a little more clear. So much time is spent by providers trying to be the best out there, reading and learning more advanced skills and pushing the basics to the back burner. All I ask is that you constantly review patient assessment and do complete assessments of your patients. You will be surprised at just how good you actually are, you will be one of the best.

Listen to your patient