At a recent EMS conference, a vendor had among their gazillion EMS-related wears, a t-shirt which read: "Do you want to talk to the paramedic in charge, or the EMT who knows what's going on?"

While many of us found this profoundly accurate statement rather humorous, it did send innumerable electrical impulses firing through the synapses of my cerebrum...  

The root cause of the flood of stimuli was the recollection of recent field observations and experiences of "patient care" with several ambulance providers and 1^st responder agencies.

I was also reminded of a recent conversation with a well know EMS consultant who had just invested time riding with a first response agency.   After the ride-along, he looked out the window rather pensively and asked, "At what point did it become OK for XXXXXXXX Ambulance (name redacted to protect the guilty) to not treat patients anymore?"

Is he right??   Have we lost the 'art' of patient care?   Has the glory of EMS technology and the 'science' of patient care taken over?

As a plebe EMT student back when most ambulances carried the manufacturer insignia of "Cadillac", my EMS instructors drummed a basic principle in my head...   When you arrive at the scene of a medical emergency, remember that the ill or injured victim is a PERSON first, and a PATIENT second.   It was considered an immediate " fail" on any scenario station if I did not bend down on one knee, look the patient in the eye, tell them my name, ask them theirs, and empathetically ask them "why do you need medical assistance today?"   It was also an immediate failure of the scenario if I did not lightly grasp the patient's wrist to offer the healing touch (and simultaneously assess the patient for a radial pulse, check skin condition, and so on).

Not wanting to believe that we as a profession have lost the caring principle, I set out to dispel the myth.  

To my dismay, after numerous observations with various ambulance and 1^st response agencies, I regret to inform the reader that it does in fact appear that too many of us have lost focus on the basics of what we are providing as EMS professionals.   This seems to be especially true of ALS providers such as paramedics.   In some cases, we have become so focused on the process, protocol, and the 'toys' we have, that we have lost the focus on the patient.  

We are really good at starting charts on the tablets and even finishing the ePCR almost immediately upon arrival at the ED, but how good are we at calling the patient by name (and I do not mean "sweetie" or "darlin'").   We can start an I.V. in the back of a moving ambulance on a cobblestone street, but how good are we at remembering to REMOVE the patient's shirt first so the line does not have to be threaded through the sleeve or the shirt cut-off by the very busy ED staff who do not have the time to unravel the maze of plastic tubing.  

We are great at assembling and putting on CPAP in a hurry, but do we explain to the family the reason for this noisy gag we are putting over their loved one's mouth and nose.   We can use GPS/AVL and real-time routing to get to a call, or to the hospital from a call, but do we choose routes to the hospital that have smooth roads and fewer turns for our patients and partner in the back of the truck?  

Chest pain patients too often get a high speed, bumpy ride to the hospital with sirens blaring, monitors alarming, and bright lights in the patient compartment - when maybe the best mode of transport is a slow, smooth ride, with soft lights and Bach playing in the background, and a warm, caring care giver holding their hand and reassuring them - wonder what that will do to myocardial oxygen demand?

Perhaps we all could use a little dose of "back-to-basics" in our EMS delivery techniques.   Remember the ole phrase "Treat the patient, not the monitor"?   Well, it still holds true today.

When was the last time YOU were strapped to a long board and experienced the thrill of bouncing along a bumpy road (not to mention seeing the science project probably growing on the ceiling of your ambulance)?   Or were wheeled out of an ambulance into the breezy ambulance bay at the hospital without a blanket covering your body AND your head?   Or, from an inter-agency relations standpoint, how do YOU feel when the nurse or physician in the ED doesn't listen to your report or even care about what treatments you provided... BUT, is that exactly what you do to those who were on the scene before you?   Do you really listen to them?

How about we resolve to consider reinforcing patient-focus concepts for 2010??   I'll use the "BASIC" acronym, but as an astute EMS industry leader who proofed this column for me pointed out, there is really nothing "BASIC" about these concepts (thanks Karen!)

1. B e nice to the person at the other end of the radio .   Communications and field personnel have much different views of the world.   The communications staff is looking at all the calls and all the EMS vehicles, trying to balance geography, speed and workload.   Field staff is looking out the windshield at traffic, weather and their 5^th call in 7 hours.   Be empathetic...
2. A ct on information given to you by the patient or 1^st Responders .   If the patient says "I'm having difficulty breathing", put them on oxygen!   It really doesn't matter what pulse ox is on room air when the patient cannot complete a sentence.   If the patient has a clearly fractured distal tib/fib, take the few minutes to let the Fentanyl work before taking off the sneaker!   First responders (fire, SNF staff, hospital staff, etc.) have great information about the patient.   Listen to and respect them.
3. Put yourself in the patient's S hoes .   How would you like to be treated or have your family treated?   It has some correlation to clinical care, but is more about the interpersonal exchange.   Take a minute to explain the care you are providing as well as what the patient can expect to happen upon arrival at the hospital, calm the fears of the patient.   When was the last time a patient called to complain that the crew misdiagnosed their 2^nd degree heart block as Mobitz Type II?   Not usually.   Patients care more about whether or not the crew was nice to them.
4. I nter-relate with your patients .   This requires more than standing back, logging information into your tablet PCR and telling others what to do...   Touch your patient - do actual hands on assessment.   Connect with your patient: both as a clinician and as a person.   On the way to the hospital, put down the stylus and hold their hand instead.   The medicinal value of touching is well proven in research literature.
5. Take a C omprehensive view .   Tunnel vision is all too common in our line of work.   Be sure that someone - preferably YOU - step back to assess everything happening.   It’s wonderful that you administer pain meds for your patient, but it doesn't help if you forgot to remove the constricting band used for the I.V.   Before you hand care off to a BLS provider to ride in with the patient, have you considered all the things that could go wrong with the patient?   When deciding to field call a CPR case, look at the family - would they benefit from Pastoral Care?   Would it be better to take the patient to the ED so that the family has social services available?   Has the nasal cannula tubing been disconnected from the O2 outlet, thereby preventing the dreaded accidental nasal flaring with the stretcher half way out of the ambulance?   It's amazing what you can see when you step back to survey the scene.

With all the discussions and current research about the perhaps limited value of ALS care on patient outcomes (more on this topic later!), maybe the T-Shirt is more correct than we care to admit.   But we can change that!   On   your very next call - walk in, talk to the 1^st Responders, approach the patient, get down to their eye level, look them in the eye, touch their wrist and say, "Hi, my name is Matt, what's your name?"   And follwed by, "Why did you call the ambulance today Ms. Jones?"  

Time for a new T-Shirt!