Patient Care ?
By: Scott Cormier
Recently, I had the opportunity to respond to some EMS calls with my local volunteer fire department, that bring to question how we are defining and providing patient care. Our department is a small volunteer department, covering 10 square miles, surrounded by two paid departments and a paid county EMS agency. We have an ALS first response engine, and a dedicated group of volunteers. The first call was for a “suicide attempt with major bleeding from the wrists.” It was a patient that had a history with our service, and upon arrival, found she had fled the scene. After a short search by our department and the police, we found her in the woods a few hundred yards away from her house. It was nighttime, and the ground was moist, and she was shivering, barefoot and wearing only a thin top and jeans. The bleeding from the wrists were no more than scratches which were not actively bleeding. After a quick assessment, the crew was ready to walk her out to the street to meet the ambulance. I protested, concerned she would hurt herself with her bare feet on the rough ground and the cold weather. One of the responders replied “she got herself into this”, and stared at me as if I were crazy. Fortunately, someone radioed for the ambulance to come and pick up the patient. As the ambulance pulled up, I met the crew and asked for a blanket for the patient. The crew didn’t have any. We used two sheets to bundle her up, and placed her on the stretcher. The second call was for an elderly woman with chest pain. It appeared to be cardiac, so our team administered oxygen, aspirin, nitroglycerine, and performed an EKG. The nitro reduced her pain from a 9 to a 6. When the transporting crew arrived, they placed the stretcher in the hallway since the bedroom was cramped, and asked the woman to stand up and walk to the stretcher. I again protested, and asked to carry her to the stretcher. I was ignored, and the woman was walked.
My venture in EMS started in 1979, after watching too many episodes of ‘Emergency.” As an adventurous 16 year old, I found a volunteer EMS service that would accept a teenager, and began my lifelong career in EMS. Shortly after, I enrolled in a basic EMT program, and then a paramedic program. One of my mentors in those early days was a woman named Ginny Bakas, one of the few certified EMT’s at our service. While I was interested in the science of EMS, Ginny made sure I understood the social aspect of EMS. She would evaluate me on how I spoke to the patient, if I were able to carry on a conversation during the entire ambulance ride to the hospital, interaction with family members, as well as the medicine of emergency medical care. She reminded me that the social interaction is a part of our medical interactions.
I went on to work for the City of Pittsburgh, a high volume urban EMS system, and certainly had my share of cynical moments. The frequent flyers, the BS runs, people in “chronic” pain. I was losing my compassion. I moved on to become an EMS and rescue supervisor with a progressive suburban agency, but my bad habits didn’t change. I guess my awaking moment was when my mother was diagnosed with cancer. I began to see the social side of this disease, and it reminded me of the lessons taught to me by Ginny. A cancer patient in pain was no longer a frequent flyer or BS call, but rather an opportunity to provide a meaningful intervention. I felt like an idiot for all of the times I ignored those lessons on compassion and social interaction. Paramedic students today receive so much more training than the measly 150 hours required for my certification. But something that appears to be lacking are those wise lessons taught to me as a teenager. Patient care is about the patient. Whether you like them or not, sympathize with them or not, or are upset that they called you at 2am because they couldn’t pee, or weigh 400lbs and climbed upstairs before calling 911, our treatment needs to be much more than IV’s and splints. And it’s not something that you can learn from a textbook. It needs to come from our instructors, preceptors, and co-workers. Maybe we should take a lesson from Ginny Bakas, and evaluate our EMS students not just for the number of runs, splints, blood pressures, or intubations they perform, but were they able to carry on a conversation with the patient during the ride to the hospital, or how they interacted with the family.
Thank you Ginny, for giving me such an important lesson in emergency medical care.