I kick off this week’s news items with a look at a great article written by Kelly Grayson a.k.a. ambodriver on twitter. Kelly is also one of our podcasters on the ProMed Network with his confessions of an EMS Newbie podcast.
The Non-interventional Medic
Kelly wrote this column over at EMS1.com and he addresses an important part of maturing as an EMS provider – when to use your skills. In fact, as Kelly points out, not using a skill is a skill all unto itself. He points to a typical Congestive Heart Failure patient with pulmonary edema, called by some “junky-lungs.”
He talks about the differences in how he would have treated this patient along the course of his career. Kelly draws something of a picture of the changes in approach to this kind of patient over the years in medical care but he also points out his approach to caring for this patient has changed because he is now loath to jump to intubating this patient when compared to his “skill-happy” EMS youth.
EMS Urgency Not Always Real
This is a skill that I developed very quickly when I started working in an ER as a paramedic, assisting nurses with IV’s, 12-leads, ACLS interventions and more. I discovered that things that I’d be in full-blown ALS emergency mode with in the back of an ambulance were much more a “let’s wait and see patient” in the ER.
Respiratory patients were standouts to me in this discovery. I’d get very nervous bringing in a patient with respiratory distress and the first thing the nurse did was take the non-rebreather off the patient and maybe, MAYBE put them on a nasal cannula. Kelly points out in his article that this was the critical thinking that we don’t do a good job of training into our paramedics (which, incidentally, nursing schools focus on constantly).
Critical Thinking Skills in EMS
I developed that critical thinking a little bit quicker when working in the hospital because I spent hours with these patients and I saw how time wasn’t really the driving factor in most ER treatment, belying the falsehood of our “run ’em all, lights and sirens, full interventions because we can” approach to patient care in too many EMS systems.
So I urge you, the next time you bring a patient in to the ER, are you doing a skill because you have to determined by the patient, or just because you know how? Remember, not using an EMS skill is just as important a skill all by itself!
Follow-up on the link for this and other news items as well as all of the additional resource links in the show notes for this episode — EMS Helmets, Product Trends, and Episode 327 of the MedicCast.