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Archive for the ‘ideas’ Category

’nuff said

with 8 comments

Yes, it’s that simple.

via

Written by ben

September 17th, 2009 at 6:58 pm

Posted in funny,ideas,links

Most Emergencies aren’t.

with 5 comments

One of the most important lessons I have learned in EMS is this:

Most emergencies are not emergencies, they are only perceived as such by the people involved.

As far as the job is concerned, this has 2 very important implications.

  1. One of the most important things to do first on scene is to quickly learn whether this is an emergency or not and
  2. No matter the situation, your patient and any concerned bystanders (anyone on scene with an emotional attachment to the patent; friends, family, etc) need to understand whether and why this is or is not an emergency and what happens next.

A witnessed arrest is probably pretty clearly an emergency. An unconscious drunk college student with no signs of trauma who wakes to verbal stimuli maybe is not an emergency, but his hysterical roommates who called might feel differently. The job starts the same in either case: we are called to someone’s emergency. But the requirements of each become vastly different when we arrive and see whether it is an emergency or not.

In either situation, we have work to do.

cf.  Patients Define Their Emergencies (The EMT Spot)

Written by ben

May 27th, 2009 at 1:21 pm

Posted in ideas,rants

What happens if we say no?

with 5 comments

In a meeting today, someone offered the timeless reminder that we can’t say no. If someone calls an ambulance and says “I need to go to the hospital” we can’t say “Well, we aren’t taking you because you don’t need to go.”

Why not? I realize that there are probably legal concerns, so what are they?

I want to envision a well-monitored program that allows a the Paramedics in a system to tell a patient that we won’t be taking them to the hospital. This differs from the idea of the “Paramedic-initiated refusal” in that no one is convincing the patent to refuse; we are telling the patient that we won’t be taking them to the hospital.

Surely there is a discreet, teachable, easily monitored set of evaluation criteria that can filter those patients who will not die if they don’t go to the hospital by ambulance. This would be best supported by some public transport system like Access-a-Ride that we have here in Colorado.

It might look something like this:

Patient: “I want to go to the hospital.”
Paramedic: “We aren’t taking you, you oren’t sick.”
Patient: “Well, what am I supposed to do.”
Paramedic: “I’ll call my dispatch and have them send a van over to give you a ride.”
…and so on.

Does anyone do this? Where and how?

Written by ben

April 15th, 2009 at 12:11 pm

Posted in ideas,rants

The focus of EMS

with one comment

From tonight’s recording of EMSGarage:

In the 70′s. we all watched Emergency and the focus of the industry was on the E.

After that it was all about the M- better training, better drugs, better medicine.

Today, the industry is moving towards a focus on the Service we are giving to our customers.

Maybe we should call it “SME?”

Written by ben

November 5th, 2008 at 8:31 pm

Posted in ideas,Podcasts,random

TED

with 2 comments

I am at the Colorado Advanced Life Suport ConferenceMike Taigman was speaking yesterday, and he mentioned TED!  I was so excited that someone else had heard about it I laughed out loud.  Then I realized I should share this gem here.

TED stands for Technolgy, Entertainment, Design.  It is an annual conference held in Monerey, CA that “brings together the world’s most fascinating thinkers and doers, who are challenged to give the talk of their lives (in 18 minutes).”  The best part is that they make the best talks available online for free.

I’ve watched several of these through the years, and I have never been dissapointed.  The talks range from serious to hilarious.

I relate this here because I believe very strongly that ideas from anywhere can be incorporated into your practice.  The example used yesterday was this TED talk from author Malcom Gladwell about the history of Spaghetti Sauce.  The point of the video was that the food industry discovered about 25 years ago that there is no one perfect Spaghetti Sauce, there are hundreds; everyone has slightly different preferences and tases.  The point for our purposes: no one learns the same, and no group of people are is looking for exactly the same information.  By injecting variety into your teaching practice, you can reach more people more effectively.

Browse through the available videos and watch one that piques your interest.  I don’t think you’ll be dissapointed.

Written by ben

October 17th, 2008 at 6:57 am

Posted in ideas,leadership,links

Debreifing difficult calls

with 5 comments

You have a huge opportunity to learn from critical calls during your turn-around time at the hospital.

After a critical call, while still at the hospital, take 5 minutes to debrief the call and review any lessons learned. This might include cardiac arrest, critical trauma, severe illness, and any call that requires lots of work and critical thinking.

In my experience, most EMS systems offer the ability to take a third rider into the hospital with the ambulance to assist with care of a critical patient.  Typically this will be a firefighter or two from the fire crew you ran the call with.  This results in everyone with whom you ran the call being at the hospital afterward (the fire engine often follows the ambulance to the hospital to pick up their missing crew member)  This means you have a great opportunity to sit down with everyone who ran the call for a few minutes and go over it.

We can learn things from any call.  Critical patients offer not only the best chance to make errors (I’ve made plenty), but also the best chances to learn from them.  Research has shown [sorry, no link] that the best time to review and retain information is one to two days after first introduction of new information.  Typically, if I review these calls at all with anyone besides my partner, it is in one of two settings (outside the call to my training guy with a stream of questions): M&M review or a call into a CQI meeting.  These trainings usually occur 1-2 months after the call: far too long to retain anything important.

So when it is possible, take an extra 5 minutes at the hospital to go over things with everyone involved.  Get permission from your supervisor or from dispatch if necessary.  Everyone will have ideas about what went wrong and right.  Some will have misconceptions about what happened that can be cleared up right then – offering understanding all around and maybe the opportunity to stop a call to your quality manager.  Everyone will have a chance to learn more about that patient and their condition.

It can be difficult to create an environment in these situations where everyone feels comfortable speaking frankly.  I’ll offer some guidelines gleaned from my organizations M&M review own guidelines(themselves taken from the Massachusetts Medical Society and an article from the Journal of Academic Internal Medicine).  All are aimed at creating a comfortable environment.

  1. Make sure that everyone understands that all questions will be respected.
  2. Limit who can participate only to those who were there.  This Any other ambulance crews or hospital staff who are interested in participating should be asked to leave.
  3. Be sure that everyone is comfortable having this discussion.
  4. Most M&M reviews also involve the understanding by participants that nothing leaves the meeting.  Since this is not an official, sanctioned type of meeting involving medical directors and other higher-ups, I really don’t think this is advisable here.  Any significant clinical issues should be brought to the attention of the appropriate people immediately.

Also, if you are the one organizing the discussion, you have the role as moderator.  In addition to creating a comfortable environment for everyone involved,you should strive to:

  1. Keep the discussion limited to he call.
  2. Start with what went right and give credit to everyone involved for their role.
  3. Identify problems without assigning blame to specific individuals.  For example, failure to give a medication in the appropriate amount of time is not solely the fault of the person giving the medication.  Blame lies with the person running the call, the person holding the drug kit, the person giving the medication, the person starting the IV, and the atmosphere of communication among the group in general: EMS calls are a team effort.  Caveat: don’t let this become the excuse for poor performance.

Learning from your calls does not have to be limited to that provided by the clinical education staff months later.  It can happen in just a few minutes following the call.   Whether it was run-of-the-mill, or the best/worst call you have ever run, you can learn things here. Give it a try.

Written by ben

October 16th, 2008 at 4:22 pm

Posted in ideas,leadership