It's 3 a.m. when you are called from a comfortable "resting" position for a 46-year-old male patient with chest pains. Your in-unit GPS and dispatching software direct you to the home, where you find the patient sitting in a recliner, sweaty, pale and clutching his chest. You begin your assessment by saying hello and asking the standard SAMPLE and OPQRST questions. You break out the latest and greatest EKG monitor, which is capable of 12-lead field transmissions, communicate with the physician on an 800 UHF radio for instant orders and consultation, and check your PDA for information on the patient's current medications. You place the patient on a power stretcher with friction locks, load him easily into a "kneeling" truck, and transport him in an air-conditioned box using your superior ACLS skills. Lo and behold, the patient survives. You crank out your PCR on a laptop computer that allows the patient and nurse to sign on the screen, and you're ready for the next call.
What does your patient remember?
Don't Forget the Patient
I've been in EMS for almost a decade and have seen all manner of cool toys, tricks, technology and tools to help providers give state-of-the-art safe and effective patient care; yet, in all that time, one simple and possibly the most important part of patient care seems to be overlooked: the patient.
There is no gizmo to do a patient assessment, create the patient report or convince the patient you know what you're doing. There is no standardized course that teaches new medics how to convince an elderly patient to open the door or an immigrant mother to hand over her baby to be checked out.
I already hear the dissenters. Who cares if the patient likes me? I'm trained to assess, triage, treat, transport and repeat. This is 9-1-1, not Disneyland. So why is it important?
Hospitals started asking that same question more than 20 years ago and came to realize that patients do care how they're treated. In fact, in the U.S., patients can choose to receive care just about anywhere they want. When hospitals started to realize that to keep the doors open and, more important, maintain a profit (so they can expand their impact on their communities), they had to start treating patients with the compassion and civility they would want for their own families. Today, all hospitals have financial incentive to focus on patient experience. The government recently implemented a system called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), which requires any facility that receives Medicare/Medicaid dollars to report certain figures openly, publicly and in a standard fashion. One of those key indicators is how patients perceive the quality of their care as measured by a series of questions administered after their hospital stay.
So why does what happens in a hospital matter to EMS? It's important because no patient, no matter how benign or deathly ill, cares about the hours you've dedicated to studying and continuing your education. They don't care what your IV percentage is, or that you have the latest and greatest technology, and they don't even care that you have the best skills in the business and were voted greatest medic in three states. The patient won't ask to see your credentials, your resume or a list of professional and personal references, and most of the time can't tell the difference between a basic EMT and a paramedic.
He won't care about any of that until he knows how much you care about him. As my first medical control doctor told us at our paramedic graduation, "In EMS you will walk into patients' lives with an assumed trust that they will give their lives to you, look to you for the answers they can no longer find and expect you to make them feel better." Somehow over the years that got translated into making them feel better by using all the great technology out there and hoping they realize they are getting state-of-the-art care.