The fact that something was concerning enough for someone to call 9-1-1 must always be taken seriously. We should therefore start with the proposition that all our patients are potentially critical, and scale back cautiously from critical to noncritical to stable as guided by the facts of our detailed assessment, keeping in mind the limitations of our assessment capabilities. If we’re diligent, we can identify critical and potentially critical patients, but in most cases we cannot definitively rule out that possibility. If we could, it wouldn’t take a team of physicians, a battery of diagnostics and days, weeks or months to make a diagnosis. Never make the mistake of assuming you’re smarter than you are.
As Seen on TV?
Most of us chose EMS as our career with the high drama of saving lives in mind. Then we finished EMT school, started the job and realized those visions of glory were the exception rather than the rule, and the job is not always as glamorous as it looks on television. Most of us in EMS are mature enough to accept this reality and commit ourselves to do the best we can for all our patients while we wait for that call of a career. Some EMS providers, however, never seem to get over their dreams of glory. They constantly downgrade patient care, blow off any patient events not seen for themselves, and never seem able to accept the possibility that any patient could be seriously ill unless they explode in front of them. And because the majority of our patients are not teetering on the edge of death, 95% of the time they get away with it. But luck is fleeting. Therefore, the best approach to assessing our patients remains due diligence.
Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He is the quality improvement coordinator for both of these midsize third-service agencies in northeastern Pennsylvania. He has 30 years’ experience in EMS. Contact Joe at email@example.com.