WolfmanHarris

Pillows are a hot commodity in my area, not for EMS per se, but all the ED's. We exchange linen at the hospital and if there is no pillow on the bed we're offloading to then we won't have one unless we take it from the patient. Generally I use an extra blanket folded up for the head and keep our pillow under the bench. If we get a long transport, or need it for splinting, or have a patient who is particularly uncomfortable (kyphosis, chronic pain, etc) I will pull it out. Unfortunately due to logistical realities I can't have a pillow for every patient and I do pick and choose when to use it, knowing I'll likely lose it. As far as hygiene goes, the pillow is vinyl. Remove the case, virox the pillow and put on a new case; problem solved.

When I signed up for the forum I used the handle "DocHarris." This was a nickname I got years ago from friends when I was a lifeguard and considering a career in health care. Over and over again I had to clear up my background in chat and elsewhere. If this were a movie or hobby forum, who cares, but in a professional setting (or pseudo-professional setting like here) representing oneself accurately is more important. As a result I changed my screen name awhile back. I don't really care is someone goes to a party and says they're a medic, or a doctor, or an astronaut. I do get a perverse, intense joy out of poking these people when presented with them, but that's neither here nor there.

Second. I still find myself forgetting who you are. Damned early onset senility.

Why do we care that much about scene time in this context?

There's a few different ways to view the role of the preceptor and Walter Tavares, an ACP, PhD candidate and the coordinator of the Centennial College/University of Toronto Paramedic program has done some interesting papers on Paramedic education including different models for precepting. I'm afraid I don't have a citation for that paper as I saw a presentation on his theories in person and my notes are long gone. From that and my own thinking and experience I'd break precepting into two main models. One if that of final arbiter of fitness to practice; that is, taking the student at the end of their diadactic and clinical time, who should have all requisite knowledge and training and to place them in a supervised work environment for evaluation. This seems to be the more traditional model of precepting and how precepting was done where I was a student. The preceptor in this model makes the sole reccommendation on fitness, though there may be an appeal process. Another model, and one that I've become convinced is a better move for education is to view the role of the preceptor as a mentor and tutor. They are there predominantly to guide and develop the candidate and while they do evaluate them, their evaluations are meant to direct their education and track progress, but not to determine fitness to practice. In this model as the candidate nears the end of their precepting they would be rotated through a wide range of evaluating medics over the course of various shifts. Those medics would then each evaluate a set number of calls on a set score sheet and the scores tabulated. The model used by Centennial College (if I recall correctly) is six final shifts, six different evaluators, first emerg call of the shift is evaluated regardless of type.

http://www.ncbi.nlm.nih.gov/pubmed/22401617 - Abstract only, but provides a good example of pit-falls in notification and the importance of adapting. http://www.ncbi.nlm.nih.gov/pubmed/22372369 - Can't speak to the quality of this paper, can't access full txt. Might be interesting if someone can get at it. http://www.ncbi.nlm.nih.gov/pubmed/20809692 - Study on prehospital death notification http://www.ncbi.nlm.nih.gov/pubmed/3942358 - death notification in sudden unexpected death http://www.ncbi.nlm.nih.gov/pubmed/21063562 - training module for emerg residents in breaking bad news (Full txt available)

Agreed with erDoc. I find the key to assauding anxiety is to immediately explain the treatment plan and progress from here. People have a very incomplete understanding of what a heart attack or stroke, or any other acute condition is, even if they recognize the name. They will recognize it's serious, but beyond that, they might have no idea what that means. Avoid false assurances, but let them know that there is a plan for their care and it's happening right now. For death notification there has been some research done into this and some papers do exist on pre-hospital death notification, family witnessessing resuscitation efforts and other related topics. The upshot of the various training sessions I've had on death notification has been: 1) Shut off equipment and remove what can be removed without interfering with coroner (i.e. remove BVM, leave ETT). Tidy the scene, place a blanket on the Pt. close their eyes. 2) Remove PPE and recompose physically and emotionally. 3) Have the family sit and remove unnecessary distractions (FD, Police, other crews) 4) Use plain language, say "Died" "Dead." No euphemisms (passed on, left us, etc) 5) Be prepared to field questions. 6) Give family time to process and offer them the opportunity (if applicable, i.e. not a crime scene) to see the Pt. again. My understanding from the literature and my own experience is that if family have witnessed the efforts, been kept reasonably informed as to progress and are given notification compassionately they will handle it as well as could be expected. Some exceptions that seem obvious but are worth noting. Pediatric patients, homicides, suicides are going to be particularly difficult notifications and family may not wish to witness efforts (or lack thereof) on traumatic deaths. I can't support that from literature, that is just my personal opinion. Best example I can think of is when I responded to a hanging where the 13 y/o son had found is mom and called. He went to lead us down to her and I redirected him to the living room and kept him on the phone with the dispatcher until a Police officer arrived and took care of him. My thinking, he's seen her once and that was more than enough. Ditto when the husband arrived and asked to see her, we advised that he needed to wait until the Coroner cleared the scene which, while correct, also meant that we wanted her cut down and package before he came down. The late Dr Robert Buckman, a medical oncologist from Toronto has a series of videos on clinical communication that can be found on youtube. He was a champion for bedside manner and quite an interesting character. Well worth looking at.

I don't have a huge problem with that actually. I think direct, clear language is effective when done right and with confidence, especially when you need to convey the immediate seriousness of a situation. My usual script for a STEMI is something to the effect of: "Sir/Ma'am, at this time it appears you're having a heart attack. We're going to be taking you directly to the cardiac unit at *redacted* Hospital. We'll be treating you with medications to relieve the workload on your heart and reduce your pain." Plain, direct language doesn't preclude maintaining a compassionate, caring tone and body language. Maybe that's what your student's problem was?