Rescue squads training ground for ER doctors

[akflightmedic]

Cool story, great idea!!

Here is a snippet of the story, click on link for full story.

http://www.phillyburbs.com/pb-dyn/news/111...08-1559195.html

By JO CIAVAGLIA

Bucks County Courier Times

What she has learned on the streets, Dr. Sonia Chacko uses in the emergency room.

Things like how to get vital signs on a combative patient; what clues living conditions might provide about a patient's health; and the challenges of starting an IV in a vehicle traveling at high speed.

Chacko has watched paramedics treat a woman who passed out at a supermarket, then start fighting them when she woke up.

When the ambulance pulled into the hospital, the crew could barely keep the woman on the stretcher, but the doctor on duty didn't understand why no one took a medical history or started an IV line en route.

“It's a different world,” she said. “It's a completely different experience.”

While rescue squads and emergency rooms perform similar life-saving procedures under extreme and difficult conditions, there often is little professional interaction, emergency medicine experts say.

Bucks County Rescue Squad in Bristol Township, where Chacko works, is one of the few suburban ambulance squads helping prepare future ER doctors by showing them what happens before a patient gets to the hospital.

[spenac]

But what if doctors decide they like it? Then my taxi job will go away.

Actually a good thing. Doctors and nurses should get some exposure of what we do. We get get some exposure of what they do when doing clinicals. Perhaps it could help us to start working together as healthcare professionals.

[Kaisu]

We went on a call to a frequent flier. She was lying in her bathroom, covered in feces. I was the only woman on the scene. In the interests of defending the patient's dignity, I entered the crummy bathroom and began to clean her up. I did my best. We used a blanket to slide her out of the bathroom and onto the cot.

At the hospital, the RN in charge complained to me that the patient was "dirty" and I should have cleaned her up. It was the first time (but not the last) that I wished they came along with us for even a few shifts. I work alongside of them in the ED, and I know the stuff they deal with, but they have no idea of what I deal with - it's an unnecessary roadblock to teamwork.

I think this is an excellent idea.

[Just Plain Ruff]

now remember, it's our job to make sure the patient is completely clean the patient, make sure their hair is done and make sure they have brushed their teeth and have put on clean underwear.

I did what I could for the patient.

[ERDoc]

She was lying in her bathroom, covered in feces...In the interests of defending the patient's dignity...

Too late.

[Kaisu]

Too late.

touche

[VentMedic]

Actually a good thing. Doctors and nurses should get some exposure of what we do. We get get some exposure of what they do when doing clinicals. Perhaps it could help us to start working together as healthcare professionals.

I work alongside of them in the ED, and I know the stuff they deal with, but they have no idea of what I deal with - it's an unnecessary roadblock to teamwork.

I think this is an excellent idea.

I see both sides and I really like the fact that no matter how much of a mess or hassle the patient is prehospital for 30 minutes, it sometimes doesn't compare to the mess and hassle they can create inside of a hospital. If I'm working as a Paramedic, I know I just have to get them through the doors of the ED. Even the ER staff is all to happy to get some of these patients to their assigned beds on the floors or units. Some unlucky RN and CNA (as well as others) will be putting up with the violent behavior, lack of potty training and withdrawals from substance abuse for 12 hours each shift. They may have not one but possibly 5 more patients with that behavior on their assignment. The next shift will probably bring more of the same if not worst since the previous shift's new patients are "detoxing" while becoming more anxious and "outspoken".

The medical floors in a hospital is not all "soap opera" stuff.

The other side of the coin, I have also seen patients come into the hospital on routine transports totally exposed or laying in feces from the nursing home because the EMT(P)s didn't take a couple minutes to get some assistance getting fresh sheets and sheeted the pt over as is.

There are a lot of ride along programs throughout the country for Doctors and RNs to get prehospital exposure. Sometimes there are conflicts as to what their role in the field will be. When physicians (residents) ride with the Specialty teams, especially Neo/Peds, they are told they will be observing and participating only when asked. The protocols being followed come straight from the Medical Director of that transport team or the Neonatologist on duty.

[firedoc5]

We had a really great Mobile Intensive Care Nurse training program. I don't know how many nurses we trained in the field. But we had several docs take it too, just for the experience and exposure to what we put up with prior to them getting the pt. in the ER. We really appreciated the interest shown from all the ER and ICU personnel. At times, especially after the first two or three weeks, some of them really tried to take over the entire situation at a scene. We'd usually go with it, at least until they would get carried away. Some seemed to get tunnel vision and not pay attention to their surrounds and how quickly it could change. They'd forget they were not in a clinical setting and that things are not in control all the time. There were at least three times that I know of where we told them that if we say for them to stay in the rig, then stay in the rig. We'll bring the pt. to them. Twice was for shootings, with the shooter still running around. And once when it was a vehicle extrication involving hazmat. We usually didn't get an argument.

I think all career ER personnel should do some ride alongs. For the MICN program we had, it was a nine week course. And to re-cert they had to have four weeks of ride alongs in a year.

[Doczilla]

All emergency medicine residency programs have an EMS requirement (mandated by the RRC so a program confers board eligibility), which is usually fulfilled by EMS ride time.

'zilla

[Richard B the EMT]

This string reminds me of a story I used to tell, on having complaints from the ER Doctor that the folded triangle bandage ends were not tucked in.

Doc don't realize that the patient was immobilized and removed from an overturned car, hanging 30 feet up a tree, when the car skidded and flipped off the elevated highway, during the blizzard that caused the power blackout around midnight!

Never happened, just fun in the telling!