Teaching Gently

[Cougar]

I am in Mexico and between getting my teeth fixed and getting a bit of diving in, I am trying to get the fund act application in for our volunteer agency in the states which is due the day I get home. I spent a lot of time in the ICU last year and haven't spent as much time teaching as I like. I fear I've let things slide a bit as far as riding herd on the herd. Putting in this application means I am in putting runs that someone SHOULD have been put in through out the last year and a half half (hey, I was in the hospital trying to die). Anyroad. As I put in these old reports I see see some major weakness in our volunteer department Basic EMTs. "Did a head to toe assessment and everything was OK." No specifics! If I see vitals at all they say things like, "respirations=regular"! Eek!

You paid guys have to understand that in a volunteer service where no one gets a thin dime to slide out of bed in the wee hours it can be really tough to find anyone, but I'm ripping my hair out here. How do I gently beat the holy &&*% out of these guys and say something like, "Just because you aren't getting paid doesn't mean we don't act like professionals. Vitals don't consist of WNL (we never looked) The narrative reports are touchy, feely community reports on the state of the village but I would hate to hear what a good lawyer would say about some of this. Does anyone have any recommendations about how to whip them into shape without having them all quit, which would spell disaster. This is a really good bunch of people and they work hard. They have some good skills, but 5 calls a month can make report writing a lost art. They do the work with the patients, I've worked with them at scenes, they just don't write it down afterwards. On the other hand, describing a year and a half old baby (yes not months...I have reports that don't even give me the date it occurred on let alone an accurate pt. age) "good color, warm, soft, moist skin" Just picture a really vicious lawyer with that one had anything untoward happened. (This baby was just fine....but my legal background says that kind of report writing can come back an bite you.)

As an aside, someone also used something I don't recall seeing and couldn't find on the net. Has anyone seen HNNEE as part of a narrative? I'm not familiar with it and I can't ask the author right now.

Anyone, does anyone have a technique for getting these volunteers to write these reports in a timely fashion while they still remember what happened. Using notes at the scene. Getting them to realize that galloping in on the white horse is all well and good but horrid reports are written with permanent ink. We can't afford to loose any of these good people and I wouldn't hurt them for the world, but this REALLY needs to be fixed. Suggestions PLEASE.

[tcripp]

HNNEE = Head Neck Nose Eyes Ears

Interesting predicament.

Before I respond, I'd like to give you a little background on me. You see, I started as volunteer in 2004 (both at an ECA and EMT-Basic level) as a first responder for several groups. It was always an expectation that there are certain rules that are followed to be able to run as a first responder. That included the fact that if you were the primary care giver, then you completed the reports and turned them in in a timely manner. I don't ever remember being given a free ride just because I was not paid.

It sounds like you already have an established policy that "it's okay because we can't get anyone else to do it". You need to change that and soon.

So, my two cents are as follows:

1. Bring everyone together and let them know what is missing in their "performance". You can do this without beating them in to submission. You need to set the expectation up front. Otherwise, they don't see the reason for doing it.
2. Give a class on effective report writing and give them scenarios so that they can practice. If they are only running a few calls now and then, do this practice at your meetings to keep them refreshed. Remember, report writing is a skill just as is taking a blood pressure.
3. Maybe have them rotate as QA/QI and have them read each other's reports. This will give a better understanding of exactly what is missing.
4. As soon as you see information is lacking, have them do addendums. Hold them to the standard you expect. The more you come back to them, the more they will get it right the first time.
5. Don't be afraid that they will all quit because you are asking them to do what they've agreed to do. It just may be that they need the prompting.

Toni

AKA finally, a paid paramedic!

Edited January 17, 2011 by tcripp

[DwayneEMTP]

HNNEE = Head Neck Nose Eyes Ears

Interesting predicament.

Before I respond, I'd like to give you a little background on me. You see, I started as volunteer in 2004 (both at an ECA and EMT-Basic level) as a first responder for several groups. It was always an expectation that there are certain rules that are followed to be able to run as a first responder. That included the fact that if you were the primary care giver, then you completed the reports and turned them in in a timely manner. I don't ever remember being given a free ride just because I was not paid.

It sounds like you already have an established policy that "it's okay because we can't get anyone else to do it". You need to change that and soon.

So, my two cents are as follows:

1. Bring everyone together and let them know what is missing in their "performance". You can do this without beating them in to submission. You need to set the expectation up front. Otherwise, they don't see the reason for doing it.
2. Give a class on effective report writing and give them scenarios so that they can practice. If they are only running a few calls now and then, do this practice at your meetings to keep them refreshed. Remember, report writing is a skill just as is taking a blood pressure.
3. Maybe have them rotate as QA/QI and have them read each other's reports. This will give a better understanding of exactly what is missing.
4. As soon as you see information is lacking, have them do addendums. Hold them to the standard you expect. The more you come back to them, the more they will get it right the first time.
5. Don't be afraid that they will all quit because you are asking them to do what they've agreed to do. It just may be that they need the prompting.

Yeah, man, I wish I could give this post more than one point. And why do you want to keep people that are so lazy and incompetent that they are unwilling and/or unable to write an acceptable report? How do you trust such a person to put their hands on a patient?

Also, like Toni said, many will simply not need prompting. There are many that are hoping that you will teach them, and then push them to behave in a manner that they can be proud of. No one is proud of behaving in the manner you describe, but they will continue to do it because they get to wear their Tshirts and have people call them heros.

Be prepared to lose some Wankers, but also to watch those that actually want to work for their community bloom when you raise the standard!! Good people suffocate when buried in shit..wait and see what happens when you give your good folks an IV injection of self esteem....

If you want a squad full of children, then continue to treat them like children and beg them to show up. Treat them like adults and put a few hoops that they need to jump through before they show up and everyone will be so much happier.

Toni

AKA finally, a paid paramedic!

Way past time Lady.

By the way...I've had this strange....feeling....for the last few hours...It's like pressure, but not in my chest exactly...think you could take a look?

[Happiness]

When I was doing my courses I was told when doing my forms Write down your observations as if you are telling a story to a judge. When you complete your forms and if you are called into court it may be your only source of information many years down the line and there are very few calls that you are going to remember all the details for the rest of your life.

When dealing with people who dont do it right away personally I would call them back to the station and have them complete it.

Do a small workshop that informs them what words are appropriate to use like for Skin you use warm and dry or cool and sweaty. The words dont nessasaraly have to be the big long latin ones but as long as they get the discription in.

Good luck,

[HERBIE1]

All good points before me. I would add that putting out an acceptable list of abbreviations is a good idea to make sure everyone is on the same page. We just had a con ed on documentation and they put up a bunch of inappropriate abbreviations. I could not believe some of the ones I saw. Many I simply dd not have a clue what they actually meant. Here's one a couple I had to explain to the instructor- DIB=dead in bed. DRT= dead right there. Certainly I have heard phrases like these spoken among providers when talking with each other, but using them in a report- verbal or written? Unprofessional.

I think there are a couple issues with the documentation problem. First, the younger folks grew up texting, and using odd abbreviations, and many simply do not realize there is a time and place for that. Second, I think some phrases, abbreviations, or vernacular may become common in a certain area, and it is assumed that 'everyone" knows what they mean. Not necessarily anything with malicious intent, just a false assumption.

[tcripp]

Way past time Lady.

Thank you, sir. I really wish I had known about the profession much sooner.

[DwayneEMTP]

Thank you, sir. I really wish I had known about the profession much sooner.

What! They didn't have paramedics when you were a kid? :-)

Dwayne

[tcripp]

What! They didn't have paramedics when you were a kid? :-)

Just the hearse drivers. ha ha

My life has been full and I have been privileged to have held jobs in so many different careers - all of which have made me the person I am today. But, when I first became a first responder, age became my biggest enemy. Well, fear of age. I'm too old to do this full time. I'm too old to work a 24 hour shift. I'm too old to go back to school. Heck, I'm too old to be smart enough to keep up with the young farts getting in to this business.

Guess what? I'm not too old. And, with my background, I have the patience and wisdom to get through a call...calmly. With a little more experience under my belt, I'll be able to add "assuredly" to that sentence. People look at me with reverence. Even as a newbie, my patients feel comfortable with me because they think I've been doing this for years. Finally, gray hairs pay off.

Look at me now. I graduated the full program in record time after not having taken a full load of classes in 20 years and with good grades. Yes, the 20 year-old students grasp the material a little more quickly than I at first glance...but I have the ability to take multiple concepts and merge them together.

24 hour shifts...heck. I work 48 hour shifts. It may take me a little longer to recover, but I eat/drink/live healthy, so I'm not worried about burnout.

And, (I know...never start a sentence with "but" or "and") I have enough of a background that I can bring more than just my medic skills to the table. I hope this will make me more of a value-add to my service.

As my husband says frequently, everything happens for a reason.

[Richard B the EMT]

DIB=dead in bed. DRT= dead right there. Certainly I have heard phrases like these spoken among providers when talking with each other, but using them in a report- verbal or written? Unprofessional.

Actually, I believe I have seen those 2 phrases in several of our humor strings, usually mentioned as someting like stereotyped 'Hillbilly" EMS talk, such as "Artery=Study of art", or "Benign=What you be after you be eight".

However, while there is a place for that type humor, intentional or not, it has no place on a written call report, or when presenting a patient in the ER. I have seen an ER doctor ream out a Newjack for using these type phrases, because the Newjack actually thought the phrases were type-acceptable.

[emtannie]

Cougar, I feel your pain.

I was lucky to have the opportunity to get into EMS via the volunteer route, and realize that this is where I want to be, but in my many years since then, I have found the same thing that you are. Many volunteers feel that because they are volunteer, they shouldn’t be held to the same standard that paid services are held to.

I agree with others, that a training session needs to be completed. You don’t have to beat them over the head to cover the issues you are seeing. Put together some examples of what you have seen without naming providers or patients, and then ask your crew “how would you handle this if it went to court? Could you explain what happened and justify your assessment and treatments?”

Remind your members that this is in THEIR best interest, and it covers their a**es if something should ever happen that they end up in court.

I work for a paid service in an urban centre, and continue to volunteer when I have time in the rural community where I live. More and more I find it difficult to support the volunteer crew, when I continue to see the mentality of “we don’t get paid, so we don’t have to meet the same standard.” I always come back with “the patient expects a competent provider; they expect someone who can provide the best care possible, not just a ride to the hospital.” I also reinforce that in rural and remote communities, we don’t just have to meet a minimum standard, we have to exceed it, because we have that patient for 30 minutes, 60 minutes, or sometimes more, before we can get that patient to advanced care, where in the city, there is almost always a crew to back you up, and the hospital isn’t that far away.

Yes, they are providing a service to their community, but they need to be reminded that they have to provide competent service to their community, which includes good report writing.

I think if you can show them that making these positive changes is not just something that is an administrative pain, but is something that will work to their advantage, and to their patient’s, they will be more willing to make the effort.

I agree with Dwayne – you may lose the wankers, but really, that isn’t a loss. Those that are committed to quality will step up and improve.

Good luck!