Preventative Paramedicine

[HERBIE1]

There you go, singling out the black people. You are such a racist cracker.

Seriously though, are paramedics, with the current state of education, er, training, really the best people to be doing this?

I think the "education" most folks need is pretty basic, common sense stuff. Obviously I am not going to compare and contrast the benefits of one type of antihypertensive med vs another, but I can explain the various side effects of a beta blocker, for example. I can however, ask a person who is taking a diuretic if they are taking a K supplement or eating a banana as instructed by their MD, and why it is important. I can ask an asthma patient if they routinely check their peak flows to see what their baseline is, and compare that to when they are having trouble- ie their asthma action plan. Not only do discussions like these help the patient, but it also gives me insight into what to expect in terms of their vitals, associated complaints, and potential complications I may see.

Any paramedic worth their salt should at least be able to do these things, right doc? I don't see that as overstepping my authority or acting in an improper manner.

[ERDoc]

Herbie, I'm not saying paramedics shouldn't be able to. Like others have said, most of it is basic stuff. The thing that would make me concerned is giving out medical advice. As Dwayne said, there are so many differences in the training that paramedics receive from state to state, county to county. You guys are awesome at knowing everything there is to know about resuscitation drugs (hell, you guys could probably teach me a few things). Counseling people about medications can be on a slippery slope to practicing medicine. Do I think paramedics are capable of it? Absolutely. Do I think that with the huge variation in training it is a good idea? I'm not too sure about that.

[Just Plain Ruff]

You search their kitchen and bathrooms ? I think you are doing that to serve your reasons, not theirs.

What the hell does that mean?

did I ever once say I searched their bathroom or kitchen. I said I looked in their bathroom and kitchen. Where did you get the idea that I search their bathroom.

And what possible personal reasons would I have to search their bathroom or kitchens?

Don't beat around the bush, tell me what you are insinuating?

Edited September 21, 2011 by Ruffems

[DwayneEMTP]

He's more or less saying that the only reason to look through a persons' personal space is to steal from them...

Why be indignant Ruffster? If that's the only reason he can see for doing so, that speaks to him, not you, right?

I don't know any decent EMS providers at any level that don't do the same, and the better docs and nurses I've been fortunate to work with will assume that I've done so with a certain type of patient and ask for my findings.

Just bring in an unclean, under nourished, 'failure to thrive' geriatric with bed sores, have the ER ask what the environment looked like, say, "I didn't really notice...." and see how much respect you get.

That's just Crotch poking the bear man...Most every provider I know would consider investigating the environment the standard of care on a subclass of apparently high risk patients.

Deep breath Brother...

Dwayne

[crotchitymedic1986]

I am insenuating that it is nosey to do so, unless the patient is unconscious unresponsive and alone. In an emergent situation, a list of medications is "nice to know" but is not "need to know" information. You should not be ransacking their home, and it opens you up to a liability should something go missing (ie... I had $100 under my mattress, now it is gone, the medics were the last ones in the room).

[Just Plain Ruff]

I am insenuating that it is nosey to do so, unless the patient is unconscious unresponsive and alone. In an emergent situation, a list of medications is "nice to know" but is not "need to know" information. You should not be ransacking their home, and it opens you up to a liability should something go missing (ie... I had $100 under my mattress, now it is gone, the medics were the last ones in the room).

Why do you assume I'm ransacking their home? I simply stated I look in their bathroom and kitchen. You are the one who brought up the less than desireable motives and just like silent farts, he who smelt it dealt it so obviously you are the one who has less than desireable motives in your heart.

That's all the response you'll get from me because you are wrong about my motives.

He's more or less saying that the only reason to look through a persons' personal space is to steal from them...

Why be indignant Ruffster? If that's the only reason he can see for doing so, that speaks to him, not you, right?

I don't know any decent EMS providers at any level that don't do the same, and the better docs and nurses I've been fortunate to work with will assume that I've done so with a certain type of patient and ask for my findings.

Just bring in an unclean, under nourished, 'failure to thrive' geriatric with bed sores, have the ER ask what the environment looked like, say, "I didn't really notice...." and see how much respect you get.

That's just Crotch poking the bear man...Most every provider I know would consider investigating the environment the standard of care on a subclass of apparently high risk patients.

Deep breath Brother...

Dwayne

Yeah Dwayne, he's just making assumptions that are wrong. I've never stolen from anyone, never had even a desire to do so. It's not nosey, every medic I know of looks at the environment and to say i'm ransacking their home is insulting but then again, he's insulted everyone of us on this thread by insinuating we are all racists and assholes but he's perfect remember.

But to each their own, I know I'm in the right and I cannot count how many patients I've seen where their kitchen was empty and I helped them out with probably the first good meal of their week by bringing them something back after my shift was over.

One case in point. Had an overdose, very stable but just took too many pills. After trying to find what pills they took we couldn't find any medication bottles except the one bottle on the floor of the living room. I looked around their apartment, went into the bathroom and found 9 other pill bottles on the floor open and empty. When confronted the patient said, yeah I took those pills too.

Had I followed Crotchitie's advice and Not "Ransacked" the patients house, I would never have found the pill bottles and would not have been able to tell the doctors at the hospital that they had overdosed on the tricyclic antidepressant and Betablocker pills that were found on the floor of the bathroom.

If I had followed Crotchitie's law of not being nosey, I would have brought in a single drug overdose rather than a multiple drug overdose thus leading the ER down the road of treating the single drug rather than their plan to treat the multiple drugs. The patient would have died without that info.

That's my personal reason, to treat my patients. Following the Crotchity law of not being nosy would have killed the patient. But you don't want to be too nosey, you might get accused of something. Perish the thought.

[Bieber]

Herbie, I'm not saying paramedics shouldn't be able to. Like others have said, most of it is basic stuff. The thing that would make me concerned is giving out medical advice. As Dwayne said, there are so many differences in the training that paramedics receive from state to state, county to county. You guys are awesome at knowing everything there is to know about resuscitation drugs (hell, you guys could probably teach me a few things). Counseling people about medications can be on a slippery slope to practicing medicine. Do I think paramedics are capable of it? Absolutely. Do I think that with the huge variation in training it is a good idea? I'm not too sure about that.

I'm pretty much going to quote Dwayne here and reiterate what I've already said a hundred times about the need for EMS to mandate at the VERY minimum an Associate's degree and ideally at least a Bachelor's; or at least have it a viable option nationally instead of only at a couple handful of universities throughout the country.

I would however like to add a couple of things. First of all, if it's a deficit in education that is making medical directors hesitant to put us in those roles of providing preventative medicine, then I would suggest that they take a proactive approach within their own services (along with all physicians who deal with EMS as well) by implementing advanced educational programs, classes, what-have-you that WILL give us the knowledge and the skill to deliver this facet of care which, in all honesty, would arguably make a bigger impact on patient survival (and more importantly, quality years of life), and on decreasing recurrent hospital admission.

I don't claim to know what's best for everyone, and when in doubt, I will always advise my patients to go to the hospital by EMS, but at the same time I am a tremendous advocate of not transporting folks who don't need to go by EMS, and in counseling and educating patients. I like to give my patients as much information as possible as to what we are finding in our assessments, what we think is going on (or if we have no clue), and what they can expect at the hospital; and for those patients who don't need EMS, I first of all always tell them that we're more than happy to take them if they want us to bring them in (because we cannot currently refuse transport), but I also make sure that they know what they can expect from us (i.e. a taxi ride if that's all their condition merits), and what I think the hospital will probably do for them. I also like to let them know what other alternative options there are (i.e. going POV if that's what they want, "staying and playing" and calling us back if something changes and otherwise following up with their family doc, etc).

One thing I've noticed is that we in the medical profession do an absolutely TERRIBLE job at telling our patients what is going on, and I think that a lot of the time we can ameliorate much of our patient's concerns simply by bringing our knowledge of medicine to their aid when it comes to their medications. I may not know the medication, but I can probably understand the medical jargon on the label or in their discharge instructions and if nothing else I can try to explain it to the patient in a way they can understand if they have concerns about it. In that sense, I think that we are capable of counseling patients about their medications to a certain degree, and I've done it before with a patient who was just having an anxiety attack because she read all of the side effects her medication can cause and it got her worried that she was going to suffer any or all of those side effects.

[HERBIE1]

Herbie, I'm not saying paramedics shouldn't be able to. Like others have said, most of it is basic stuff. The thing that would make me concerned is giving out medical advice. As Dwayne said, there are so many differences in the training that paramedics receive from state to state, county to county. You guys are awesome at knowing everything there is to know about resuscitation drugs (hell, you guys could probably teach me a few things). Counseling people about medications can be on a slippery slope to practicing medicine. Do I think paramedics are capable of it? Absolutely. Do I think that with the huge variation in training it is a good idea? I'm not too sure about that.

No quarrels with that, doc. Totally agree. There are HUGE variations in training- especially when the provider may be from a medic mill where they learn the absolute basics with no theory behind what they are taught. Generally within a few minutes of talking to a student or current provider- about EMS, of course- I can generally tell how rigorous their training was. Until our training IS elevated and standardized, I share your concerns.

[crotchitymedic1986]

Quit blaming the EMT/Pmdc schools for your systems failure. It is your company's job to train/orient employees, if they fail to do so, blame them.

[ERDoc]

Quit blaming the EMT/Pmdc schools for your systems failure. It is your company's job to train/orient employees, if they fail to do so, blame them.

Wrong. School is for lernin', the job is for wurkin'. It is not my hospital's responsibility to teach me to be a doctor. Airlines do not teach pilots how to fly planes. The only training an EMT or paramedic should need when they take a job is learning things specific to that company, such as paperwork, rules/policy, etc. You should know how to be a paramedic before you get a job as a paramedic (although it is obvious that didn't happen for some).