Professional Organization, Federal/State/Local Gov't
Excellent Patient Care is the Gold Standard even on routine calls. Treat your patient as you yourself, or you want your family to be treated. This is especially true for geriatrics.
Level One: Positioning, oxygen
Level Two: Suctioning, Beta Agonists (Proventil, Brethine)
Level Three: CPAP (Continuous Positive Airway Pressure)
Level Four: BLS airway adjuncts
Level Five: Supraglottic airways
Level Six: Endotracheal intubation!
Effective ventilation is the key to good airway management. Maintaining circulation helps distribute oxygen where it is needed.
From Ambulance Driver; Kelly Grayson http://ambulancedriverfiles.com/ Used with permission of the author.
Golden Rules of Patient Care:
Rule Number 1. Patients don't read the textbooks. All patients will die.
Rule Number 2. You cannot change rule number one. Learn to accept death as a condition of life.
Rule Number 3. The patient might die despite our best efforts.
Rule Number 4. Primum non nocere! "First; do no harm."
Rule Number 5. Primum succurrere! First; Hasten to Help - arrive quickly and safely.
Rule Number 6. The child that isn't crying might be a problem.
Rule Number 7. The oldest mission of medical healers is to treat pain.
Rule Number 8. You do not know everything and neither does the doctor.
Rule Number 9. Sometimes the best intervention is a BASIC one.
Rule Number 10. You are a medical professional - not a public servant!
The Core Concepts of EMS:
1. Scene Safety; without it, nothing else will matter. This must be ongoing always.
2. Nothing else works until an airway is established. All noisy breathing has some degree of obstruction.
3. ALS can not and will not work without BLS. Each skill set is unique.
4. All bleeding will stop eventually. Control Bleeding; Control Shock!
5. All shock patients are cold; conserve body heat by keeping your pts. warm; make sure they are comfortable and have a blanket. Never delay treating a patient for shock.
6. Shock may develop at the time of the injury or illness, or even hours later.
7. Patients call us because they are usually in some form of pain.
8. Pain may be a major cause of medical shock. We should treat patients in pain better than we do.
9. Pain is an indication of possible injury.
10. Never force your patient into anything, including transport.
11. Treat the patient, not the monitor. Mechanism of Injury is not a complete patient assessment.
12. Explain what you are doing before doing it. Especially to children and the Elderly.
13. Your routine call is your patient's big event. Be courteous to the patient and family.
14. Treating the patient sometimes just means being nice.
15. Patients don't usually call 9-1-1 just to sign your refusal.
16. Communicate-to your pt, to your partner, to the dispatcher, etc.
17. Do Not RUSH anytime, anywhere, or accidents will be the result.
18. Slow down take a deep breath. RELAX and FOCUS.
19. Scene time should be limited.
20. "We must do something" is in fact inadequate patient care and a lie. Doing something just for the sake of doing something is bad medicine. Doing something just to create the impression of doing something is also bad medicine. Unfortunately, this seems to be a significant portion of EMS thinking.
Shock is defined as abnormal metabolism at the cellular level (Inadequate tissue profusion). Shock is a culmination of multiple organ systems in the body that have failed or are in the process of failing. Even with the best of care, there is a significant risk of death. Shock is the end stage of all diseases, and symptoms will often be dependent on the underlying cause. Shock is also a life-threatening medical condition whereby the body suffers from insufficient blood flow throughout the body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in the body's tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen rapidly. Medical shock is different than emotional, or psychological shock that can occur following a traumatic or frightening emotional event.
A patient is a person who receives medical care, attention, or treatment. Patients are not customers as they do not buy our goods and services. Patients may become clients when we charge for our professional services, but we don’t always charge for said services. You must understand this completely. This also means being empathetic, caring and understanding to your patients, their family and others you come into contact with involving your patient. EMS should become a specialty branch of medicine; specifically, emergency medicine and mandate better education and continuous training.
Remember: 1. An unconscious patient is a co-operative patient. May not be a true statement.
2. The more the patient talks, the more likely it is they never needed you to begin with.
3. Sometimes; despite training, despite best intentions, you can't win.