Street vs. Book

[emt722]

Hello!

I'm a relatively new EMT and I volunteer at my local ambulance corps.
What I learned in class:
- scene size up,
- primary assessment,
- treatments,...
New information I learned on the field:
- try to collect identification/ insurance papers from the patient,
- take notice of air bag deployment/ seatbelt/ site of car damage for MVAs
- collect transport papers from patients living in nursing homes...

I have heard that EMT skills develop largely from direct experience, but my problem is that I feel somewhat lost and a bit overwhelmed when I am actually on call. In between taking vitals and filling out the PCR, what else should we be collecting from patients? and are there other points we should be taking note of when we are on scene of a call?? Sorry to sound like such a newbie, but any tips/advice would be helpful!

Thanks in advance!

 

[Mariemt]

Look around the house. Notice placement of furniture, smells. .. cleanliness etc. You may have a social worker contact you about living conditions or may want to call adult or child services about conditions in the home.
Sometimes in the winter with a parka on, you don't realize the elderly person doesn't have heat, etc. In a home that appears to be run down, you can turn a faucet to see if there is water.

You are their advocate.
Tunnel vision is a problem for many. Whether driving 10-33. Or seeing a patient in a garage full of CO. Remember safety. Just flipping a door open is not enough to air out fumes. Call for fire, or use scba.

 

[emt722]

Thank you! =)

Another (potentially stupid) question: what happens when the patient is unconscious/ no form of identification/ no way of gaining a history? what would we fill on the PCR? = just N/A?

 

[Handsome Robb]

Unknown

 

[emt722]

haha, alright. I guess I'm over thinking.

 

[Handsome Robb]

Unresponsive patients with no one around to give you information are the easiest charts to write. Everything is objective. This is what I saw, this is what I did.

Done.

 

[emt722]

Very true! =) Guess that's good for us

Also, what is the very basic stuff we should be telling the receiving triage nurse? What I mostly hear is: to include patients name - chief complaint (moi/noi) - vitals - treatment - meds/ allergies...
so, basically a quick regurgitation of the PCR?

 

[Handsome Robb]

That's something your FTO and agency will teach you because every hospital is different.

My reports to nurses are long and detailed but EMS and ER here are integrated very well. We're a team.

If you want an example I'll write one out but like I said some might want everything and other just want name, chief complaint, vitals and interventions.

 

[NomadicMedic]

At the very least: name, age, what happened, what you found, what you did.

Or, do what I did. Ask a few nurses, "what do you want?"

My bedside reports are usually pretty quick, but rich with detail. (Much like a California red wine...)

 

[emt722]

awesome! I appreciate all the help =)

I'm definitely going to meet with my FTO's soon

 

[Tigger]

It should go without saying but nonetheless...watch your tone.

My partner gives excellent reports. The best I know of. But often times he comes off as if he is talking down to the RN (or doc) and you can tell they start to tune him out, which is too bad. Even if you do know everything, be mindful of presentation.

 

[emt722]

Yeah, I understand. Iv'e been in situations where it was the opposite - RN's looking down on me =/ not the best feeling.

can't we all just get along??! lol

 

[Akulahawk]

Where things get really interesting is when you're an EMT-B and after you give report, the ED staff starts asking you about things like "Where's the IV?" and "What was the Blood Sugar?" and "What meds did you push???" Then you tell them you're not allowed to play with sharp objects because you're just an EMT...

What then gets really interesting is when you pretty much hand them the diagnosis on a platter. There's only a very small group of patients that I'm capable of doing that with. It's at those times that they might realize that you're not a minimally educated knuckle-dragging EMT. After they get to know you, (and if you're there often enough, they will) they will not only just take report, they'll actually closely listen to it because they know you're one of the ones that isn't a technician.

To get on to the point of this thread a bit, while it's not entirely accurate, I used to tell my trainees to throw out what they learned in school. It's not that I want them to forget it, rather it's that I want them to look for and understand the larger picture. I want to get them away from the NREMT "take a test in exactly a specific manner" mind-set and really begin to see why things are done in a certain way in the field... we gather info from multiple sources and do things or have things done at the same time, which is something you can't easily test. They need to learn that field work isn't as linear as they present the scenario stations in class. In reality, they come to realize that the book information is important as a foundation to grow from and not the absolute definitive way to do every interaction with a patient.

Yes, we used to spout the BLS before ALS stuff. It was a reminder to us that we need to remember the basics and proceed from there and start with the least invasive interventions necessary to do the job.

 

[firetender]

haha, alright. I guess I'm over thinking.

That's a BINGO!