Monday, April 11, 2011

Further Information

I've noticed an interesting trend. One which I hope continues. It seems to be doing so.

When I took my EMT-B class, we were told about DNRs. More recently,  the MOLST form was created. I have yet to see a MOLST form on a call, but I've seen quite a few DNRs now. That was pretty much the only on-scene patient-provided paperwork we were specifically taught about.

Over the past couple of years, I've started seeing a wider variety of paperwork, and some of it is very useful.

At the beginning, we'd sometimes have patients give us a hand written med list. Definitely better to have a written list than to have to hunt through a drawer full of pill bottles. Then, we started getting more and more printed, rather than handwritten, lists. Even better. I would say that at this point, more often than not, a patient will have a list of some kind, and more and more of them are printed now than even a year ago.

The next interesting paperwork was when we got a call to a daycare home. The providers met us at the door with a folder of information about the child, including medical history and contact information for the parents. Very organized and easy to read. I discovered later that day that the state requires such paperwork, and I must say, it was extremely helpful to have. Score one for the state! We weren't going to get many answers from a pre-verbal child and the providers had several other children to continue caring for, so it would have been challenging for them to give us all the information verbally. It would be difficult for them to remember that amount of information about every child they care for, as well.

Then we got a call where the patient handed us an amazing printed out sheet of information. Apparently, there was a neighbor who liked doing things on the computer who had created these info sheets for friends and family. Color coded and everything. Demographic information, medical history, medications, doctor's name and contact info, etc. Very well done. Wouldn't it be amazing if every call had one of those? Almost like a patient coming with an instruction sheet. And almost- but not quite- as helpful as the times we've had patients with their own nurse present.

Relatively recently, we've come across a few patients who also give us printed out sheets of information. They list medical history, including information about infectious diseases, with a warning. We've seen these posted on the outside of the front door, so we see them before entering the house, and can add PPE if we need to. We've had them handed to us as we entered, or seen them taped to a table top. I think some of the reason for these is so the patient doesn't have to answer the same questions over and over, but some is out of their concern that we get the information as soon as possible, and I appreciate that. Some of these also have information about any likely causes of an altered mental status, in case the patient is unable to answer questions at all. Most of these patients have been people who live alone, so might not have anyone else present to answer for them.

I don't know if there are organizations out there encouraging this approach, but there might well be. We've been seeing it more and more. It really is helpful to have things spelled out sometimes. It makes for much quicker communication between us and the ambulance crew, too, if they can see the same piece of paper. Saves the patient having to explain, and potentially saves any embarrassment over discussion of sensitive issues. Even if they need to be discussed, we're all starting from a better understanding, so the patient can answer pertinent questions, rather than having to explain the entire thing.

I've also seen information about some interesting commercially available alternatives for providing more complete medical information. One is RoadID, which is a bracelet or similar item with phone numbers and/or access to a link to retrieve information online. There are also USB medic alert tags now, which contain further information. Another one I've seen information about is the Invisible Bracelet from the American Ambulance Association. That one uses a cell phone to text information, which would probably be the most useful for us, since we don't have internet access or a laptop at a call.  

I haven't seen any of these in the field, but it's only a matter of time.

1 comment:

  1. There is a program set up by a neighboring ambulance of ours called Know Your Neighbor. They got the community involved giving out kits that include a magnet to put on the fridge which alerts EMS that you have an information packet including demographics, PMHx and med lists on the inside door of your freezer. The had kits and information available at drug stores, grocery stores,restaurants and any other willing businesses.They included the the program in their talks at schools giving out the supplies and suggesting it as a gift to grandparents. It also offered that the people could bring the information to the ambulance co if they needed any kind of help putting the materials together. Now they did get long plastic tubes to put the paperwork in but large freezer bags would work just as well. The freezer was chosen just as a means of everyone having the information in the same place with the magnet an easy way to alert crews that it was there. The program has been a huge success. Unfortunately the powers that be at my organization thought it was not cost effective in our much larger running area