Sunday, January 8, 2012

It's Hard to See a Black Dog in the Dark

How many times have you gone to a call with some preconception in your mind, because of what dispatch said?
How many times has it turned out to be wrong?

Or how many times have you gone to a call that started out calm and suddenly, things went south in a hurry?

It's easy to miss things you aren't looking for. Easy to miss things that blend in with the background, so to speak, things that appear ordinary until you find out that for this patient, they are not. And easy to get distracted by some obvious thing, so you forget to look around for what else is going on.

In EMT-B class, they taught about how a "distracting injury" can make it so a patient isn't aware of pain elsewhere.

Likewise, a "distracting symptom" or  "distracting long distance dispatcher diagnosis" can get in the way of the EMT staying open and aware of the big picture.

Sometimes, I think it would be better if dispatch didn't give us any information, so we'd start from the beginning and be alert for anything.
Other times, I wish they'd give us MORE information... but that's a different story.

It's important to have a method, an order to your chaos. Important to do a full assessment every time, preferably in the same order.

Do I always do that?

Um... no.

I have an excuse. (Doesn't everyone?)
I don't always have time to do a full assessment.
Sometimes, the ambulance arrives at the same time, or very shortly after we do, and I get about 30 seconds with the patient before transferring care.

It's not a lot of time, but it's possible to get a lot of information in that short period of time.

My challenge is to:
a) get as much quality information as I can
b) while establishing patient rapport and
c) documenting everything I find before the ambulance leaves

Some things that help:

1. Using a script for documentation, much like I'd use for a radio report.
2. Really knowing where everything on the PCR goes so I don't have to hunt around. Some of it can be filled in on the way to the call, some between the house and the back of the ambulance. Being able to walk and write, in the dark, is a handy skill.
3. Learning as much as I can about "typical" calls, so I know what to ask, what to look for, without having to try to remember some mnemonic.
4. Practice, practice, practice
5. Good pre-planning and post incident analysis with my team, so we can improve every time. Even if that "team" is only me that day.

And last, but not least:
6. Knowing when something is "not right" or "doesn't fit."  Kind of like Sherlock Holmes: look for what is out of place. It is especially helpful to have a team who all look out for such things, and bring them to my attention. Sometimes, the best information comes from a family member who is talking to someone other than me.

We need to see what is obvious, and find what isn't.
We need to be able to see PAST the obvious.

No comments:

Post a Comment