Under Construction :) Under Construction :) Under Construction :) Under Construction :) Under Construction :) Under Construction :) Under Construction :)

Monday, July 26, 2010

Overheard in the Triage Line

RN: So he's on Coumadin?

EMT Trainee: No, but he's on Warfarin.

I think I peed my pants a little trying not to laugh.

Tuesday, July 20, 2010

Dignity

Dignity in healthcare can mean a lot of things. But right now, to me, it means respecting your patients as human beings with the same amount of worth as you (or even more in some cases).

They are not unpleasant tasks to complete.

They are not lumps on stretchers to be shunted between hospital departments like a life size game of pong.

They are not there for you to resent when you get off from work late.

Most importantly, they have the right to bed educated on their condition and participate in their own care. They have this right regardless of what language they speak, or their psychiatric diagnosis (within reason, of course), or their ability to speak at all. A patient trapped in their own body after a stroke is just as capable of communicating their wants and needs and opinions if you take the time to ask.

If you find yourself unable to take the time to ask your patients if they're comfortable and doing okay (or as okay as you can be in a hospital), please, remove yourself from your current career path. That vitals machine above their bed doesn't tell you that they would feel...

...slightly more human if they had an extra pillow to support their bad back.

...slightly less terrified if you gave them a quick summary of what would be happening to them in the next few hours.

...slightly less embarrassed if you gave them a diaper instead of just leaving them on a chuck.

*

Dignity in health care should mean that when I walk in to an ER to bring a patient back to another facility, they should not be covered in their own blood while lying in a urine puddle that's expanded across half of the stretcher.

Dignity means that regardless of the facts that this patient only speaks Spanish and can barely move on their own after the stroke, they deserve the same respect and care that you would want to receive yourself.

When this patient proceeds to tell me that they're in severe pain, and I can see them still actively bleeding despite stitches, due to the fact that their extremely productive pneumonia related cough keeps tugging at the wound, you should not involve yourself in an hour long standoff with EMS over the transfer decision.

The correct bare minimum answer would be to properly clean up this patient, apologize, and apply gauze and an icepack.

When you haphazardly clean this patient, leaving them in their stained gown with clots still gurgling in their mouth and dried blood on their face and chest, and order me to transport them, that is an acute deprivation of dignity.

When you bounce into the hallway where you've left me attempting to mop up the ongoing flow of bloody sputum and announce that you've "won" because you called the receiving facility and they agreed to the transfer, I'm probably just going to stare at you.

Because I thought we were talking about patient care, and this patient's right to properly receive it.

I would've continued telling dispatch that I refused to transport due to the patient being unstable, but at that point I concluded that it was in the patient's interest to get as far away from you as physically possible. Even if that meant going via the receiving facility, where they refused to accept the patient once they realized that you had inaccurately described the patient's condition over the phone.

Because we transported the patient to another ER after that. And the first thing they did was far more effective than what I was able to do with a towel, saline and 4x4's in the back of my ambulance.

They asked how you were doing, did your interview in Spanish, and offered to get you a diaper.

When I saw how your face lit up with relief, I almost hugged the nurse.

Because dignity will always be a critical component of patient care.

Sunday, July 18, 2010

MOLST (pt. 2)

This is a New York State MOLST form:



The original copies are always pink, but photocopies of the original can also be acceptable. The patient keeps a copy and the doctor who signed off on the form with them also keeps a copy. Patients are advised to keep a copy taped on their fridge or folded in their wallet. Nursing home patients should have their copy in their medical chart at the facility.

MOLST can be used for both pre-hospital and hospital care. I'm sure there's a little more legal discussion involved, but I know the basics in what I look for when I need to make decisions on scene.

The first part discusses CPR, and the patient can choose yes or no. Make sure this is signed by a doctor, the patient (or the patient's HCP), and 1 witness. It's no good without those pretty squiggly lines.

The next part (and this is where it improves on the traditional DNR form), gives the patient three basic choices for "Life Sustaining Treatment":

Comfort measures only: Comfort measures are medical care and treatment provided with the primary goal of relieving pain and other symptoms and reducing suffering. Reasonable measures will be made to offer food and fluids by mouth. Medication, turning in bed, wound care and other measures will be used to relieve pain and suffering. Oxygen, suctioning and manual treatment of airway obstruction will be used as needed for comfort.

Limited medical interventions: The patient will receive medication by mouth or through a vein, heart monitoring and all other necessary treatment, based on MOLST orders.

No limitations on medical interventions: The patient will receive all needed treatments.

The patient goes on to specify whether they want to be intubated or not, and for how long using which kind of machines. They can state whether or not they want to be transported to the hospital for further care. They can state if they want a feeding tube, a trial period with a feeding tube, or no tube at all. They can choose how aggressively antibiotics will be used in their treatment.

And then there's a little space at the end for the patient to write in whatever else they may or may not want to be used in their treatment, such as dialysis or blood transfusions.

Again, be careful with your squiggly lines at the bottom of this second part. You need the doctor, the patient (or HCP), and 2 witnesses.

There's a great online traning program for New York State EMS providers here.

And you can find more information here:

Medical Orders for Life Sustaining Treatment - NYS DOH

Thursday, July 15, 2010

Dear lady in full niqab on the train,

I would have decked that racist bastard for you if the train doors hadn't closed. Taking the seat across from you and turning my favorite Nancy Ajram song all the way up was the best solution I could think of on short notice.

Anyways, the overdose on my eardrums was totally worth the expression on your face when you recognized it.

Or what I could see of your face, at least. :)

Wednesday, July 14, 2010

Apparently I'm a grownup, and all of my friends are having babies, or getting married, or engaged to be married, or just graduated and career hunting.

I missed the memo.

Seriously.

Thursday, July 8, 2010

Things I Don't Like To Wear

Heroic EMT Slain In Brooklyn - NYPost.com

Mourning Bands are worn on your shield, usually from the time you hear about the death to the time the person is laid to rest. If you don't have a shield (most private ambulance companies in NYC don't require them), then you wear it on your left shoulder. You know, those buttoned down little flaps on the top of your shirt that you might attach your ID to?



Please be safe out there. Both on duty and off.


For reference, see:

Badge Mourning Bands - paradestore.com

Mourning Band Etiquette - forums.officer.com

Wednesday, July 7, 2010

Heat Waves (And Other Fun Things)

If the temperature outside is 103 degrees Fahrenheit, I do not want to stair chair you into your home. Stay in the hospital. They have better air conditioning.

Especially since I threw out my back last week on another stair chair job and am now wearing a ThermaCare heat wrap to deal with the pain. (Days off are for the weak. And for people with air-conditioned houses to relax in all day.)

I also do not want to go wandering around the worst (un-air-conditioned) housing projects in the city with a police escort looking for my patient. (Although I don't mind helping an old lady carry her new air conditioners to her apartment after we give up searching.)

I do, however, want to go to Brothers Police and Security Store. SO. MANY. UTILITY. POUCHES.

Thursday, July 1, 2010