Fire EMS: Continuation of Care

By Michael Morse

You have been on scene with a gracious couple for nearly 15 minutes, waiting for the EMS rig to arrive, treat, and transport. The patient, an 82-year-old-female complaining of shortness of breath and dizziness, has been evaluated, her vital signs assessed, and she has been provided supplemental oxygen administered by cannula. She is relaxed and comfortable. During that time, a loose friendship has been formed; you and the crew have bonded with the patient and her husband.

Because you are an ALS engine company, you have options:

  • Start an IV
  • Administer appropriate medication per protocol
  • Maintain patient comfort and stand by

On this particular call, you choose to stand by. The ALS Ambulance ETA is less than five minutes. You have made the decision to delay IV and medication until the EMS crew arrives, for valid reasons. The patient is stable, supplemental oxygen has helped considerably, an immediate IV will not change the patent’s condition, and medication administration may not be necessary to maintain the patient’s present comfortable status.

Everything is going great until the ambulance arrives. The paramedics saunter into the elderly couple’s home, neglect to wipe their feet, don’t introduce themselves and begin to interrogate the patient without bothering to ask you for a report. The lead medic snidely asks why there is no breathing treatment being administered, and finally addresses the patient:

“Can you walk?”

The fact that the EMS crew’s combined age is half your age is not lost on you as their arrogance begins to seep under your skin.

What we have here is a failure to communicate. What we need is an intervention. What we do not have time for is an intervention with communication skills as the focus. The patient has called for help because of her trouble breathing. You know that she has a history of asthma, managed with her inhaler for the most part, but today some bad news from her daughter exacerbated her condition. You also know her condition will worsen with increased stress. Your first instinct is to slap the young paramedic in the back of the head and then teach him some manners. Thankfully, you have prepared for such a scenario and know exactly what to do.

  • Introduce yourself to the medics: “I’m Captain Johnson, Engine Co. 15.”
  • Introduce the patient to the medics: “This is Mr. And Mrs. Stinson.”
  • Give a clear, concise and accurate report: “Mrs. Stinson is 82s year old and complained of slight difficulty breathing with a sudden onset brought on by stress, managed with 2 liters 02 by cannula.”
  • Run down most recent vital signs: “SP02 92% upon arrival, increased to 97% with 02, BP 142/88, Pulse 88, Respirations 18.”
  • Explain current status: “Mrs. Stinson has requested transport to the ER for evaluation. Her doctor has been notified and her daughter is on the way to meet her there.”
  • Offer to help carry: “My crew is standing by to assist.”

Unless the medics are complete idiots, chances are they simply needed a good kick in the butt. There is a very good chance that the crew is actually quite good at what they do, but may have just returned from a difficult call, had a sleepless night, or are simply expecting the engine company to behave as badly as they were behaving on their arrival. Nothing works better at bringing somebody back to his or her former professional selves than a powerful example. Leading at a time when arguing is an option is always the right choice. Chances are the ambulance crew will pick up where you left off and continue the patient care the way they were trained to.

Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.

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