Hybrid Medic

I was scrolling Facebook and came across an article about an ambulance service in Maine leaving a widow on the side of the road while they were transporting her husband, who was in cardiac arrest. You can find the article here.

From what I can gather from the article, the family was from Nova Scotia and were skiing in Maine when her husband smashed into a tree. The ski patrol rapidly moved the husband (the patient) off the mountain and to a clinic, where the facility called for an ambulance while they attempted to stabilize him. According to the article, the ski clinic did not perform any assessment, and according to the patient’s wife, neither did the paramedics. She insisted that they listen to his chest, start an IV, and take his blood pressure while they were packing him for transport and splinting his elbow. She says that they spent 30 minutes performing these actions.

Beyond poor care, the widow’s other complaint is that she was told to sit up front. Which if there is a lot of activity in the back, I could understand because  I don’t want potentially hysterical or intrusive family members in the back while I’m working something critical. To add insult to injury, she was let out of the ambulance and subsequently left on the side of the road. I don’t know the reasoning behind this, maybe she got hysterical or argumentative, I don’t know but there better be a good reason for that.

Clinical assumptions aside (and I did raise my eyebrow a few times), I bet the crew was less than considerate to the family, and perhaps in response to her insistence of being in the middle of things which could have perceived as being in their way. But had the situation been handled with a little more tact, I bet this would barely have generated a complaint at all.

You as a provider have a fiduciary responsibility, that is, having the characteristics of trust. If you display behavior that is not consistent of being worthy of trust, then the patients will not trust you to deliver the best care and certainly not for their family. This is important in all cases, but even more so in cases that involve poor outcomes, because poor outcomes could equal lawsuits even if you delivered stellar care, simply on the assumption that because you acted poorly that you performed equally as poor.

Remember that family members, unless they are physically in your way, often are merely trying to help. If you explain that their help is appreciated but not needed, they would be more than happy to step aside and let you do your job. You should up the level of insistence as they up their belligerence. My lieutenant has pulled many family members aside while we were working and explained that we have a job to do, and handled them with tact even when the outcome was poor. We often hear back about how well we did even though the job was botched or simply didn’t end well.

It’s as much about protecting yourself as it is your reputation. Appear to be trustworthy, and people will trust you despite how bad of a job you did, and will forgive you for your mistakes.

I was pondering why despite the accessibility of medicaid these days, and the large number of people we pick up that are on it and still in bad shape or go straight to triage, why the access to health care is still not enough.

It comes down to something called health literacy.

I define it as the ability to recognize and comprehend a problem with health, understand it’s level of seriousness, and access the appropriate level of care to meet that need. A lack of health literacy increases the likelihood of minor injuries and illnesses to become major, or problems that are chronic to become chronically acute. It’s one of the many reasons that without an education component, creating access to “free” health care will become a money pit.

But there is even a problem with that, that the new health care law ties reimbursements to visits, and that hospitals will receive less funding per patient if they have recurring visitors. After having several hospital stays myself for major and minor operations and getting educated by nurses and seeing my wife come home and beat her head against a wall after reading charts on patients that have chronic problems managed poorly, I know what the hospitals go through to teach people about their condition. It means that despite their best efforts to educate, some people will still go back to their normal state once they leave the hospital. It will inevitably lead to another hospital visit, and the hospital won’t get the money the deserve because a patient came back to them.

You can’t explain anything about health to anyone if they don’t understand in the first place, hence why to me health literacy is so closely tied to actual literacy. We even have universal access to basic education, and we see what the government has done with that. I’m a product of public education, as is my wife, and probably my son will be as well. It was engrained into us that school was important, so we went. I don’t see that much where I work these days. Basic literacy in inner cities is so poor that health literacy fails as well, and the fire department and the hospitals bear the brunt of it with people that are either not sick enough to justify the ride or so sick from something that could have been prevented.

Want to help health care? My suggestion: teach a kid to read, write, and think critically. Only when people understand their own health will the health of us all improve.

I’m in that space where I am uninspired by anything, and it’s hard to force to write something. It just doesn’t sound right.

It just seems that there is little going on right now, very little controversy to write about anything. Does it sound bad that I need some controversy to get me going?

I have been very reflective lately though, about things that have transpired and seeing a big pattern or a series of unfortunate (or fortunate) events that have created the situation in which we now reside. After talking to some old sages while working overtime the other day and remembering some old conversations I’ve had with colleagues in the past brought me to a simple question: What if this is really all we have? Are there really no new ideas?

Sure, we have innovators in emergency services out there that supposedly “create” something new, but is it really creation, or is it recycling and renovation?

I read a book over the summer called “On Killing,” it’s a book on the US Army reading list about conditioning soldiers to fire their weapons by creating hyper-realistic situations. They researched the rates of fire and damage patterns from past wars and compared them to the Vietnam war and found that firing rates were faster simply because it was easier, but it was still easily faked. Through the creation of realistic training the Army found it could make units much more effective but creating muscle memory where soldiers will fire their weapons out of instinct.

Several months ago I covered part of a mass casualty exercise put on by Jim Logan and Dr. Joe Holley where they recreated an MCI incident. The training was as close to realistic as it could possibly be made, and it is a smash hit every time it is put on. Personally, I loved it.

It is also proven fact that firefighters, when exposed to live fire in training, and the training fires made as realistic as possible, will respond in those patterns every time out of habit and instinct.

So what am I getting at? It has been well known since the 1970′s that we can produce responses based on realistic training, so we are applying military training techniques to other areas of life. To me, it seems that we’re just renovating and recycling.