I guess I was sick the day they covered "clairvoyance" in EMT class.
I think maybe your crew members may have been sick the day they covered ABCs in class, though.
I have to agree with the majority. Dispatch info was sufficient to warrant the minimum of feeling a pulse while asking just how asymptomatic he was. Red flags are only useful if you watch for them. Any responder who summarily dismisses dispatch information is not making use of quality "think time" on the way to the call.
I think sometimes responders get a bit lax about the ABCs. They figure if they patient is up and talking, he's breathing and perfusing adequately. That's not always the case, and as at least one other person pointed out, asking the patient for physical exertion (walking to the ambulance) with a HR of 20 isn't good patient care.
Nothing takes the place of putting your fingers on the pulse of a patient, and I can't think of anyone who should have a pulse check done sooner than one who has had a near-syncopal episode. What causes fainting? Lack of O2 to the brain. What causes lack of O2? Poor perfusion. What can be a cause of poor perfusion in a patient not bleeding out from evisceration? Poor pump. And if you conclude there is a pump problem, you don't ask the pump to work harder. It doesn't get any more simple than that. Ask any BLS responder what they would have done and they'll (hopefully) tell you they would have checked the ABCs. packaged patient on a stretcher and hollered loudly for ALS for a possible cardiac event. Those were Basic skills that were overlooked by your crew.
And now for my soapbox: Adopting a "Joe Cool" attitude that is dismissive of dispatch information can be a dangerous thing for some patients (and responders as well). More than a few responders' halos have fallen because they adopted an "I won't believe it until I see it with my own eyes" attitude. So many times you hear a responder say "We treat patients, not dispatches" or "You can't save anyone with a PCR box" or something similarly foolish, only to have them eat their words in the end. Often it's the young newbies trying desperately to sound seasoned and hard, like the old guys who sit at the table (who aren't necessarily the ones you want to emulate). The end result might be that a responder stops utilizing one of his greatest tools - the ability to HEAR what a patient, bystander, relative or dispatch is trying to tell you. It's not enough just to listen.
On this call, I think you gotta admit there are some lumps to be taken. Not by you, necessarily, but it sounds like the other two may have treated this too casually and could have cost the patient dearly.
Secondary soapbox: A good responder makes use of his QA, not by arguing loudly against the overwhelming tide of opinion, but by re-evaluating the facts, assessing the situation as a whole, and honestly admiting that a different treatment plan may have been a better idea. That's how we all learn. EMS keep you humble, if nothing else.
and the state isn't mandating an order either. I guess I worded it wicked stupidly:sad:. Providing no AV blocks and relative stability, I just have typically started w giving the bolus simultaneously because stroke volume (specifically preload) is stuck in mind when thinking about churning up a guys rate with Atropine. Don't see much good in increasing the rate and myocardial O2 consumption if there is limited intravascular volume.
