I hear this all the time from first aid vollies.
The important issue here though is that without the education that underpins these ideas, its not 15 years of experience, its 1 year repeated 15 times.
I don't care if you've been a first aid volunteer with St Johns for 10 years, it does not trump my bachelors degree and a year of experience when it comes to assessing a patients needs. By that logic you could earn your MD with a hundred years on the job as a CNA.
I went to a job with a first aid volly for a 57 female post syncope/SOB. O/A Pt looks SICK, extensive cardiac history, etc. The FA volly wanted to d/c her from the spot we found her after *drum role*... taking her pulse and finding it to be "normal". We had something of a disagreement about that and it ended up being taken out of my hands (long story). Afterwards, he tells me condescendingly that when I get a bit more experience I will learn that there are some pts that just don't need, as he called it, "excessive interventions" like taking her BP. MI wasn't even on his radar because there was no crushing central chest pain. The mind boggles. If you don't know the difference between syncope of reflex mediated/vasovagal origin, and a massive bloody anterior MI (or even what they are!!), then you don't get to make decisions about a pt who could have either (or a million other things), no matter how many times you've watched someone else do it.
I can't stand this idea. A taxi driver with a CPR card (*cough* EMT *cough*) could do this.
One of my favorite examples in the struggle against this idea is falls in the elderly.
Option 1: Turn up lights and sirens, collect dot point information that you don't understand put them on the bed, put them on the monitor & some absurd amount of oxygen, then successfully place an IV on your third attempt (damn labile nanna veins). You take them to hospital and later complain about low pay and boring non-emergency jobs while sitting in the ambulance bay. You turn up every few weeks to the same person who keeps falling and you repeat the same meaningless collection of information, interventions and transports. A few months later you stop going to that person's house. You don't know it but they were moved to high care supported accommodation because of their falls and worsening health, away from their friends and the neighbourhood they've lived in all their life, and 18 depressing months later died of sepsis/community acquired pnemonia.
Option 2: You turn up assess granny, find her to be in the best of health. You don't transport her because your system trusts that you are educated enough to be able to make these decisions. Then you look into why she fell. You know from your
education that oldies falling is responsible for a decent slab of injury, reduced quality of life and even death. After a little detective work, you discover that the lip of nanna's rug is catching on her slippers. So you move the rug. From your
education, you know that low vision is high on the list of causes of falls in the elderly. You do a quick test of visual acuity and find its sub par. You use an amsler grid (READ: the pts living room blinds) to establish the possibility of age related macular degeneration and organise for her to see her GP as soon as practical. From keeping up on relevant research and health care initiatives instead of re reading your protocols for the millionth time, you remember that a local clinic is trialing a falls referral team so you give them a bell and they are happy to come and assess her the next day. You finish your cup of tea, bid nanna good bye and toddle off home.
I know which one sounds better to me. The list of examples like this is long. Gatro pts are another example. You could take them all to hospital (no doubt Code 3 with 15LPM O2), in the process infecting half the town, or you could risk stratify them and leave some at home after educating them and their family and writing a care plan including antiemetics, hydration/electrolytes and an appropriate medical follow up if necessary. In doing so you reduced the spread of disease, reduce ED work load and prevent an unpleasant and unnecessary few hours in ED for your pt. You may even increase their coping capacity so that when the pts husband has gastro a year later, they don't call an ambulance (probably a long shot
).
None of this stuff is really immediate (or in these cases even involve a trip to ED), but it is still very important and well within the realms of reasonable practice for a well educated (but sans MD) health care provider.
