It has been a while since I started a new thread and I often tend to post on the more abstract, introspective side of medicine when I do. So without breaking tradition, here I go again. I have two points of observation here, so feel free to hit one or both.
First, I have noticed over the years as my educaction increased, as my experience lengthened, so did my conversation, my chattiness if you will. By this, I mean I take time to speak to patients. I engage them in conversations. I ask questions unrelated to their presenting condition, I give concern/regard for things in their life other than the issue in front of me. Don't get me wrong, I am not sitting on scene running the clock, however I do not rush through every little thing required. I know they need X, however I also know X can wait two more minutes if they are in thought or telling a story. I do not overtly control every little thing on scene as much as I used to. I know it will get done, I know how and when to get it done, so I have subconsciously removed the mechanical, robotic response of our scene action. My assessments can vary widely depending on the ebb and flow of whatever is transpiring in front of me, I do not systematically check off X Y Z. I will get to it. If urgent, sooner than later of course.
I bring this up mostly because it has been a verbalized trend among students, and younger/newer "peers" I have worked with. Their feedback is positive and they ask how I came to do this. I really do not have an answer for them, I usually just say years of practice and leave it at that. To my fellow experienced providers, is this common for yourself? Are you able to objectively see a shift in your patient interaction techniques through the years? Is this all just muscle memory like everything else we do repeatedly? I do enjoy keeping scenes calm, conversation flowing...is this an area we can improve upon with new students? Effective communications, psychology, etc?
Anyways, for the disappointing part of this post, see below (And you QA/QI guys will maybe enjoy this and have a takeaway for your own crews).
I happened to be on scene in my small town as a volunteer responder backing up the paid Paramedics from a town over. We had a sweet, 70ish y/o female feeling unwell and weak. I have been to her before, she is usually rapid A-fib. Sure enough, once the Paramedics arrived with their monitors, they confirmed she was tachy around 140-150 and their desire was to give metoprolol per standing order. To do this, they needed IV access. This crew does not know me personally, and their assumption was I am maybe a basic if that. I stood in the truck and watched as the first medic blew a 22g twice in her left arm. Then the second member (an advanced EMT), said I got this. So he boldly took a 20g and went for the right AC. This lady had spider veins, his medic just blew two 22gs...why go for a 20? She needs medication, not fluids...end result, he blew the 20g in her right AC.
I then politely suggested, why not just drop a 24g in her hand? It is enough to get the medicine on board and address the issue without further sticking this lady. The medic looked at me and for brief second his eyes flashed like it was the greatest idea and then his face changed and he said "I cant wheel her into the ER with a 24! No one uses a 24g".
To which I said "access is access and you are doing the right thing for the patient". Anyways, he then told his partner to do a slow Code 3 to the ER and they were departing, he would attempt again en route. I do not know what the outcome of the patient or his care decision was....and I do not care to hear bashing on this particular medic. My point of this is...when did we become so proud that we base our competency on the size of needle utilized as opposed to bragging that we used an appropriate sized needle to deliver the appropriate care to a patient in an appropriate time???
Had the service I responded with been licensed above a BLS level (its a rural FD FYI), I then could have done some medic stuff and absolutely would have completed all this prior to their arrival, however this is not the situation. Anyways, back to the topic...where did we "go wrong" in our training and education where we instill this line of thinking?
