In the EMJ Podcast from April 23, 2013 ”The Wells scores for VTE” (iTunes link), a notion that is briefly mentioned and discussed is the move away from the “rule in/rule out” strategy for (possible) disease management in emergency medicine, instead employing clinical probability, the burden of disease and considering false negatives and false positives.
And how does this tie in to the world of Paramedicine? Let me demonstrate.
I’m sure most of us have responded to calls where patients have punched their minor ailments in to a computer, and the wonderful world wide web has diagnosed them with cancer, the black death, and being pregnant with triplets.
In a sense, paramedics often do similar things. We are quick to turn up to patient, assess them, expect the worst, then make them expect the worst, and transport them to hospital. Just in case. To be sure, to be sure.
The only thing that is sure is that it is clogging up the hospitals.
Instead of ruling a specific disease in “because we can”, how about emphasising clinical probability and disease severity, and weighing them up against each other? We need more training and education focussing on minor injuries and diseases, allowing us to recognise issues, and deal with them appropriately. More diagnostic kit is becoming increasingly mobile, with blood analysis now not only for glucose levels, but for white blood cell count, and more. A framework of robust clinical decision making guidelines for the well educated paramedic, together with optional online (phone/video) consulting for a second opinion and appropriate referral pathways is the way of the future.
The “You call, we hall, that’s all” paradigm is outdated.
Paramedics are specialists in unscheduled and emergency healthcare. Care right at your doorstep. An you won’t necessarily even have to cross it.