Follow your dreams…and your patient

“Every hospital should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future.”

Ernest Codman 1914

 

Let me adapt that to our profession, one hundred years later:

“Every Paramedic Service should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future. This information should be shared openly with staff for education purposes and to allow a greater interprofessional understanding of each role involved in patient care”

Florian Breitenbach 2014 (Thanks @MDuschl)

Eulogy

It’s not what you expect to see when casually checking your social media sites after getting up in the morning: A series of short eulogies on a friends account.

Death has only tangientally touched my personal life. Deaths in the family occurred  at a very young age where I didn’t know them enough and didn’t understand the concept of death, and not knowing them as an adult, unable to build a bond between them and myself.

We, in contrast, had spent four years of our lives together that shaped and changed us: we had become paramedics together. Through university, through paramedic school, in the classroom, on the road, at graduation: we did it together in our group, growing from keen students to grown up paramedics. Whether at one of our first practice scenarios in school, or at a job working together: you were a solid colleague, a mate that I could count on, someone who had my back even on tough calls. You got on with the job that we both loved: helping people, and having a laugh with them, never at them.

Although we weren’t close, we kept in touch as colleagues, even if I was in your country of birth, and you were in my country of birth. I was glad that we were able to catch up over a pint when you came to visit England recently, and it saddens me that we won’t be able to do it again as we had planned, either here or over your way.

Pleasure to have met you, an honour to have worked with you, and a sad day reminiscing about the good times spent during our journey together.

Design

Design, a sometimes forgotten and neglected topic not only in the Paramedic world. Examples include the often poor visibility of exterior ambulance design, unsafe practices on interior ambulance designs, hideously designed uniforms, and not properly thought through industrial design of the equipment we use (heavy, cumbersome, unreliable, expensive. Or all four).

One thing that has always bugged me 
is the utilitarian approach to designing the patient area of the ambulance. Essentially the Paramedic’s office, a bit more thought would go a great deal. I was reminded of this shortcoming today when I visited the London Design Museum. There are some great designs and designers on this earth, but apparently we need to stick to old-thinking style layouts, with the accompanying drab and depressing colours. How about improving our workspace – I’m sure it would have a positive impact on   happiness at work, and even a good effect on (conscious) patients and bystanders. Environmental perceptions shouldn’t be underestimated.

IMG_5178

 

An interesting piece of ‘design’ was the Music Memory Box, designed to help dementia sufferers. The box is filled with objects and tunes that the individual has a strong emotional bond with; these ties are still present even with advanced dementia, and can provoke quite startling emotional outbursts. I can already picture a bunch of poor demented paramedics in a nursing home, with somebody having put the radio tones for a call in the Music Memory Box. The otherwise quite placid retiree would come out with a strong “Oh damn! Not another call, I wanted to eat my lunch!”.

 

I’ll leave you to ponder with a picture and a quote from a sculpture outside the Design Museum:

IMG_5175

 

Though human genius in its various inventions with various instruments may answer the same end, it will never find an invention more beautiful or more simple or direct than nature, because in her inventions nothing is lacking and nothing is superfluous.

Leonardo da Vinci.

 

 

Further reading & Links:

Ambulance Visibility: ambulancevisibility.com

Ambulanzmobile: Delfis Ambulance Design: http://www.ambulanzmobile.eu/brand/en/models/emergency-ambulances/delfis.html

Design Council: Making Ambualnces that don’t kill people: http://www.designcouncil.org.uk/publications/design-council-magazine-issue-3/making-over-the-ambulance/

London Design Museum: http://designmuseum.org

Transport Design of the Year 2012: Redesign of the Emergency Ambulance: http://www.designsoftheyear.com/tag/redesign-for-the-emergency-ambulance/

Music Memory Box: http://www.watershed.co.uk/ished/projects/music-memory-box/

Keeping it real

Paramedic

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.

Learning styles

A post provoked by uni studies and listening to podcasts. I wanted to post this on the facebook wall of the EMS EduCast, but it wouldn’t let me. So I decided to publish it here!

Hello EMS EduCasters,
In one of your episode you mentioned different styles of learners. It reminded me of an EM Crit podcast (Weingart, 2013), where a study by Pashier, McDaniel, Rohrer & Bjork (2008) is brought up. The authors conclude after their experimental trial that the concept of different learning styles doesn’t exist in such a way that common knowledge may have led one to believe. Weingart bluntly puts it in his recording that there is no such thing as an audio or a visual learner, and that books are hard to read for a reason – because study is difficult!.

I believe he makes a good point. I like to watch a video and listen to podcasts, and sometimes shy away from reading the hard stuff – but at the end of the day, reading gets you through a lot more information, but it is hard work. A mix of all ways of parting information is ideal in my opinion.

What does everybody think – are you surprised? I was initially, as I just took what I had heard about different learning styles for the bare truth, without having any credible sources to back me up.

Keep up the good work, and autumnly (chilly) greetings from London, UK,

Florian

 

References

Pashier, H., McDaniel, M., Rohrer, D., & Bjork, R. (2008). Learning Styles: Concepts and Evidence. Psychological Science in the Public Interest December 2008 vol. 9 no. 3 105-119, doi: 10.1111/j.1539-6053.2009.01038.x
http://psi.sagepub.com/content/9/3/105

Weingart, S. (2013). Podcast 105: The Path to Insanity. Retrieved from http://emcrit.org/podcasts/path-to-insanity/

Minimum skill levels on emergency ambulances

If you phone for emergency medical assistance, you would think and hope that there is some sort of minimum set who will actually respond to your call for help.

Call in Germany, and you will be guaranteed that the arriving ambulance is staffed with at least one Rettungsassistent (see paragraph 25 of the Durchführungsverordnung HRDG vom 3. Januar 2011, this is for the state of Hesse).

Call in England, and…well…you might get a Paramedic, or a Technician, or both, or an Emergency Care Support Worker, all three, a mix…it’s up to the individual service. All I could find was the Health and Social Act (Regulation 22), which merely states:

In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.

 

To me, that reads a little like “if you can get by, then you’ll be alright”.

It’s high time for some research to be done in to this (I’ve just started), to ensure that skill levels when staffing frontline ambulances are evidence based, that they are cost effective, that they can deliver the care when and where they are needed. In other words: When a patients needs help, they get the help they need.

The Urge to Merge

Image

Thought I’d share a poster I recently created for uni about the possibility of merging Fire/Rescue Services with Paramedic Services in England. Acknowledgements and thanks to TJ for helping me craft the idea.

Constructive criticism welcome.

The Urge to Merge