Thursday, October 16, 2008

Just because we can?

I had an 'asthma' patient not too long ago, who came over to me freaking out, gasping for breath, moaning, crying and clutching her chest, throat, face etc. I sat her down, stared her straight in the eye and told her directly to calm down. I coached her breathing for very few cycles before realizing that she was, for lack of a better expression, full of it. She would gasp and spit, choke and sputter, then look up at the scoreboard and cheer raucously for her trailing team. She would be close to death, then pick up her cell phone and start texting her friends. A colleague of mine walked over and asked, like I was completely inept, why this asthma patient was not on O2. Ummm....because she doesn't need it?

A few weeks later, I was running an event as control when one of my teams got a call for an injured cheerleader. She had been kicked in the head, rather hard, as she fell from the top of a formation. The trainer had walked her over to our post and sat her on the back step of our ambulance. She had a nasty headache, as well as nausea and dizziness. She did not have neck pain or tenderness, and from all accounts, had not actually fallen onto her head. I know I wasn't at the call and didn't assess her myself, so perhaps it is unfair to criticize the team's treatment. They put her in a KED (since she was sitting down), and were preparing to backboard her as EMS showed up. The paramedics checked her over, WALKED her to their stretcher, placing her on it sitting up comfortably, and left for the hospital.

A little girl turns her foot at a kid's event, my partner and I head over to check her out. She is sitting on the turf, no tears, no obvious look of pain on her face. She winces slightly when I touch the lateral edge of her foot, but there is no instability and only minimal swelling. Placing an ice pack on the injury does wonders to relieve the pain. My partner pulls me aside and asks if I'm planning on splinting it. I say no, and explain when he gives me an incredulous look. I am not putting a small child in a massive, uncomfortable knee-toe-splint for an injury that just doesn't seem to logically require immobilization. Sure enough, she is up and running around by the end of the event.

Over-treating patients seems to be a rampant disease among many of the people I work with. The "Just because we can" attitude drives me insane, and I strive to counter-act that whenever possible. On our training nights, this attitude is clearly visible among many of the responders. When we focus on patient assessment techniques, vital signs and theory, people are bored and disinterested, brushing it off as been there, done that. This is even the case among responders who are and always have been terrible at patient assessment, obtaining accurate vitals consistently, scene management and the like. As soon as we pull out the equipment, however, people get more interested. Backboards, the KED, crazy splinting stuff, people would rather do that than practice the oh-so boring, routine steps of assessment and treatment. There is also a great tendency to jump on the chance to 'practice' their skills on a real patient. I don't like that mindset, but sometimes I worry that I am under-treating in response to their over-treatment. I guess it has to be a fine balance, and always, always with the patient's welfare at the forefront.