What Say You?

I am sure that most of you have noticed that I have been wading my way through another bout with writer’s block.  It happens, right?  I’ve beaten it before, and I will beat it again though.  I’ve gotten some great support from some friends who have suggested topics, and offered ideas for future posts.  The one I am sharing with you today though is one I find interesting.

Last week, I was complaining on my Facebook wall about my struggles with writer’s block, and my friend friend sent me an interesting question:

“I saw that you had writer’s block the other day and was curious to know if you’d be interested in running an informal and non-scientific survey of your faithful readers. Here’s what I am curious to find out: I have the opportunity to watch hundreds of transfers by the various private services in RI take place at various hospitals while I am posting. It seems as though virtually all of the techs riding with their patients sit in the airway seat behind the patient, usually entirely out of view of their patient. About the only time that I sit in that seat is when I have a backboarded patient (so my patient can see me) or a patient with an airway issue, at all other times I am either on the bench or in the “captains” chair, in full view of my patient. I wonder if this is generational/experiential/company SOP, etc. and why so many EMT’s now choose to be out of view of their patients? Just a thought, I am sure you have your own feelings and experiences from Springfield, and maybe this will help break your block.”

Personally, my answer is simple, but it comes with an “*”.  Although I often tell people that I am only 5’9” the truth is I am actually 6’5”.  When I am working on a truck, they are 99%-100% of the time, van ambulances.  With my long gangly arms, I can reach everything in the truck from the comfort of the bench seat.  When I say everything, I pretty much mean everything.  Its freakish.  The only time you will find me in the airway seat is if I am (obviously) managing the patient’s airway, or if I am training, and my student is at the patient’s side.  Otherwise the bench seat is where I live.

As a matter of fact, if I even have to slide up to the end of the bench seat and out of their views, I excuse myself and let them know where I am going.

Although the place to be is in our patients’ view, interacting with them and being not only good clinicians but also good care givers, it seems like some people might occasionally need a reminder of where they should be.  So let’s answer Jon’s question: where do you sit?  Where should you sit?

 

  • I sit on the patient. Builds rapport.

  • Railrob

    Scott, this is one of those topics that belongs in the first few days of the basic EMT class.We are there to care for the patients in many different ways. Speaking to and listening to patients is equally important skill to learn as is airway care. Learning to actually interact with my patients on transfers rather than hide behind them in the captains chair filling out the run report was extremely important lesson that made me a far better paramedic when the time came. I see far to many EMS practitioners that treat the patient as a commodity rather than a person. Sit on the squad bench and interact with the person!

  • 5’9″? Who do you think you are Wes Welker?

    @Railrob: I wonder if this is an after effect of a generation that uses text messaging and email more than phone calls and face to face communication.

  • Thehappymedic

    This has nothign to do with the text message generation IMHO. Wether I sit directly in their face, ignoring them completing documentation (when appropriate) or directly behind them (after telling them how to get me “I’m right behind you, just raise your hand if you need me”) what’s the difference? If my patient needs my interventions, I’m on the bench. If they don’t, it doesn’t matter where I sit.
    The difference between hiding and giving someone a little privacy is huge.

  • @thehappymedic: I believe it makes a great deal of difference in how our patient’s perceive us. Have you ever wondered how your patients perceive you when you tell them ” just raise your hand if you need me”? For many of them, the ambulance trip is not the norm. The ride, the reason behind the transport, the outcome of the transport or the final destination may cause a great a deal of anxiety and fear in a patient. Some may vocalize this fear, others may not and just sit there not wanting to “disturb” us while some sit behind them doing paperwork or just daydreaming. I think you may be overlooking the psychological impact of having the person who is “responsible” for their care easily accessible and not feeling like they are just another report. For some the transport might be the only opportunity they have to get out of the NH, rehab, or wherever they pass their time and our interaction with them may be helpful to them feel some normalcy in their lives.

    And yes, there are those patients that are going to sleep, are altered and may not be responsive and some that just don’t want to talk. Maybe with those patients it does not matter where you sit. But if the provider climbs in after they are loaded and proceeds to immediately sit out of view of the patient, how do they know?

    I am not bashing your opinion or how you operate, but your response is to a degree what I expected: “If my patient needs my interventions, I’m on the bench. If they don’t, it doesn’t matter where I sit.The difference between hiding and giving someone a little privacy is huge.” But, IMHO, where you sit may in fact be an intervention, not necessarily for the physical, but for the psychological well-being of your patients.

  • Glad I got out of that racket

    Most RI privateers might as well be hauling bags of sand on their stretcher for all they care. They’re only working for that company until they A) get wind another company is paying more, B) finish whatever schooling will allow them to get a higher-paying job, or C) get hired by a full-time fire department, which they then infect with the bad habits and “whatever” attitude towards patient care they acquired in the privates. And their companies know it, and treat them/pay them as such. And the employees know it, and so the company gets minimal effort, and the cycle goes round and round.

    You could say it’s the same with privates everywhere, but it’s not. The differences just between RI privates and MA privates are night and day. Part of that is the differences in state oversight, part of it is the additional scrutiny resulting from 911 contracts in MA that don’t exist in RI, part of it is the bare-minimum culture of EMS generated by the EMT-Cardiac “bare-minimum ALS” level.

    Getting back to the question at hand from your FB friend- a RI privateer who spends the transport in the airway seat is not, generally speaking, the guy or girl you want transporting your grandmother. The only time I sat there was the 2am psych transfer out of state when all the poor guy wanted to do was get some sleep- in which case the stretcher was reclined far enough for me to see the belt buckles.

  • Medic York

    Before I became a medic I worked as an EMT in a never transfer heavy commercial service. What I have learned is every patient has a story (and I am talking about transfers). I have met a lady who once dated JFK in elementary school, even met a gentleman who traveled from Poland to the USA in search of his long lost brother, who he ended up finding. What I am trying to get at is that everyone person has a story, when it is just you and the patient on a transfer in the back take the time to listen to their stories you may be pleasantly surprised by what you may hear.

    Also from my medic stand point if you can not assess your patient who is sitting up from the airway chair, especially if your patient is in full fowlers. What if your patient on a long distance transfer started to sleep and you moved into the airway chair. They soon go apneic while you are texting or doing documentation. I know this is a very unlikely circumstance but are you willing to bet your EMT/Medic card on it?