In my previous column, I mentioned the importance of pre-hospital Patient and Family-Centered Care in emergency response. PFCC focuses on the holistic treatment of patients and encompasses the golden rule of medicine: treat others how you would like to be treated. In addition to fixing any physical ailments, it is also important to keep patients informed, act respectful, and be patient with friends and family. At first, it takes a conscious effort to engage in PFCC. However, with practice, it is possible to incorporate PFCC into your professional protocol.
1) Always make your team your highest concern. PFCC starts with your personal family and extends to your professional family. Use the appropriate safety devices as soon as you enter the ambulance. Seat belts save lives; we advocate and promote it, but do we really follow our own recommendations?
Always be in control of your vehicle by operating it at a safe speed and in a safe manner. Numerous reports and studies have demonstrated that speed — and more specifically excessive speed — has no positive effect on patient outcome and is a major contributing factor in death and disability of EMS personnel and their patients.
Everyone in the ambulance MUST use proper safety restraints at all times. Your 1.5-ton Toyota Camry handles significantly different than the 5- to 10-ton ambulance you’re propelling down the street at over 60 miles per hour! Make sure that everyone authorized to operate (drive) the ambulance has been properly trained in emergency vehicle operations. Once you arrive on scene, don’t simply go through the classic scenario evaluation “parroting” process of “the scene is safe and I have on my PPE (yawn, yawn).”
Make sure the scene is safe for you, your partner, and other members of the response team. Just because law enforcement is on scene doesn’t make the scene inherently safe. Be sure to use proper PPE. This might only include gloves, yet a child with a decreased immunity system from disease or medications will appreciate you not making their situation worse by coughing your germs on them because you didn’t use a mask.
2) Become culturally aware and competent. The United States Census Bureau recently announced that it will be providing 2010 census documents in more than 50 different languages. That means that there are at least fifty different recognized languages within the US citizenship. Trying to understand or be competent in more than one or two is probably difficult at best.
An effort must be made to understand the primary tenants of the predominant cultures in your area. What do they know about the local EMS agency? The services EMS provides? Are there medical practices they consider mandatory that your agency considers optional or does not accept? What about gender interaction norms? Is it appropriate for a male EMS Provider to fully assess a female patient? Or the reverse? Is there an interpreter available 24/7? Is a child the only person in the family that can translate or interpret for you? If so, is this situation medically appropriate for a young child to be involved in?
One classic example is the parent who is critically ill as a result of a sexually transmitted disease or illicit drug use. Having a five-year-old translate the information that you need and that the parent is giving may be difficult for them to understand and runs the risk of emotionally damaging the child. Understand your resources before the situation arises.
3) Become familiar with children with special health care needs (CWSHCN) in your area. All too frequently EMS enters a home where the equipment and technology inside is equal to an Intensive Care Unit. They suddenly feel overwhelmed with the complexity of the CWSHCN. To help eliminate this problem in Utah, the State EMSC Coordinator and his team developed a program where EMS became part of the discharge planning process for every child with any type of special medical needs being discharged from the local children’s hospital.
The child’s local EMS agency was also notified and a visit was scheduled to occur shortly after the child arrived home. Information was shared by both the child and EMS. With all parties having a greater understanding of the medical needs of the child and the medical capabilities of the local EMS agency, any future response to this home will be from informed EMS professionals.
4) Involve children and parents in local training programs. There is no education greater than experience. Learn to assess children of all ages. Talking to a frightened toddler when she is otherwise healthy can be an eye-opening experience. Learning to discuss vital signs with a teenager can also be life-changing for you. Frequently children with special needs or their parents are excited about being able to help train EMS providers in the finer points of their medical conditions and how to properly care for them in crisis. Experiencing the changing of a trachea tube or seeing how to care for an indwelling catheter is an opportunity unrivaled by books. Be a lifelong learner!
5) Treat your patients as if they were your loved one. Make an effort to the consummate professional, and learn to care for the family members of the ill or injured just as you would want to be cared for. The effort is minimal and the rewards are incredible. “Do unto other as you would have them do unto you” is a simple childhood lesson that means everything to EMS!
