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If I had a nickel...

Writer's picture: Chris DarbyChris Darby

Reading posts from E.M.S. friends old and new this week, I realized many of us have been around so long that the same issues resurface or are often rebranded with refreshed details. Some problems are timeless. We have all shared the same frustration with equipment and operational issues throughout our careers. With that in mind, I have resigned myself to the selfish notion of getting back to work and enjoying retirement. Is that admitting defeat?


A post from the Ontario Ambulance Historical Society group on Facebook, sharing a photo of the Ferno™ #30 all-level stretcher, brought back my earliest recollection of health and safety issues in the industry. Back in the day, slugging that behemoth off the ground into the rear of a primitive ambulance was a lot of work when your patient was over 200 pounds. It was good that the volume of bariatric patients was a fraction of today’s statistics, back when the #30 cot was our only platform.


One comment on the post noted, “You would have to be a weight lifter to clean and jerk [the stretcher].” From the perspective of being a competitive Olympic weightlifter in my teens, I think lifting the #30 was actually more complex and awkward than a simple clean and jerk. I never applied for WSIB as a weightlifter, but I did as a casualty care attendant.


To the manufacturers of the latest power stretchers, some might opine you do it for the profit. I side with the belief that you seized an opportunity to approach and correct a long-time problem and that your success is a paramedic’s dream come true. Just wait! There will be more innovations to come in the industry.


 

As an eternal optimist, a couple of points keep me coming back for more. First: the spirit of some medics to champion the cause of paramedic health and safety reigns supreme. These individuals make time and possess the fortitude to take on the task of improving the conditions for everyone in the profession. To a few naysayers that might brand them as unionists or “pot stirrers,” I beg to differ. Paramedics and patients benefit from improvements, sometimes labelled as one-sided for the workers, but often, they are one and the same.


My E.M.S. colleagues will remember the Elder valve, then the Flynn valve for ventilating our non-breathing patients back in the day. Both devices are a distant memory to most and should be part of a history lesson for the fledgling paramedics coming up through the ranks. We were not trusted to operate bag-valve-mask ventilators, a skill then reserved for registered respiratory technologists. The grief we all participated in, seeing gastric contents airborne in the back of an ambulance. Well, enough said. After pleading for training and improvements, the E.M.S. gods stepped up with constantly evolving versions of a B.V.M.


Illustration by Chris "Bones" Skelton

Following the inevitable consequences of gastric inflation, the manifold suction system in the ambulance got its workout. Another fine example of an automotive mechanic applying a technical solution to a scientific medical problem. Foot on the accelerator, more suction. Stopped at an intersection, no suction. After begging for an answer, Ford and Chrysler were taken off the medical equipment roster. Today medics have the tools they need to do the job.


If only I had a nickel for every time I heard a casualty care attendant, later a paramedic asking for help to treat patients more efficiently. I could buy an entire shift of paramedics a round of Tim Hortons!


A paramedic’s skillset should officially include the title of “patient advocate.” Evidence-based care is more than the application of the scientific results of studies. It is also the byproduct of listening to professionals who come to their patient’s rescue and have invaluable knowledge and experience. To be clear, I don’t mean with the Jaws of Life, though some need that treatment from our colleagues at Fire.


 
Illustration by Chris "Bones" Skelton

And another thing, while I’m on a roll. The other raging problem plaguing our healthcare system is the chronic issue of offload delays for paramedic crews. I believed that our community and province were seeing the worst of times. The problem has been tossed around like a volleyball. Recent time spent around the E.R. watching the patient flow as an observer was frustrating, realizing the conditions are worsening. I had my blinders removed after befriending a champion for the cause from the Montreal area, Hal Newman (@BigMedicine).


Hal is a long-time paramedic who has served in Montreal and a couple of places in the United States in emergency medical services. He is a master of the cause and healthcare. Where he gets his live statistics is beyond me. Reporting the sad state of the gaps in E.M.S. coverage, Hal keeps followers updated in both official languages in a fashion rivalling CNN.


I looked at several sites and cannot find our area’s live statistics. A purposeful roadblock, I suspect. My hat is off to Hal for his daily, sometimes hourly updates of E.R. capacity levels and shift-by-shift E.M.S. staffing shortfalls. The public rarely hears this aspect of medicine unless they know someone in the E.M.S. or healthcare industry. Bureaucrats and politicians must cringe when the facts pop up for followers.


Illustration by Chris "Bones" Skelton

The number of patients reporting to the E.R. seeking the near impossible or unreasonable during the time I spent in the waiting room begs the question. Has any institution considered positioning a counsellor or nurse in the waiting room to listen to the patient, or would be patient? The suggestion is for a healthcare professional to pose alternative solutions instead of the clerk facing the distraught and sometimes disgruntled person?


Patients are triaged for the urgency of their medical condition. Maybe a nurse practitioner would have the skillset to abate the onslaught of patients whose predicament is inappropriate for the E.R. The process would validate the patients’ medical component of their perceived problem and the practical side. This other layer of assessment might reduce some unnecessary visits to and waiting time at the hospital.


Give the patient some privacy, like an enclosed but windowed booth for someone feeling intimidated by their circumstances. This process might prevent long waits for non-urgent cases that inevitably cause frustration and terrible outbursts in the waiting room. On two occasions, I witnessed patients calling 911 only to hear unsuccessful attempts to seek transportation to get help the person believed was available at another site.


We all want to be heard. It can calm nerves when we are seeking help. That goes for paramedics as well as patients. Oh, for a nickel!




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peteraitchison99
2022年4月29日

Thanks for the well thought out article Darbs.


One issue that really galls me is the number of walk in clinics that we have around our city, London, and the crap hours that offer service. It seems to me that there might be a lot of family doctors operating clinics instead of taking on patients in the old fashioned way, you know, I'm your patient and you're my family doctor!

So we have all these clinics around the city and what hours do they operate -- well mostly 3-4 days a week and closing between 1500 and 1700, with the rare one opening on Saturdays! I mean really!

If you are going to have a walk in clinic they should…

いいね!
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