By: David March, Training Officer, 2013-2014
EMS at its core is about two primary tasks: 1) rapidly responding to patients in order to provide time-critical life-saving interventions, and 2) transporting patients quickly and safely to a higher level care facility (usually a hospital of some sort). Some times we lose sight of these central components since we have the luxury of staying on scene for longer than most organizations, giving us more flexibility in our triaging operations. However, these remain our most critical operations. The first is achieved with quality ABC’s (airway, breathing, circulation), while the latter is largely a matter of hand offs.
The earlier you make a transport decision, the sooner our patients get the care they need, and the sooner you get to go back to bed. If you arrive on scene for a patient who is having difficulty responding appropriately to simple questions, who has suffered serious trauma, has had an unusual medical episode, or otherwise seems to be fairly clearly hospital bound, go ahead and make the call then. Our training and experience allows us to fairly reliably size-up a scene and determine what interventions are going to be necessary. Of course, without more time with the patient, you can’t be certain a trip to the hospital is going to be necessary. I’ve arrived on scene to find a patient that was almost entirely unresponsive and immediately called AFD (Arlington Fire Department), only to lead them to a fully cogent and ambulatory patient ten minutes later. If you’re unsure and the patient doesn’t face any immediate life-threats, take the time to asses them properly, but for most extreme situations, you should be able to make the call as soon as you arrive on scene and be reasonably confident in your decision. Worst case scenario, AFD is dispatched and you have to meet them at the door to explain the confusion.
Many of us are also so used to dealing with somewhat uncooperative patients that strongly do not want to go to the hospital, that we forget that many patients do. It doesn’t hurt to start off your patient assessment by asking them if they would be interested in going to the hospital. Many patients, particularly those who have just gone through a disconcerting medical episode, or who have a chronic condition, will already know they want to go. Calling AFD at that point shortens their wait time, and reduces the amount of repeated medical history the patient will have to go through.
Once AFD has been dispatched, you have a short window of time to get everything ready for the hand off. If your patient requires continued care and attention, that is obviously all you should focus on. However, if the patient is fairly stable, it is helpful to have a PCR (pre-hospital care report) prepared by the time the ambulance gets there, as well as an up to date set of vitals if there are enough crew members. The form you hand off will likely not be the complete write-up we will keep for our records and submit to Baldwin. For this skeleton report, it’s most important to note the patient’s name, birthday, medical history, allergies, and the critical details from the incident that lead up to EMS being called. Press down hard, as the report we give AFD is a carbon copy and will be illegible if you don’t.
If your patient is ambulatory and able, you can assist them to wherever AFD will be arriving. If they aren’t, at a minimum try to ensure that they have shoes, ID, and their health insurance card. If their friends are with them, encourage them to decide if anyone is going to ride along in the ambulance and figure out how the patient is going to get back from the hospital. When the CRC informs you that AFD has arrived, go meet with them and fill them in on what you’ve learned and what has happened while you’ve been on scene. Give them the pink sheet and make sure they’re able to read the patient’s name and birthday. Don’t let the ambulance leave without finding out which hospital the patient is going to be transported to.
Handing off a patient transfers responsibility for their continued care to the EMTs in the ambulance, and releases you and your crew from liability for future incidents that night. However, it is only appropriate to make this transfer when you can be confident that your patient is going to receive the care they receive. The EMTs and Paramedics you will be handing patients off to will likely have much more experience and training than you will. That does not, however, absolve you of responsibility in ensuring that your patient gets the attention they require. If the ambulance crew is not taking your patient’s condition as seriously as you think it deserves, it is your responsibility to convince them otherwise. Be polite and professional, but be firm. Our first and foremost responsibility is to our patients and it is well-worth some awkwardness and bruised egos to make sure they have their concerns adequately addressed.
Most of the time, hand offs will be easy and hassle free, and you’ll get to go home knowing that your patient has been transferred to someone with the necessary experience, training, and resources to give them the care they need.