Sandi Sets the Standard

At the time I was taking my EMT-B certification class, Sandi, the captain of Mid-County, was employed as a patient technician in the emergency department (ED) of the hospital to which the squad carried most of its clients. Sandi was, I believe, sharply aware of the stinging criticism that the ED nursing staff would sometimes fling covertly at the rescue squads. She didn't want any of it directed at Mid-County and she set about redirecting their expectations by demonstrating a higher degree of pre-hospital attention to Mid-County's patients than that to which the hospital staff was accustomed.

As I began to run calls with a greater understanding of what was going on, I noticed Sandi's strategies and assumed that EMS interventions were performed in like manner by all emergency medical providers.

One aspect of Sandi's patient care philosophy was that everybody she carried in her ambulances--if the situation and patient's condition made it practical to do so--was stripped and redressed in a hospital gown. The nurses have to do this anyway as soon as a patient is transferred to a bed in the ED, so Sandi saved them the trouble and time it took to do it themselves.

The strategy has benefits that are critical to patient care. One of an EMT's jobs (arguably the most important one) is to assess a patient's condition. Among the many facets of patient assessment is a visual inspection of a patient's body. The inspection is intended to reveal information about the nature of the patient's illness or injuries--things like bruising, bleeding, skeletal deformities, swelling, skin color (gray, for example, is a bad color). If you don't remove a patient's clothing, you risk missing something important, something that might change your mind about what the patient's problem is and cause you to rethink the treatment you're going to provide. The decisions you make on the basis of that information can make the difference in the patient's living or dying as a result of your care.

But what KIND of abdominal pain?Patients don't always tell you--sometimes they can't tell you--what the problem is. When you're dispatched for a patient complaining of stomach pain and the patient isn't forthcoming about what precipitated the pain, you don't know if he has a hot appendix, or if he's been drinking and aggravated his pancreatitis, or if somebody punched him in the gut, or if he has a strangulated hernia. Inspecting his belly can help you overcome your assumptions and deal with the patient's reality. It's easy to inspect his belly while you put him in a gown. The inspection is easy to forget if you don't.