Medic Interrupted

Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.

In the business of EMS, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for but a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.

These patients are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me many of his personnel were not doing assessments on frequently transported patients.

When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”

This is a very dangerous practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is just not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level, you are the person that is most responsible for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.

So you ask where’s the benefits? Why should I be happy to be transporting this patient for the third time this week? Well because you are at a huge advantage to provide really good care. You’re even at greater advantage then the patient’s primary physician.

If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments every six months! Do you think his primary physician, let alone anyone assesses this mans health twenty four times a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.

When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name medical history but that’s where the familiarity stops. Afterward ask yourself how what you found compares to what you know? Whats different or new about the patients presentation?

EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways. If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Providers, then we will not only benefit ourselves as professionals and our industry, but also provide our patients with better care.

So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.