Continuing what I wrote in Part I about the talk on education at TED Talks. Diana Laufenberg: How to learn? From mistakes. It is a 10 minute video, but the relevant part part I am interested in comes between the 6 minute and 7 minute points.
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You have to be comfortable with this idea of allowing kids to fail as part of the learning process.
Don’t even suggest that EMS students should not be referred to as kids. The kids she is referring to are 11th grade students, old enough to fight and die for their country (although not old enough to buy alcohol), and not much younger than the typical EMS student.
Let’s look at some examples of our failures.
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During transport, how many of us sit on the captain’s chair behind the patient, where we cannot see the patient?
How do we continue to assess our patient from there?
How do we recognize when something has changed?
Do we assume that nothing will change?
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When we arrive at the hospital, how many of us disconnect the monitor/defibrillator and leave it in the ambulance?
Does a monitor/defibrillator only work in the ambulance?
Do we not bring the monitor/defibrillator in to the call for syncope patients, chest pain patients, or other ALS patients?
Do patients never have rhythm changes between the inside of the ambulance and the hospital bed?
How would we know if there is a rhythm change?
How would we shock V Fib without a monitor/defibrillator and without an AED?
If we do not need the monitor, then why did we attach the monitor to the patient at any point?
If we look at the patient’s rhythm, now, and see a sinus rhythm, what does that tell us about the rhythm before we looked at the rhythm?
When we leave the monitor in the ambulance, we are paramedics operating at a less than First Responder level.
This appears to be a form of patient abandonment.
We do not have to leave the patient to abandon our ability to care for our the patient.
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We are called because something has gone wrong. Do we show up and choose a protocol and then never think about anything again?
This is failure.
We need to learn from these failures.
We need to learn to not defend failures.
We need to learn not to continually repeat failures.
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We need to abandon the status quo and think about what is best for our patients.
If we just punish people for these behaviors, rather than educate them about why these behaviors are not good patient care, we can direct the Clipboard Nazis QA/QI/CYA people toward other things.
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To be continued in Failure Is an Option – Part III.
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I am always trying to improve my habit of bringing the lp15 in on calls with me. My partner and I are in the habit of typically bringing in the bag on simple calls, and practically the entire truck on high-rise or nursing home calls where your no where near the truck. Unless the patient is unstable I do take the moniter off going into the hospital. Cutting down on time to transfer the patientamd avoid entanglement, etc. Half joking here but when you only have side facing benches the captians chair is the safest place for people to sit, and when half your patients or more don’t sit on the liter.
When the situation allows doing a full ALS assessment at the point of a contact does all parties well.
“During transport, how many of us sit on the captain’s chair behind the patient, where we cannot see the patient?”
As with everything, it depends on the patient. Does the patient need to be monitored every single second the patient is in the ambulance? Does every patient in the hospital receive some sort of monitoring or direct observation 100% of the time they are in the hospital? Heck, how many patients in the hospital get vital signs taken ever 15 minutes like EMS is taught to for non-emergent patients?
How hard is it to monitor for major changes when I can talk to the patient from the captain’s chair? Do we need to sit right in front of the patient to recognize major changes, or can recognition occur when sitting in a less than optimal location for assessment, but a more optimal position for safety and comfort? After all, once a change in status is recognized, the provider can always move to the bench seat.