We each have many limitations.
Should we assume that one specific limitation, that we do not understand, is too limiting to work in EMS?
Don Burslem could have used that prejudice as an excuse to not hire Chad Grabousky.
But Burslem decided to take a chance on hiring Chad Grabousky, and more than two months later, he’s very glad he did.
“His patients love him, our staff loves him, and he actually does a wonderful job in back of the ambulance, better than some of my hearing staff,” Burslem said.[1]
Oh, no! What if . . . ?
We can always make excuses for our prejudices, but it is better to learn what the actual limitations might be, how those limitations might be accommodated, whether those accommodations really work or just provide the appearance of accommodation, and what the benefits are of the limitation.
We do not live in a binary world. things are not all good, not all bad.
If we do not understand that, then we should not be administering medications, since medications have benefits (for some patients), side effects, and toxicity.
Medications are not inherently good or bad. This is not even close to being news.
All things are poison, and nothing is without poison; only the dose permits something not to be poisonous. – Paracelsus (1493-1541)
EMTs need to communicate with their patients, with their partners, with hospital officials over the radio.[1]
Do we really need to communicate on the radio? We include radio communication in EMS classes, but who really needs to know what frequency we communicate on? I don’t.
A lot of communication with dispatch has been by MDT (Mobile Data Terminal) for the past decade. I cannot hear the information that appears on the MDT (but there are text to speech programs available). I do not need to speak to hit the responding, or on scene, or any of the hospital buttons to communicate.
But what about lung sounds?
He will not be able to differentiate from rales to rhonchi. Both are very different treatments. No matter how good his observational skills are . He will not be able to differentiate which bad lung SOUNDS the Patient is experiencing!![1]
We have too many ignorant people like this in EMS.
Our method of education seems to produce plenty of basic EMTs, medics, nurses, and doctors who believe this myth.
Wheezes are often a sign of CHF (Congestive Heart Failure).
Lung sounds are only a small part of the assessment of the patient with respiratory distress.
Wheezes ≠ albuterol.
Crackles ≠ NTG (and specifically ≠ furosemide).
Rhonchi ≠ antibiotics.
Decreased lung sounds ≠ tension pneumothorax.
Decreased lung sounds are irrelevant to pulmonary embolus.
We have too many people applying treatments based solely on lung sounds. I brought a stroke patient to the ED. The nurse listened to lung sounds, hooked up a nebulizer, and left the patient alone for half an hour. The patient had a good oxygen saturation, did not have any respiratory distress, but did have neurological distress. The nurse was treating the lung sounds. While this is not common, it is due to the mistake of limiting assessment to one finding.
Click on image to make it larger.
Not only is wheezing included in the diagnostic criteria for CHF, but wheezing is given more weight than crackles.[2]
Wheezes often indicate CHF.
For those who do not understand that sound is vibration, it is possible to differentiate among lung sounds by placing the hand on the chest to feel the vibrations, which can be as distinctive as sounds they produce.
What is important is a full assessment, not an incompetent jump to conclusions based on lung sounds an inadequate assessment.
–
Footnotes:
–
[1] Deaf EMT ‘better than some hearing staff’ with Bethlehem ambulance company
By Lynn Olanoff
The Express-Times
on May 12, 2013 at 6:00 AM, updated May 12, 2013 at 6:06 AM
Article
–
[2] Clinical diagnosis of congestive heart failure in patients with acute dyspnea.
Marantz PR, Kaplan MC, Alderman MH.
Chest. 1990 Apr;97(4):776-81.
PMID: 2182296 [PubMed – indexed for MEDLINE]
Free Full Text in PDF format from Chest.
.
I took ASL courses in college with a Deaf professor. After spending plenty of time with her, and meeting many other Deaf people, I think that the Deaf could very well work in healthcare. I imagine it would be trickier, but that’s just my perception as someone who grew up hearing. I can’t imagine my life without hearing. To them, they may not perceive the possible challenges involved as a Deaf healthcare provider as challenges at all.
While taking my first course with this professor, she lent me this book “Silent Alarm” by Steven Shrader. It is the autobiographical account of a Deaf EMT in Atlanta. As I recall, he can hear some things with the help of hearing aid, but the hearing aid certainly does not “cure” his deafness. I wasn’t a particularly big fan of the book for several reasons, but it did open my eyes to how the Deaf can work in EMS–or any healthcare capacity, come to think of it.
I know a nurse who worked at an ER nearby who is legally Deaf. She has an electronic stethoscope to help her hear heart and lung sounds. Without it, she can’t really hear anything. She lost her hearing later in an accident later in life, so she doesn’t have many of the speech traits that are often associated with the Deaf. In fact, the vast majority of the patients (and some of our coworkers) never realized the was Deaf. She relies more heavily on quality patient assessments to guide what direction she will take. She uses other physiological clues to help her determine what exactly is wrong with the patient. I think she was a great nurse and an excellent member of the healthcare team.
All of the Deaf people I know have more heightened senses and seem to be much more aware of their surroundings. They make observations that I ordinarily wouldn’t have noticed until they point it out to me. The benefits of these heightened observational skills/senses would probably help them in the healthcare field, far more than their deafness would hinder them.
Like you’ve said, assessments should be conducted from several angles. Getting “tunnel vision” from hearing crackles or wheezes doesn’t help anyone. Thorough, multi-focal exams, however, will.
Just my two cents.
In consequence we might as well remove auscultation from from tests performed. Why do a test without consequence?
Are you serious?
Diagnostics has many aspects as does the history of a patient that preceeded to the emergency.
Not being able to hear and understand what the patient tells the medic results in less information
to base treatment or transport decisions on.
Not being able to hear breathing or heart sounds results in a lack of information for the medic.
Both is a risk for the patient because missing or reduced breathing sounds may not be tension-ptx, but may point to another problem.
And hearing deficits may result in problems communication with other responders at MCIs or dangerous scenes. Not being able to hear a warning about a danger or the aproaching truck while on a multi-lane accident scene is a danger to the medic himself.
Paramedicine is medicine with the senses. Eyesight, hearing, touch and smell have to substitute for the possibilities available in a hospital. Without hearing the simple taking of a bloodpressure becomes impossible if the diastolic value is of interest (shock, cardiac and generally older patients to evaluate vascular state).
So while i’m all for equal treatment of disabled where possible, not everyone is equally capable and suitable for every job. Healthcare as a field offers other jobs where hearing is not required at all or not as important as in thos jobs involved in diagnostics or high risk scenes.
Yes, there is useful information that can only be obtained by hearing; but I think you’re not only overstating their importance, but also not thinking about alternative methods for getting the information.
For example, if hearing is necessary for determining diastolic blood pressure, how do automated B/P machines work? No, I’m not saying that a person should rely on automated B/P; but if a machine can measure diastolic B/P without hearing, why can’t a trained EMT?
And while hearing would be helpful in warning someone of an oncoming danger; there are benefits to being used to functioning without hearing. E.g. how useful is shouting from the breakdown lane going to be with extrication equipment running and other loud noises?
I agree that “not everyone is equally capable and suitable for every job;” however, I disagree that hearing loss is an automatic disqualifier. If a person isn’t suitable, wouldn’t that become apparent during the hiring process and/or the probationary period? Why reject them without seeing what they can do?
As an aside, oscillometric NIBP devices measure the MAP and computes the systolic and diastolic values based on changes in pulse pressure amplitudes. Arguably this is more accurate than listening for Korotkoff sounds.
Just because we’re in the field does not mean we’re magically different than in the hospital. We’re different mostly because we lack rigorous education.
Regardless of that silly distinction…hearing is definitely a plus when compared to not hearing.
Is it an exclusion to providing competent patient care? I’m not sure it is required.
I know of a legally blind ALS provider.
I still think I’d rather have him over one who couldn’t hear. Just my first gut instinct.
BH,
We used to bleed patients to make them better – even when the problem was anemia.
We killed a lot of people this way.
We were probably just following someone’s first gut instinct.
What is your first gut instinct of people of other races, or other gender providing care?
First gut instinct is just another term for prejudice.
.
Aaaaand there’s the reductio ad absurdum. Rogue Medic 101. I’d almost forgotten why I don’t come here much anymore.
BH,
Why should we be doing anything based on some first gut instinct?
First gut instinct in favor of one person with a disability over another person with a disability is prejudice, so why are you surprised that I point it out.
I did not encourage discrimination, but you are.
I did not encourage a choice between disabilities, but you did.
It is not reductio ad absurdum on my part, when you had started with an absurd comment.
.