The way the job makes you think

She sits there, weak, and starting along the way to confusion. She's asleep when we arrive, and her husband answers when we arrive. Before we walk in the door, I've already spotted the removable wheelchair ramp, and the wheelchair itself by the door. As we walk into the living room, I see her gradually waking up in the corner. Immediately, I spot the specialist cushion she is sitting on to avoid pressure sores. This tells me that she is spending long periods of time sitting in the same place. Further evidence is added by the hospital-style table that sits by her, everything strategically placed within reaching distance. I talk to the husband briefly, and I can see the exhaustion in his eyes, the sag of his shoulders, and the relief on his face that tells me he is exhausted, and needs some time off.

We sit down and talk for a while, and I learn that she can't get upstairs any more, and that this means she can't get into the shower. I learn that she has a frame, and sticks, but that she generally can't use them. I discover that her husband is having to lift her in and out of the wheelchair/car/seat/bed if she wants to move between them.

Without noticing, my mind starts ticking over what they need. First off, they need some respite care sorting. She needs a stairlift fitting. She needs modifications in the bathroom in order to allow her to get in and out despite the increasing weakness. They need a hoist installing so that he's not putting his back out moving her from place to place.

These are the things I'm thinking, as I would with any other patient. Difference is, this isn't my patient.

It's my auntie.

Exciting times

Occupational Health passed, and I finally got confirmation of my place on the course today. I'll be starting fairly soon, but forgive me if I don't tell you exactly when.

It's a great day to get this confirmation - not only is the next step in my EMS career now in place, but today is also the launch of the Chronicles of EMS - not to be missed. I'm sitting at my computer as I type (there's a surprise!) waiting for the premiere to start. Whilst I've yet to get involved in any way, I have been following with interest. With this, and the discussions I'm seeing around the blogosphere about EMS2.0, I feel like we're standing on the verge of something incredible, and I'm going to be there. Admittedly, the whole EMS2.0 thing is a bit more of an American thing than British, but I believe that it's effects will be seen this side of the Atlantic too. Already, UK pre-hospital care is being significantly influenced by studies from across the pond, and we're seeing more and more pre-hospital research being done. I want to be a part of this.

So here's my vision of EMS2.0:

I want to see paramedic-led pre-hospital research. I want pre-hospital research to be about more than "doctors have found that this helps, now let's see whether paramedics can apply it with sufficient skill - despite less exposure - to use it pre-hospitally".

I like the concept of paramedics as a means to ensure that people get the right sort of care - members of the public don't have the same knowledge as people who work in healthcare, let's use the ambulance service to get people into the right type of care, or even keep people from needing to go into the healthcare system at all.

I want to see clinician-led telephone triage systems, or at least a system which increases specificity in terms of calls which warrant a blue-light response. If we can increase sensitivity too, that would be a bonus.

I want to see paramedics being given more power to define their own scope of practice. I like the minimum skill set that currently exists, but I want to see courses and assessments available which pass on the knowledge required to increase the skill set, and to ensure that competence is maintained.

And that's just for starters. UK pre-hospital providers, what do you want to see in EMS2.0?

What can you do?

I was at work the other day, doing A&E support work.

One of the patients we went to was an elderly gentleman with alzheimers. I can't remember what was his presenting compliant was, except that it meant he needed to go into hospital. Problem was, he really didn't want to.

In this situation, we have to determine whether this person has capacity to refuse.

Are they capable of understanding information?
Are they capable of retaining information?
Are they capable of weighing up the information available to them, and making an informed decision?

Unfortunately, the answer to all of these questions was "no", however he was adamant that he was not coming with us, and wanted to stay in his chair.

Taking over 2 hours on scene, we eventually bullied this little old man into coming with us, but this was only due to being lucky enough to be able to seize the one moment out of the entire two hours where he relented for a moment.

So I have some questions for you, dear reader (if there's anyone out there still reading)

1. How long are you willing to stay on scene in a situation like this?
2. What options are available to you if the patient continues to refuse?
3. There is someone there with Power of Attorney over the patient. How does this affect your thinking?

Now I know that there are powers available to various people under the Mental Health Act - the patient can be sectioned, but I'm fairly sure that the patient wasn't eligible for any of these.

Oh, and (surprise, surprise) it was after opening hours for her GP surgery