Today's back to SGH after a day of ambulance run and after i talked to gab, i totally agree with what he said... that the ambulance attachment was a humbling experience.
I wonder how many of those who have done emed will agree with us, cos i do know of people who think it is a waste of time! My ambulance runs were very fruitful experiences because
(1) I saw patients in an acute setting which is different from seeing them at the emergency department. Well, of cos not all cases were deserving of the ambulance call, but i thought it was amazing how much better or worse patients can become within a short timespan of the transport from home to hospital. It's a side of medicine i have not seen.
Also, there are patients who never made it to the doors of A&E and we actually have a biased view of what's really taking the lives of people everyday.
(2) I learnt that doctors no longer claim monopoly over the medical knowledge, cos some paramedics i met clearly knew their stuff. Although they may not have the academic knowledge of the basis of diseases, what they know abt approach to symptoms are similar to what we're learning! For example, we learn that in approach to giddiness, we must first find out if it is vertiginous and non-vertiginous and i saw this clearly demonstrated!
Also, they do not blindly excute SOB protocol when a patient is breathless cos they know that there is such a thing as cardiac asthma and giving ventolin can ppt tachycardia and will further compromise the tissue perfusion of an ischaemic heart.
Amazing right?
(3) I learnt how we, as doctors, should not take paramedics for granted. I have seen how bad the attitude of some hospital staff can be when they receive the patients from the paramedics and i shall rmbr that i will not do the same in future. Of course i might not be able to say the same for ALL paramedics, cos i was fortunate that my paramedics is quite gd and this is what he did:
I had a case of a very minor knife cut of the finger. The patient's response was clearly disproportional to the injury cos she was wailing, screaming and clearly in distress (to the extent that all of us thought the wrapped cloth around her finger was a severed finger). The paramedic calmed her down and addressed all her ICE (ideas, concerns and expectations) patiently. I asked him why he even bothered and his reply was he did it for the benefit of the doctors and other hospital staff. In a way, it is a thankless job, cos the doctor wont even know the before status of this patient and he wont even be grateful that the patient is now more 'stable'.
(4) I learnt that experience can really teach a lot. These paramedics have not been taught the theory of most of the things they deal with daily. I must say what most of them have is common sense which i feel that studious us lack very often. Experience can teach u to make better decisions, know exactly what should be done next and also pre-empt problems. In a practical sense, transporting patients itself is rather challenging cos u have to know what is the safest and most effective way to carry the patient in different home environment.
(5) I also learnt the importance of communication. Yesterday i saw a pt whom we suspect collided into the railings on the expressway on purpose. Cos he did not want to be saved and said he 'wanted to die'. Throughout the whole process till he was safely transferred to hospital bed, i realised that he was only willing to talk to the paramedic and not even the doctor! (Perhaps it is a separate issue, cos the doctor was super impatient with him and developed a temper)
I'm actually qt amazed by how the paramedic can switch from 'child mode', to 'crying woman in great distress mode' and then to 'grandma/grandpa mode' very quickly. The way things are communicated transcends the difference in age, race, mental and emotional state.
(6) On a minor note, i think not everyone gets to sit in the ambulance or even wishes to have the opportunity to in the first place. It's quite a memorable experience holding on the railings to keep ur balance when the ambulance is moving at high speed. Also, i was allowed to report into the walkie talkie like thing saying,"alpha xxx, alpha xxx, arrive at hotel 5. over" I think they were quite amused by how happy/excited i was :)
Alright, i hope i managed to convince those who have not done emed to look forward to their ambulance run. Also, if u havent figured out by now, this experience have been humbling cos i learnt that as doctors we should not assume we know the most, or the only ones with medical knowledge. We should always rmbr that a great deal could have been done for a patient u're seeing now and we should never take others for granted.
One paramedic trainee said,"Some doctors are quite yaya banana." haha..
So, hopefully everyone can work in harmony to provide excellent patient care in future :) Paramedics are called Para-medics for a reason :) agree?
