Monday, May 5, 2008

Emergency Room Care

I recently had the opportunity to spend 10 hours straight observing in the local emergency room. The local hospital seems to be somewhat unique in that the EMT's are based within the ER and work in the ER if they are not busy with ambulance calls. I wasn't sure what to expect going in and was second-guessing myself as to whether or not I should have driven the 2 hours to the nearest big city to do my time in one of the large regional medical centers there.

The day started slowly as I had to wait for the paramedic on duty to arrive back from lunch. The second medic on shift was sleeping in the on-call room. After a while of standing (& studying) a call came in from the local police who were en route chasing a vehicle heading towards the ER. We grabbed a wheelchair and headed out to the unloading area. Sure enough, a vehicle soon came tearing into the parking lot followed by a patrol car. One passenger jumped out and hustled a second passenger towards us. The medic had me assist the patient into the wheelchair, at which point we headed back into the ER. The officer following the vehicle was left to deal with the driver & first passenger. I was instructed to obtain baseline vital signs and a brief patient history/chief complaint. I have to say that I wasn't very impressed that they left me, who is not even a certified EMT-B yet, alone to obtain all of this info. Luckily I've had several family members who have spent hundreds of hours as hospital patients so I had at least some idea of how to work the machine. You see, in class we have practiced obtaining vitals manually with no electronic equipment. My natural inclination was to obtain a pulse by finding the radial pulse and counting heart beats. Silly me, the machine will do that for me! After having that kindly pointed out to me by the medic (after I manually obtained pulse/respirations) I felt a little silly but hey! at least I'm prepared for what the local ambulance is equipped with (certainly not machinery that reads everything for us!).

This patient was rushed to the ER for a potential overdose. The hard part of this, for me personally, was that this patient was someone I knew. I was left to spend the next couple of hours talking to the patient to help keep them from falling asleep. As what they had ingested was not potentially fatal, nothing was done for them in the ER other than to place a call to a counselor to visit with the patient. I found that very surprising and a little disturbing.

The vast majority of my day was spent obtaining vital signs on patients, watching the medics insert IV lines, and assisting with transporting patients to X-ray and CT scans. Not one ambulance call the entire time I was there. Bummer. There were several patient transfers in which the on-call EMT's were called in to drive patients from our local hospital to the nearest big city regional medical centers.

In hindsight I realize now that I should have gone to one of the regional medical centers for my hours. In my time at this ER I saw one dehydrated infant, two possible strokes, and one silent heart attack. The down side was that so much equipment was not functioning that day that the stroke patients were transferred out to a bigger center and the heart attack was eventually transferred also.

I have informed my family that should they or I ever require emergency medical care, tell the local ambulance to keep on going and bypass the local ER. I know I'm not a professional but I was not impressed with the quality (or rather lack of quality) of care. It took almost 2 hours to diagnose the silent heart attack due to the malfunctioning equipment and I found that very scary.

The day provided me with just another reason that I'll be happy to be in the big city...quality medical care. On the flip side, I enjoyed the time spent in the hospital and it served as a reinforcer that I am making the right decision in applying to nursing school. It was also a big confidence booster as I study for my EMT practical & written exam coming up this weekend.

One thing I noted that day was that almost everyone assumed that because I was wearing scrubs I must know what I was doing. Scary. People listened to what I said as if I were an expert. I think most people are so frightened or unnerved to be in the emergency room that they forget that they have the right to ask questions and to question the care that they are receiving. It's a lesson that I don't want to forget... it's my right as a patient to ask as many questions as I need in order to understand the care that's being given.


Vanessa said...

I"m so sorry that one of your first patients was someone you knew. I can't imagine how difficult that must have been. Hopefully they get the follow up care they need.

nichole m said...

2 hours to diagnose a heart attack? Woah. Scary. Do you have any more hours to do? Hopefully you could go to one of the bigger medical centers and see something worthwhile. :-P

sa_scully :-)

Noodle said...

It scares me beyond words when my dad or grandmother has to go to my (very small) hometown hospital.

Sounds like yours was a sad and scary experience. :(

Anonymous said...

ok woman,, I've been away and am catching up.. I'm so jealous... we never got to go to the er when we trained.. we sit in the ambulance hall with the paramedics and hoped for a call.. I never got one.. but I did get to go help certify a gas station with the fire marshal,,so they could open... whooo hooo. like that was going to come in handy in the woods in a road ditch in the dark...with a dying person...

I'm sorry sir, before I save your ass can I see your health inspection sticker please??? Yes.. I was not impressed..