EMS World

NOV 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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ISSUE FOCUS: PATIENT AND PROVIDER SAFETY 28 NOVEMBER 2018 | EMSWORLD.com B eing invited into someone's home is an act of trust, one prehospital care professionals participate in thousands of times during their careers. For a community paramedic (CP), that initial trust turns into an ongoing rela- tionship: Our patients share not only imme- diate medical concerns with us, but a wide range of challenges and stressors. Helping them navigate these barriers is what we do, but it comes with risks. Melissa, a full-time CP with the Allegh- eny Health Network in Pittsburgh, arrived at her patient's home for a scheduled an d co nf ir m e d fo llow- u p v i s it. T h ey had been working together for several weeks on fairly sensitive issues that had led to recent 9-1-1 calls and emergency depar tment visit s. They were working to find physician suppor t to reduce the man's dependence on high daily doses of opioid medications to control his chronic pain and better manage his new insulin pump. The patient lost both leg s in a work-related incident nearly a decade prior and relies on adaptive technologies to maintain his home. In addition to his physical ailments, he was concluding a ver y contentious divorce that also caused significant financial concerns. From the moment he ans wered the door on their follow-up visit, it was clear to Melissa that her patient was agitated. While none of his frustration appeared directed at her, he was furious with the judge responsible for his alimony agree- ment. Within minutes of her arriving, he said he intended to take his guns to the courthouse and shoot ever yone if the rul- ing was not changed. Melis s a subtly maintained a physi- cal route of escape from the house and attempted to redirect the conversation while simultaneously deescalating his anger. The patient abruptly wheeled out of the room, returned brandishing a pistol, and removed the magazine to show her the hollow-point ammunition he intended to use. He described his plan to execute "the mass shooting to top them all." Maintaining a professional composure, Melissa expressed that she understood his current frustrations were overriding his health concerns but was unable to assist with these legal issues. She depar ted quickly, assuring him she would check in with him in a few days. After leaving she contacted the authorities to relay what she'd witnessed. Why CP Safety Is Diff erent Traditional EMS providers are often called to uncontrolled and unpredictable environ- ments. From their earliest training students are taught to assess and address potential dangers. "Is the scene safe?" is often the By Jonah Thompson, CP-C, NREMT-P, Christie Hempfl ing, BS, EMT, and Dan Swayze, DrPH, MBA, MEMS KEEPING COMMUNITY PARAMEDICS SAFE One provider's close call becomes a learning experience for others Photo: Allegheny Health Network

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