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.

Issue link: https://emsworld.epubxp.com/i/1042097

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Page 32 of 51

32 NOVEMBER 2018 | EMSWORLD.com ISSUE FOCUS: PATIENT AND PROVIDER SAFETY planning her exit as the interaction dete- riorated. She was able to blend her tra- ditional street smarts with motivational inter viewing skills to verbally deescalate the patient and quickly and safely depart the scene. 3) Two-person teams for initial visits— While single CPs are common for follow- up visits, most of the CP teams present at the AAR already used two CPs for the initial assessment of new patients. This precaution was reemphasized during the AAR as an important risk-mitigation tool. The goal of the initial visit is not only to develop a therapeutic rappor t with the patient but to a ssess the patient and their physical and social environments for potential threats to providers dur- ing subsequent visits. Melissa and her partner determined it was likely safe to conduct follow-up visits with this patient individually, which is why she was alone during this incident. The teams still felt follow-up visit s could be done safely with one CP but emphasized awareness of how quickly the risk can change even with patients you've previously vetted. 4) "Previsit" the patient—Unlike tra- d i ti o n al EMS r e s p o n s e s , w h i c h a r e unscheduled and emergent, CPs of ten can research the patient before their first interaction. Mapping and satellite imag- er y can help the CP identif y potential threats in the neighborhood and famil- iarize the CP with landmarks to find the patient as well as map out the closest escape route. Prior 9-1-1 record searches can give the CP a more complete picture of previous public-safet y interactions. Simple web searches and open-source criminal records databases can reveal potentially dangerous criminal activity and /or interac tions with the criminal justice system. Medical and discharge records are helpful in helping the patient manage their health, but criminal-record and Google searches can help the CP bet ter mana ge their personal s afet y. When CPs visit patient s on a sched- uled basis, they should use all the tools available to mitigate risk. Many teams, including those in Meliss a's program, have these tools available. The following areas were identified as opportunities to change current practice to increase the safety of the CP during home visits. 1) Determine if a home visit is neces- sary—Face-to-face visits with patients help build rapp or t, e sp ecially during the first interaction. Subsequent home visits are often necessar y to help com- plete forms or conduct other follow-up inter ventions that require the CP to be physically present. However, rather than defaulting to the belief that all patient contacts should be face to face, the CP should determine if the home visit could be effectively replaced with a phone call. If the patient's home environment or neighborhood is unsafe but a face-to- face meeting is required, plan to meet at a safer venue where the interaction can occur. 2) Know crisis resources in the area—At the time her incident occurred, Melissa's CP team did not have a well-rehearsed Unlike traditional EMS responses, which are unscheduled and emergent, community paramedics often can research the patient before their first interaction.

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