As I’ve trained EMT’s and medics over the years I have often emphasized two things that my experience has taught me as being critical skills for medics on the street. 1. Know how to manage an airway. 2. Know how to communicate with your medical control and be able to paint an accurate picture of what is going on. These two skills alone will save lives.
Well, that’s street EMS. You have an ambulance stocked with gear, a knowledgeable partner, and direct communication with your medical control – a hospital emergency department. You also know you are going to be doing your thing for less than an hour. That is street EMS in most of the USA.
Things like wilderness medicine, expeditionary medicine, tactical medicine, and certainly prolonged care in remote austere environments produce a whole new set of circumstances, considerations, and necessarily expanded knowledge and skill sets.
What We Know
Medicine is a really big world. As a Special Forces Medic back in the 70’s and early 80’s and later as a street paramedic I thought I really knew my stuff. After medical school and residency I came to understand what a small bit of knowledge I really had. As one learns he certainly rises to a higher level of understanding, but he also rises to a higher level of ignorance. In other words, as a very wise man once told me “you don’t know what you don’t know, and you don’t know you don’t know it”! We all have limitations and the wise know what theirs are.
So, at the end of this brief history of my educational journey, the question that I need to answer for you is “what can I do to make you a better medic”. Even if you are a lay person, a parent, a first responder, a flight nurse or even a licensed provider, what can I do to make the daunting task of being a medic easier?
Let’s start at the beginning. Medical decisions are based upon information. Everybody needs to learn how to do some kind of a patient assessment. Essentially, learn some questions to ask. The more sophisticated your knowledge, expertise, and experience is the better you are at this process. When I was a first-year medical student my professor taught us that 70% of the medical information needed to make a diagnosis comes from the history. What the patient tells you is the best information source. I have since learned that when I’m really stumped and can’t figure out what is going on with a patient there is about a 90% chance I’ve missed something in the history.
What Can You DO?
If you are medically responsible for a family, a group, or a team, there are a couple things you can do immediately to help you with the task of obtaining medical information about those you are responsible for.
Firstly, in the modern age of electronic medical records, anyone who has established themselves with a physician has access to their personal medical summary. This is a treasure trove of medical information. It contains your past medical and surgical history, your family medical and social medical histories. It contains your allergies, your immunization history, and your current and past medication lists. The summary will contain your recent vital signs any recent laboratory or radiological reports. It has the answers to a good many of the questions you would ask to care for a person. It is a summary, not an exhaustive record of every visit to the doctor and so this summary is typically 3 to 8 pages long.
Now, this a personal health record that is protected under HIPPA laws. So, there are some important legal considerations here. The individual can voluntarily give you this record, but, it is easier if they just keep it. If you have ever been to a developing country providing medical care, and especially in the rural or frontier areas of a developing country providing medical care, you will notice that people maintain their own medical records. They carry them with them. When they go to a doctor they have their records with them and the record of their present visit will be added to the record they personally carry around with them. There is the answer.
Effective Medical Planning
If you’re medically responsible for a group, the last thing you need is to be responsible for is everybody’s health records. Unless it’s your own children, my advice is to make sure everybody in the group you are responsible for has a recent copy of their own health summary. Here is another observation for you to assimilate into your medical planning. Most people don’t really know much about their medical situation and certainly much less about the medications they are taking. It continually amazed me in the clinics I’ve worked in how ignorant people are regarding their medical conditions and medications. That’s one of the reasons we have electronic medical records now days. It’s easily shared information within an expanding medical information network.
So, you have your people (and yourself) get a copy of their health summary from their private doctor and have them secure this in a water proof bag (like aloksac) and it becomes part of their “kit”. If you end up needing to provide care for them, have them allow you to review their personal health information as part of your assessment.
You, as the medic will need to carry the forms needed to record any care you might provide for the members of your group. But once filled out, your record of care becomes their record of care – it stays with them.
Realistically, you are not going to get every piece of information you need from the health summary. All of that is “old news”. Things like the chief complaint (cc) and history of present illness (HxPI) you will still need to illicit from the patient and record in your SOAP note or whatever method you are using to record your encounter.
How does this help you as the medic (or not the medic), you ask?
In the military there is a saying “intelligence drives the battle”. In medicine we might extrapolate that and say “information drives the care”.
Let me give you an example of how this might work. Let’s suppose you and your extended family and friends are four wheeling into the Dark Side of the Moon Devil’s Triangle Mountains for 3 days and you have a sister-in-law who suddenly has a seizure (very frightening for those around her). She can’t talk and nobody else in the group knows much about her medical history. No cell service available. “Ah ha”, you say, “let me look at her medical record”.
Sure enough, right there in the health summary under active diagnosis is “seizure disorder / epilepsy” and under her active medication list you find “Kepra 500mg BID”. “Brother of mine”, you say, “does your wife have epilepsy”? “She does in deed”, says he. “Brother of mine” you say, “has your wife been taking her medication”? “I don’t know” says your brother. “Well, let’s take a look at her medication bottles.”
Based upon the fill date on the bottle of Kepra she would have run out 6-days ago. Well Done Medic! You were able to successfully Sherlock your way through that case and make the diagnosis. Now, you can act with the precise information you have and begin providing appropriate care for this patient. In other words, the seizure was most likely the result of the patient having run out of her medications (the most common cause of seizures in an emergency department). There are certainly other causes of seizures – and none of them are good. But, because of the history you had available to you, alcohol withdrawal, poisoning, head injury, bleeding in the brain, brain tumor, etc., are far less likely to be the cause of this seizure (proving the rest of your evaluation is consistent with the history). Your job was made a lot easier because of medical pre-planning.
The take home lesson here is the medic is medically responsible for his team, family, group, tribe, etc. Before things really go south, put some information based advance planning into your medical preparations. Even if you are not a medic, get your health summary and make part of your kit. How valuable would that be when you show up in the ED in the middle of anywhere except home? Encourage your family members and friends to do the same thing. In medicine, information drives the care.