Although our role as Paramedics has become more dynamic and evolved dramatically over recent years, fundamentally, our role has been and will always be to transport patients to hospital (even those who aren’t actually sick). Now, in certain circumstances, people genuinely just panic and call for an Ambulance, and once they have been assessed and reassured, are probably better off staying at home. These are the patients, more than any others you attend who have the potential to die, leaving you the difficult job of explaining to the coroner why you didn’t do your job and transport them to hospital. By following these steps, you will make this job a little easier:
- Don’t go into the case assuming that you’re going to convince the patient to stay at home – if they really want to go to hospital, you’re just creating more work for yourself trying to convince them to stay. You may as well start driving them to hospital. This is even more so the case on nightshift, when you’re tired, and you just want to go back to bed. Remember, patients who have been taken to hospital can’t call you again (at least not for the next few hours!).
- Make sure you’ve resolved whatever the problem was that they called you for in the first place – if they’ve called you about a rash that they’ve had for 3 weeks, but only now have called an Ambulance, its no good, just telling them that this isn’t an Ambulance case. Give them options on what they can do tomorrow or later, such as contacting their GP (Sometime, people call Ambulances simply because they honestly don’t know another way of solving a problem).
- Complete a thorough an full assessment of the patient (I know you want to go back to bed, but this is important). As a general rule, I will do a more thorough assessment of a patient I’m going to leave at home than one I will take to hospital. This includes: Pulse, BP, Resp Rate, GCS, ECG, BSL, Temperature, Pain Score, auscultate the lungs. If you assess all these, and nothing stands out as being un-usual – its pretty safe to say that they do not have anything acutely wrong with them that can’t wait until the morning. Also, it makes patients feel like they’re getting their money’s worth out of you – many probably wont have had this much of an assessment by their General Practitioners.
- Thoroughly document everything – more important than simply doing a thorough assessment of your patient, you must document that you have done so (the results of this assessment is your justification for leaving the patient at home).