Just a Little Note For The Rookies

My buddy Jeff Brosius once gave what may be the shortest Trauma Activation ever: "One street pizza with pulses. Five minutes. Be ready."

While at first glance that seems flippant, while the medic is busier than a one-armed wallpaper hanger trying to keep the patient alive, those nine words do everything a pre-arrival notification is supposed to do: the ED knows they're getting a critical vehicle vs. pedestrian MVC with multi-systems trauma, and they have five minutes to gather the trauma team.

It may not win you style points (although I thought it was rather Hemingway-esque), and may indeed get you whacked on the peepee by the Monday morning quarterbacks who review such things,but it accomplished the medic's goal: to make sure adequate resources were on hand to assure continuity of care.

There's a difference between a pre-arrival notification and a handoff report, kiddies. If what you tell the nurses and doctors over your cot as you transfer patient care is not substantially more thorough than the phone or radio notification you delivered prior to arrival, you're doing one or both of them wrong.

One of the most common mistakes I see rookies make in the back of the rig (You know I'm keeping tabs on you in the rear-view mirror, right?), is that they a) have poor time management skills, and b) little situational awareness outside that patient module, and c) no sense of priorities.

It takes a while to develop the situational awareness that tells you that last bump you went over is the railroad tracks five minutes from the ED and that it's time to call report, all while you're busy doing other things. That will come with practice.

So will the time management, but the first step in doing that is learning to multi-task. You can start an IV and talk on the phone at the same time. I know, I've done it a million times.

And if I open the rear doors of the rig and you're not getting ready to unload, or you're on the phone with the ED as we sit in the ambulance bay, yet the demographic section on your run ticket is completely filled out, right down to the insurance blocks you got from the patient's wallet biopsy…

… you need to pull your head out of your ass, and remember that patient care comes first.

And that pre-arrival notification is part of your patient care.

Your pre-arrival notification needs to be concise, relevant, and most of all, timely. The ED doesn't need to know the patient's complete medical history, medication list, allergies, Zodiac sign and favorite color before you arrive at the hospital. They need no more information than what resources they'll need to continue patient care, with enough forewarning to have the time to marshall those resources. If the person on the other end of the line demands more information than that, they don't get the concept either.

Your handoff report is supposed to fill in the blanks of your pre-arrival notification. Or, phrased another way, the pre-arrival notification is a skeleton report, and you flesh it out at bedside.

Being overly detailed on your pre-arrival notification doesn't earn you any points with the ED staff; it just makes you look like you have no sense of priorities. While you're rambling on aimlessly with extraneous information, the nurse or doctor on the other end is rolling his eyes and making "let's get on with it" gestures, and God forbid you end that with asking for medical control orders, because 99% of the time they'll be denied, or so conservative as to have no clinical effect.

After all, if you can't distill what's relevant from what isn't, and paint an accurate patient picture with a clear treatment plan in relatively few words, why should they trust you with medications and invasive procedures?

Just remember that the best pre-arrival notification you can deliver is rendered absolutely useless if you end it with the phrase, "… and we're at your door." Better that you called them five minutes earlier, and given them a simple heads-up.

So keep your eyes open, be aware of how far out you are, and call the friggin' hospital in a timely fashion. Yes, I know the pre-arrival notification is purely a courtesy, but your partner can't very well defend your back for missing it now and then if you're not, well… courteous the rest of the time.