How Decisions Made in the Prehospital Setting Impact Outcomes for Patients

Prehospital care is about much more than just stabilizing patients and moving them on to the next step. The decisions you make can have far-reaching implications for a patient’s life and well-being. This is why it’s so important to gather as much information as possible, and to act collaboratively with family members. Include them in the decision-making process as much as you can, and remember that the patient has final say over their treatment. 


To Convey or Not to Convey? 

One of the first decisions paramedics must make after they stabilize a patient is whether to transport them to the hospital or not. Many medical providers, including EMS professionals, err on the side of providing as much treatment as possible, but this is not always in a patient’s best interests. Research shows that with access to more information about a patient’s condition, EMS providers can make better-informed decisions about conveyance. 


Consider the confused patient with dementia, for whom a hospital visit will involve long waits, terrifying sounds, and little chance of improvement. Or the cancer patient with a do-not-resuscitate order for whom the hospital is little more than death’s intimidating waiting room. Talk openly with patients and their families about these decisions, and don’t assume that conveyance is always ideal. 


Denial and Delay: Taking Patients Seriously 

When an emergency is not obvious, it might be easy to dismiss a patient’s symptoms. Research shows that some medical providers take certain groups less seriously—particularly people of color and women. Indeed, the practice of denying the severity of an emergency and delaying treatment may play a significant role in public health crises such as the maternal mortality epidemic. Women seeking care for postpartum hemorrhages often face critical treatment delays. 


It’s important to treat all emergencies as if they matter, and to take all patients seriously. Conduct a thorough exam. When in doubt, transport the patient. Be mindful of how you convey information to hospital personnel, too. If you suggest that the patient might be exaggerating their symptoms, this can affect the treatment they receive. It may even cost a patient who is having a real emergency their life. 


Compassionate Care 

Medical emergencies are terrifying. Everyone who faces such a crisis is at risk of long-term trauma, even if they survive. Mitigate this risk by offering compassionate, culturally competent care. Don’t demean patients, use unkind language, or dismiss their concerns. Never restrain a patient unless doing so is a matter of life and death. Treat children and elders with respect, while offering calm reassurance. Doing so may mean that you become the hero of someone’s story—not the reason they look back on their medical emergency with anger and trauma. 


Prompt, Appropriate Evaluation and Care 

Prompt care is critical to the survival of all patients, both before and after they reach the hospital. Quality care demands skillful evaluation of every patient you see. Don’t just go by first impressions. A patient who complains of trouble breathing will need a respiratory assessment, while chest pain almost always requires transport. Some patients may appear to be doing OK even as they face serious health crises. Relying on subjective measurements can skew your perspective and endanger patients, so follow consistent policies with every person you encounter. 


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