Tick Tock

Times, they are a-changin'. Or so said Bob Dylan. Personally, I'd reverse the lyrics. Over the past few months I've had the opportunity to work with several student paramedics, either as a working crew, or when they're out on vehicles and I'm on the car. Some are good, some less so. Some who are too young, whilst others are either mature students or have maturity beyond their years. All, however, seem to have arrived bamboozled by the power of the clock. 

I'm going to be honest. I don't give a damn about the time limits we're given, particularly when it comes to turn-around times at hospital. It's probably best that I don't give a damn, because I suspect that my turn-around times are probably giving my management team nightmares. I do, however, give a damn about my patients, so I get to the call as quickly as I safely can, I treat them as best I can. We have fifteen minutes in which to hand our patient over to hospital staff, clean the ambulance, restock the missing bits of kit (if possible - sometimes it's a bit of a challenge to do anything short of reallocating resources from either hospital or another ambulance), use the bathroom if required, grab a quick drink and sometimes a bite to eat, and, of course, complete the paperwork. 

Admittedly, the fifteen minutes on which we're currently assessed don't start until our patient is on a hospital trolley or in the waiting room, so the three hours(!) I waited the other day with a patient on our trolley bed won't count against me. I do realise that we don't have to have a coffee or use the facilities after every call, but the pressure of this quarter-of-an-hour time limit has led to what, at least in my eyes, is an ugly new trend, particularly amongst these new paramedics and students. 

The trend? Completing the paperwork before we've even left the scene of the call. Not just the basic details, but every last bit of paperwork.

I hate it. The patient is in the back of the ambulance, a history has been taken indoors, observations checked and rechecked (after all, every patient must have two sets of obs - yet another box-ticking nonsense in many cases), the patient has received treatment if appropriate and/or required, all whilst the family are standing outside wondering what's happening. Often, the patient is wondering the same thing too. 

The patient is in the back of the ambulance for one reason and one reason only. You've made the decision that they need to go to hospital. Well, either that, or the patient has made that decision themselves and aren't going to be persuaded otherwise. In either case, the reason is the same. That patient is going to hospital. They don't want to be sitting on their own doorstep for an extra fifteen minutes with the blood pressure cuff aimlessly inflating automatically at five minute intervals. They don't want their family standing outside the ambulance concerned that something terrible has happened. They certainly don't want to be ignored for the time it takes to complete the scribbled account of everything that they've just told you. 

They want to go to hospital. 

Many (most?) of our patients need no treatment on route to hospital other than a smile and some friendly, calming banter. Talk about the weather, talk about their children and grandchildren, talk about their wartime experiences, talk about the football or last night's garbage television. Talk, and write. And if you can't do both, then just talk. If your patient isn't interested in conversation, then you can just write, but be on the move. And if, by the time you get to hospital you haven't completed your paperwork, do what I do, and take whatever time it takes. 

Paperwork, as well as being the bane of the life of any paramedic, is a legal document. If it's not written down, it didn't happen. Standing in front of a coroner and claiming that you provided treatment but failed to document it will leave the coroner with no choice but to accuse you of lying, so you do need to make sure that everything is written down. It is, of course, helpful to write down the patient's details as they tell you their name and date of birth. But as far as the story, the history and the symptoms are concerned, just listen, make mental notes or even quickly scribbled ones on a notepad and then write them down properly later, once your patient is no longer yours. If you can do it in the allocated time, all well and good. If you can't, if you need to pay extra attention to detail, if you need to ignore the clock, just do it. 

Concentrate on your patient, not on the clock. It takes a while to learn the knack of writing and talking at the same time as being on the move across the pot-holed London streets, but it's a skill worth learning. But if you can't manage it, then just wait. Arguing that completing the turn-around in the allocated time is beneficial to other patients by being back in service quicker, is no more than complete nonsense. If you've taken exactly the same time to complete the call by standing outside the patient's house for those precious minutes, then you're not back in service any quicker. 

Concentrate on your patient, not on the clock. It takes a while to develop a system that ensures that everything that needs to be written down actually makes it from thoughts onto paper, but it's a system that's worth having. If you can't manage it within the precious time allotted to you at hospital, then just take a little longer. Each patient is worthy of your personal attention. That tick-tocking noise in the back of your mind should come a distant second. 

A little more of the personal touch and a little less of the clock-watching paranoia can turn a good paramedic student into a great one. Try it. You may be surprised at the results.