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Thoughts From A Clinician

Excuse me, do you have the time?

 

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         No matter what you do or where you go everything is driven by time.  Our shifts at the airport, emergency department, operating theater, and even our hobbies are based on time.  Whether we want to admit it or not, a clock is the thing the rules us all.  Those twelve numbers and twenty four hours in the day run our lives.  That may sound harsh, but it is the truth.  It is not fun to hear it, but let us call a spade a spade.  A clock it where we make our money, sleep, and even entertain ourselves.  This is not a negative thing, just a fact of life.  Medicine is no different.  It is ruled by a clock as well.  What time did you give this medication, when did the patient arrive, and what time was the patient discharged?  All of this is carefully documented by excellent patient care staff all over the world 24 hours a day, 7 days a week, and 365 days a year.

         One place where time can greatly vary is bedside times of a critical care transport team.  We practice, critique, and even preach quick bedside times.  Daily we are reminded that we need to have ten minute bedside times and that is the measure of a successful and every good critical care team.  What if I said that is not the panacea?  What if I said that a quick bedside time does not mean that the team is good or better than a competitor?  Someone reading this is already drafting an e-mail to me right now.  Allow me a moment to explain myself before I get any e-mails questioning that statement. 

         In the military we always used the phrase slow is smooth and smooth is fast.  This means that we can be quick, but just take a breath and concentrate on your task at hand.  We try not to let the stress or other human factors get into our head and impede our ability to do our job in a timely manner.  That is what we need in these situations.  We want to be as quick as we can be, but within reason.  If we have an ICU level patient that is intubated, on eight drips, and is overweight then a ten minute bedside time is just not logistically possible.  On the other hand, if they are an NSTEMI with nitroglycerin and heparin running and oxygen at 4LPM via nasal cannula, then it is possible. 

         The point is that it is up to us to train to be smooth and fast with our equipment, patient transfers and even handoff reports, but do not sacrifice form for repetitions.  Make sure you are thorough and concise with everything you do.  No one reading this would skip a step on the checklist of airway management, so why do we do it at the bedside?  Make your transfer routine work for your partner, you, and your service.  This is a dynamic process and we need to be prepared to change as our needs change.  In essence we all have the time, but whether or not we take the time, is up to us!

 

 

 

 

Klint is a US trained Critical Care Paramedic, who holds specialty certification in neonatal pediatric transport and Flight Paramedic certification.  He is currently pursuing a Baccalaureate degree in EMS management through Western Carolina University. Klint works full time as a Flight Paramedic in the Midwest, USA.  Klint is also an EMS Instructor with DistanceCME. In addition, Klint is FlightBridgeED's newest blog author, and is heavily involved in Free Open Access Medical Education and EMS education. 

Klint can be reached atThis email address is being protected from spambots. You need JavaScript enabled to view it.';document.getElementById('cloakfa4b9d896c893d5f98fd459f256759c0').innerHTML += ''+addy_textfa4b9d896c893d5f98fd459f256759c0+'<\/a>';  or on

Twitter: @NoDesat

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