THE RIGHT AMOUNT
February 26, 2013
By Jeff Clawson, M.D. and Brett Patterson
I attended a Q Instructor Academy in October and I’m also a PDC software instructor. My (new) home agency is planning on implementing the Medical Protocols in spring, and I’d like to be ready for one question that’s going to come up.
In the past I’ve had an EMT or paramedic working dispatch wanting more justification for why certain questions appear in the Medical Protocols.
Recently, I was challenged on the Key Question (KQ): “Has the patient taken any drugs or medications in the past 12 hours?” One medic said, “We don’t care what meds the patient is on, we’ll find out when we get there.”
What’s the principal intent of asking the question? Is this information generally considered of value in other EMS systems?
Union County Police Department
Westfield, N.J., USA
I’ve asked Brett Patterson to help you with your question.
Each question in the MPDS has at least one of four primary objectives. That particular ques- tion, as you correctly speculate, has to do with both responder information and, also, dispatch triage. I’ll address the latter first, understanding that the question does not ask the patient to list all medications, but rather were any drugs or medications taken within the last 12 hours.
A patient under the age of 35 with chest pain and no other priority symptoms is not likely to be having a heart attack. However, the enzymes present in cocaine predispose people to ventricular arrhythmias, which is why cocaine was included in the CHARLIE level (patient needs ECG monitoring, at minimum).
If the chest pain patient has recently taken blood pressure or cardiac medications, especially nitroglycerin (NTG), this is useful information for the responder, especially diagnostically if multiple doses were taken; it may also explain on-scene blood pressure issues.
The medic you spoke with is assuming the patient will be able to speak for her/himself upon arrival. However, as we know, this is not always the case.
I have been a medic for over 30 years now and have had the privilege of teaching EMD to many medics and EMTs. I have learned that opinions vary. I would encourage you to conduct an experiment. Ask your EMT and paramedic students to write down the information they would like to have before arrival for both medical and trauma patients. My experience has been that these opinions vary greatly, and are based on experience. The MPDS attempts to provide the Four Commandments, any relevant safety information, and a very brief recent past history via Key Questioning. While this may be too much or too little for some, it really does satisfy most, once the method and rationale are understood.
IAED Academics & Standards Associate
Medical Council of Standards Chair