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EMS is an incredible educational opportunity with high acuity, rare pathology, and immense autonomy-to-training ratio. With poor follow up, EMTs and paramedics may miss out on its lessons. 1/
EMS is full of missed opportunities, for patients and providers alike. The bottom-line paradigm of "you call, we haul" has left patients underserved and providers undereducated. 2/
Of all of our patients, most are undifferentiated and underserved. Many are poor historians, chronically ill, and SICK. H&P and critical thinking are often ignored in favor of rapid pattern recognition. We all fall into this trap every now and again. 3/
During med school, I ran a unique call @DHParamedics. 20 y/o F c/o abd pain and distention. Broad daylight. Her BF was heavily intoxicated; they were at a diner in a poor area of town. History of “liver problems” and “surgery when I was a baby.” 4/
She was frankly cirrhotic. My internal bias/pattern recognition told me alcoholic cirrhosis, albeit super young—I must be missing something. A little digging into her Hx and I realized she had undergone a Kasai procedure 19 yrs ago. 5/
She knew few details, but it was deducible she had been born with biliary atresia, undergone a massive surgery, and, too poor to F/U consistently over the years, was now in acute-on-chronic liver failure with SBP. AKA SUPER SICK. 6/
I’m tired of “EMS doesn’t need to know that.” I often wonder how many fascinating things I overlooked because I wasn’t trained enough to realize how bizarre they were, or what pts I blew off out of sheer ignorance, especially early in my career. 7/
Thanks to F/U, I learned that pt was added to the list for a liver transplant. Thanks to a thorough medical education @UVMLarnerMed, I knew what was going on and how rare it was. Thanks to great paramedic mentors, I didn’t anchor on erroneous pattern recognition. 8/
EMS providers need all of these—ongoing F/U, education, and mentorship—to thrive in their field. This will reduce burnout. It will improve patient treatment, rapport, and trust. 9/
