Outcomes

My partner, TJ, tells me that she was pretty before the accident. She still is, but you have to look past every thing else. We're assisting the medivan driver, helping to carry Christy in her wheelchair up to her parent's second floor duplex. She'd spent most of today on her crutches at school. Christy is 16, and a year ago her life changed forever.

*****

In EMS, we have such a rare opportunity to see how our patients do in the long run. There are exceptions, we all have our frequent fliers and system abusers and it always seems that everyone in the service knows how Mrs. Jones or Abe the Smelly Drunk is doing. But the patients we'd really like to learn about are usually the ones that were significantly sick or injured, the ones where we want to know if we made a difference, if our treatments mattered. Maybe we want to know so we can improve our skills, know what to do differently in the future. Maybe we want to know because the run really bothered us and we need some closure. Maybe we want to know because it was an interesting case and we're just curious. Or maybe because we really care and we hope that the patient makes it.

Due to numerous factors, the largest of which being HIPAA, but also because of the size of our systems, and the number of patients, doctors, and nurses that we see, we don't always know what happens to our patients. Dropping them in the ER bay may be the closest we ever come to knowing the outcome of care for a particular patient. I'm fortunate to work in a small system where I know all the ER doctors and nurses by first name. Often times, the critically ill or injured patient I transport to Portland is the same one I brought into the ER an hour earlier. I'm able to talk to the doctor and nurses, read the patient's paper work and past history, and have a good grasp of how the patient is doing and know what their treatment plan will be like. Other times, I'm able to ask the doctor about a particular patient and they can give me a quick run down of how they did in the ER. Usually though, it's a mystery we drop the patient off. Even still, I often wonder what happened to Mr. Thompson, who was from out of town and here on vacation, that had a heart attack at the hotel pool. He went to Portland from the ER, but did he make it from there? Or was his family's last happy memory of him at that little hotel pool?

*****

Christy was at a local state park last summer, enjoying a beautiful sunny day with family and friends before the start of school. She had climbed to the top of the waterfall, 65 feet above the pool below with rocky banks on either side. Christy misjudged the jump, and hit the cliff face of the falls before landing face down in the water. She was pulled to shore by friends and lay there until the fire department and ambulance arrived. Christy was conscious, but her body was broken, literally.

Based on the radio report the medic gave during transport, the air ambulance was waiting on the helicopter paid when Christy arrived at the hospital. She stayed a very short time in the level 3 ER, before being flown to Portland.

*****

As a medic, I always want to better my skills, to be the best paramedic that I can be. Part of it has to do with pride, I also want to be good at my job. Mostly, it's so I can take better care of the next patient. Part of the process of bettering my skills is evaluating how I've done on each call, what I could have done better or differently, and whether my interventions meant anything. Often, I'll ask the doctors or nurses if what I did was the right thing to do. Recently, I had this experience with a chest decompression. That particular patient went to Portland, but I don't know about her long term survivability. Chances are, I won't know until I see her again at the care home.

Because of the small area I live in, that's how I learn alot about patient outcomes. A patient will recognize me while I'm in line at the grocery store or walking downtown with my wife. Sometimes its a family member. Usually they'll thank me and tell me about how they did after I dropped them in the ER. It doesn't happen often, though.

*****

Christy spent months in rehab and started the school year late. At first, she was able to only get around by wheelchair. As the year has progressed, she has grown strong enough to use crutches for most of the day. She keeps up on her school work and attends a full day at the high school.

For a while, until we knew what happened with Christy, she was the talk of the company. She was the big trauma call that everyone wanted to be on. The call was dissected and arm chair quarterbacked. Decisions were analyzed and questioned until everyone in teh company had their own idea of how they would have run things. It wasn't until Christy came home that all that stopped.

*****

Christy holds her crutches across her lap as wheel carry her up the front stairs. The medivan driver holds on the top of the chair while TJ and I are at the bottom. She's a small girl, very petite with a fragile looking frame. TJ tells me she was quite small before the accident, too. Her hair looks healthier now, when we first started helping her, her long blond hair was stringy and thin looking. Her eyes are sunken back and her face looks hollow, but she wears a smile for us as we joke about how handsome men always have to carry her upstairs. She has a pretty smile, even without her two front teeth.

We set Christy down outside her front door on the landing. The medivan driver opens the front door then holds open the screen door. She smiles up at us, says thank you and wheels herself inside. We smile back, tell her that we'll see her in the morning and close the door behind her.

I didn't run on Christy the day she took her fall, I was at teh other end of the county. Just like everyone else in the company, there was that wish in the bottom of my gut that I wanted to be there, to be the medic taking care of the critically injured trauma patient. To tell you the truth, I'm much happier to be the medic helping to get Christy up and down the stairs every day for school. Though broken, she's recovering and her outcome is a positive one.