Be Prepared for Emergencies in the Clinic/Office: I know I wasn’t
Most Family Practice (and Specialist) clinics are not prepared to deal with an Emergency walking in their door. Yet, patients will often turn to a nearby clinic for help instead of calling an ambulance.
I remember once, as a resident, seeing a patient who came in to the clinic for a schedule appointment and happened to be having some chest pain. He thought it was anxiety due to some recent stressors at home. He didn’t look unwell or uncomfortable so I asked him a few questions and examined him. In the back of my head, I figured this patient should have a cardiac workup, just to be safe. This means some blood tests and a heart tracing (EKG). There were a few red flags so while it could be done at the outpatient lab around the corner from clinic, it just didn’t make sense. Since I was worried enough to want this testing done, the safest thing was to recommend he go to the ER. I gave him some aspirin and his friend drove him to the hospital from our clinic on the outskirts of town, and it turned out yes, he was having a heart attack. His troponin – the chemical the heart leaches out in to the bloodstream when the heart tissue is angry, as when deprived of oxygen in a heart attack – was 2.41. That’s high! Definite heart-attack high.
In retrospect, I should have called the ambulance to take him in. Patients with heart attacks can suddenly go into dangerous heart rhythms, and a paramedic can detect and deal with this, whereas a friend driving a car cannot. Although the patient got timely and appropriate care, and nothing bad happened, it could have. Had he gone into such a rhythm in clinic, we would have been woefully unprepared to help him in a smooth and efficient manner. In an emergency, one needs to know their role in care-giving, where all the helpful equipment is, and how to get the patient to definitive care (i.e. the hospital). That makes it easy to stay calm and to ensure that everything the patient needs is done when and how it should be.
Dr Simon Moore, a friend and Resident Physician in the Nanaimo Family Practice program, has recognized that most clinics are like the one I was present in; staff are not prepared to deal with real emergencies and often fail to call 911. Equipment that can save a life may be present, but is scattered or hidden.
One of the graduation requirements of UBC’s Family Practice Residency Program is that residents participate in a research project in their final year. Simon has gone above and beyond with his project, a video that can make a difference. I encourage all health care practitioners to see his incredibly high-end video (and complete the brief survey for research purposes). It can help you prepare your staff and office for that day when you face an unexpected emergency.
Find it at http://www.officeemergencies.ca