Jeff Clawson, M.D., Brett Patterson
Brett:
I am currently seeking advice about the bleeding control panel.
Yes, this boils down to a debate I am having with an ED-Q, and they have supplied me the article from 2012 where you are the author (Seeing Red, Journal, July/August 2012).
The ED-Q is adamant that the only time EMDs utilize the Control Bleeding Panel is when the bleeding is serious.
My counter point is that the bleeding control is when possible and appropriate and not only for SERIOUS Bleeding. The usage of the bleeding control panel can be effectively used to control (let’s call it) “moderate” bleeding and gives the caller actions to help stem the moderate bleeding, which can decrease the anxiety in the caller and/or patient.
As an EMD Instructor I have never seen anything in the teaching material, which indicates the panel to be only used for SERIOUS Bleeding notwithstanding considerations of other injuries as Axiom 2 of Protocol 21 indicates.
I’m not seeking, and never would seek, an answer from you or the Academy that indicates “ED-Q is right and you’re wrong,” but in the context of the attached article and in the context of doing the “right thing for our patients,” I’m just after some further guidance.
Thanks very much for your time. I look forward to your advice.
Cheers,
Guy A. Law
Communications Quality Support Officer – QAS State Communications Development / Quality Assurance Unit
State LASN Operations | Office of the Deputy Commissioner
Queensland Ambulance Service | Department of Health
Brisbane, Queensland, Australia
Guy:
I am hesitant here because your question seems to be seeking a black-or-white answer, yet I think the answer is fluid.
There is no law or standard, that I am aware of, that mandates bleeding instructions for MINOR bleeding . As a clinician (and EMDs are clinicians), we need to consider the entire set of circumstances from the emotional needs of the caller, to the complexity of the scene, to the clinical needs of the patient.
I remember listening to an audio during my QA days long ago where an elderly lady found her husband of decades lying face down in an empty bathtub in cardiac arrest. He was a candidate for CPR but there was no way she could turn him over, much less get him out of the tub. The caller was very distraught, and simply hanging up the phone was out of the question. Anyway, with all other efforts exhausted, the EMD asked her if the patient was bleeding at all with the simple hope that some direct pressure instructions would keep her busy and feeling helpful rather than hopeless. I thought the move was genius. Anyway, I hope you get my point here.
While bleeding control instructions may not always be clinically necessary, they may be beneficial in some other way. Your example concerning moderate bleeding with an anxious caller or patient exemplifies this point. However, if bleeding is obviously minor, and there is other work to be done, triaging to some other direction may be entirely appropriate. As for the letter of the law in QA land, I would consider these factors before telling someone they did the wrong thing.
I did review the FAQ from 2012 and, although I was happy to see it resurrected and referenced, it was a bit brief and could do with a little more explanation. I wonder if our editor would consider updating it with this response. I think we could all do with a bit more color in our QA discussions that so often seem to be either black-or-white.
Brett Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency
Dispatch®
Brett:
My thoughts are in sync with your information and advice, and I totally agree with your key points.
Thanks for the reply. I totally understand the hesitancy as we deal with a lot of gray, and in our world, x is not always y. There is always “fluid.”
My seeking advice from you in this particular situation was that the article was being used by the ED-Q as a “black-and-white” solution, and my team and I are working hard to change this mindset. In my discussions with the ED-Q, I was advocating that it isn’t “black-and-white” and our actions need to be gauged upon the holistic assessment of the patient and situation based upon the information obtained by the EMD.
We know that there are subsets of our ED-Q/EMD staff who are “black-and-white” thinkers, and anything we can do to support these staff and give them strategies to help them to consider and deal with the gray and swim in the “fluid,” I’m always happy to support and assist where I can. The more color the better.
Onward through the fluid. 😊
Thank you very much for the reply. Take care and stay safe.
Regards,
Guy
