Paramedics respond to a 911 call. They find a patient, barely conscious. In the stress and anxiety of the moment, family members are unable to answer all of the paramedics’ questions regarding medications and allergies. Precious minutes are lost while they search for the information.
There’s a simple solution, according to long-time paramedic (now retired) Ian Pythian.
York Region provides an “Emergency Medical Information” package – an envelope designed to hold a photocopy of the patient’s health card and a form to be filled out, providing a description of the patient’s medical history and conditions, a list of current medications and supplements, and allergies.
The envelope is placed on the outside of the refrigerator, secured by a magnet – ready and waiting for paramedics.
Pythian, a paramedic for 51 years, thinks it’s a great idea.
He started his career back in 1968 when ambulance services were privately-owned, and spent about three decades working in Bradford. Pythian ended his career as a paramedic with a regional EMS service, and now teaches Emergency First Aid at Seneca College, and provides training on the use of Automated External Defibrillators (AEDs).
On Thursday evening, he was guest speaker at a R.O.S.E. (Reaching Ontario Sharing Education) program hosted by the Bond Head Women’s Institute, at the condominium building at 200 Holland Court.
About 20 members and guests turned out for the presentation. Pythian began by describing a common issue facing paramedics responding to a medical emergency: “One of the problems I found a lot was that, with all the anxiety, it was quite hard to get medical information from the patient or the family.”
Paramedics not only need to know the nature of the complaint – the symptoms and reason for calling 911 – but also the medical history of the patient over the past few years, an up-to-date list of medications, and any allergies.
“During cardiac arrest people are very anxious. They can’t answer those questions,” said Pythian, noting that allergies in particular can be important. “If I’m giving a person medication, I have to know if you can take the medication.”
If a person is unconscious, “obviously they can’t answer the questions.” Even when paramedics do get answers, it may not be helpful. Being told that the patient takes “a green pill” or a “little white pill” doesn’t tell EMS what they need to know.
And Pythian has more than once been told by a patient, upset and in pain, to “quit asking those stupid questions.”
The Emergency Medical Information package contains all of the necessary information, put together in advance and left in place until paramedics arrive.
If there is a Do Not Resuscitate (DNR) order, it should also be placed in the envelope. Being told by a family member, even with a medical power of attorney, is not enough, Pythian noted. Without the DNR form, paramedics will continue to attempt to resuscitate the victim. “We must see the DNR.”
Pacemaker or other implant? Tell paramedics, and whether the device is on the right or left side, information that is critical when placing AED pads on a patient.
“It really helps us with our diagnosis, and our treatment plan,” he said, and is also helpful for hospital staff: “It’s all there for them.”
Pythian encouraged residents, once the Emergency Medical Information form is filled out, to make several photocopies – and consider carrying a copy in a wallet or purse. “Maybe you’re not at home when something happens,” he noted.
Pythian was told that some residents in Simcoe County were advised to place their medical information inside a plastic container, and leave it inside the fridge.
“That’s a bad idea,” he said. “In 51 years, I’ve never gone into a fridge.”
Not only are paramedics unlikely to think of checking inside the refrigerator, the capsule is likely get hidden behind the food.
Pythian provided other useful tips in case of medical emergency:
Those who live in an apartment building should have a family member or friend wait in the lobby, to let paramedics into the building immediately rather than fumbling with entry codes.
In poorly-lit rural areas, having a person watching at the end of the driveway and signalling to the ambulance can also speed response. “Even though we do have GPS, it can be hard” to locate the right residence, especially at night, Pythian said.
And if a patient has to be taken to hospital by ambulance, don’t immediately follow EMS. Family members may end up speeding, following so closely behind the ambulance that paramedics are “afraid to hit the brakes,” and may try to go through red lights. Besides, he said, “there’s not much you can do by getting there at the same time as we do.”
Pythian had one more bit of advice for his audience: If you think you are suffering from a heart attack or stroke, don’t go to a hospital emergency room in a private vehicle. Call 911.
Paramedics are now trained to not only begin treatment immediately on arrival – often performing CPR and stabilizing the patient in his or her own home before transporting them by ambulance – they are also mandated to take patients to the specialized hospital where they will get the best care.
For a heart attack, in this area that’s Southlake Regional Health Centre. For suspected strokes, it’s the Mackenzie Health Centre District Stroke Centre in Richmond Hill.
“Don’t go by car. Please call 911. Pay the $45 to go by ambulance,” Pythian said, because being taken to the right hospital means that “there’s a whole team of doctors waiting for you.”
He acknowledged it can be difficult to know when to call 911 - especially if it's a first heart attack. Some victims have waited up to four days before calling 911, because they weren’t sure if their symptoms were “anything.”
That’s because not everyone has the classic symptoms of cardiac arrest, like chest pain, tightness or pressure, radiating pain in the arm, and sweating. Women are more likely to experience pain in the neck, jaw or upper back, than in the chest.
Even Pythian, a trained paramedic, didn't have recognizable symptoms. “When I had my heart attack, all I had was pain in my wrist.” He eventually had a triple bypass.
“Sometimes you just don’t recognize things,” he said – which is why it’s important to seek medical help.
Pythian answered questions from the group, and handed out Emergency Medical Information packages to every guest at the session.
He had one final bit of advice. In a medical emergency, “call 911 right away. Do not waste time.” And when you do call 911, “stay where you are. Don’t move until the ambulance arrives.”