Paramedics Course – Time Critical Patients

Time Critical Patients

Micro-lecture by the Australian Paramedical College

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about the time-critical patient which refers to those patients who are so acutely unwell that every single second you delay getting them to hospital can mean the difference between life and death.

Time Critical Patients

Today we’re going to talk about the time-critical patient. Now, you guys will probably have read a little bit about time sensitive, time critical, critically unwell patients. They generally all mean the same thing. What it’s referring to is those patients who are so acutely unwell that every single second you delay getting them to hospital can mean the difference between life and death. Now the good news is, approximately 80 to 90 percent of the patients we attend as a state ambulance paramedic don’t actually require time sensitive responses. So this presentation really does help you guys to identify what types of patients come into that time criticality patients and to help you guys to understand the nature of managing a time critical patient.

The aims of this session are for us to take a look at what is the definition. What does it mean to have a patient who is time critical? Recognise time critical features in patients presenting with what we call the four H’s and four T’s. Now, those of you who have already done the diploma, done the Workshop Two which is the diploma or maybe you’re working towards Workshop Two, you will have already heard about this notion of four H’s and four T’s. The four H’s and four T’s are reversible causes of cardiac arrest. I personally thought it was quite timely that we use the H’s and T’s to structure this session on because they are reversible causes of cardiac arrest. It doesn’t really get more time critical than that. So we’re using the H’s and T’s to structure this lecture. Of course we will discuss methods for managing time critical patients.

So let’s take a look at this case study which exemplifies what we are talking about with a time critical patient. So you are called to a road traffic collision. So you’re called to an MVA, RTC, whatever you want to call it, motor vehicle accident, road traffic collision. On arrival, it becomes clear that a male has been struck by a vehicle and the male is now laying on the ground. As you assess him, he is conscious but in a confused state. He looks pale and he is also holding his abdomen which looks swollen. So try and picture it. You are the paramedic. You’ve arrived on scene. There’s lots of people panicking, saying “Hey, we need things over here.” Now this guy is laying on the ground. He’s been hit by a vehicle and he’s confused. He’s pale and he’s stressing. Now that’s not a good sign. So let’s talk through this in a little more detail.

As you arrive on scene, you are going to do your primary survey, danger response, airway and C-spine, breathing, circulation [inaudible 00:02:49] exposure. You’re going to call in a situation report to dispatch because they’ll need to know about it. Then you’ll go to assess him following the primary survey approach. But in terms of time criticality it’s your responsibility to try and assess is this person sick or not sick. If he’s sick you need to get going. Because let’s be realistic, guys. Some patients do not respond well to taking your time waiting 40 minutes for a second crew if the local hospital is only 10 minutes away. These are the decisions you’ve got to make.

We’ve already said that most patients do not require emergency care but instead call for help when an existing condition has become exacerbated. So with regards to your history taking, it’s so important that you’re able to do a history taking and establish what condition they have and how often it becomes exacerbated. What are the trigger points that makes it exacerbated? For those who do require urgent care the paramedic must make safe decisions quickly and must be able to prioritise the care they deliver. What this means is, using all of your clinical skills, your history taking, your previous experiences, you’ve got to be able to work with your crew mates and you’ve got to communicate with your crew mate, with your patients and you’ve got to use all your knowledge, underpinning knowledge of history of body systems and you’ve got to be able to prioritise the care that you deliver. In other words, you need to give oxygen because they’re looking pale or have oxygen saturations below 92. Do they have a tachycardia? Is there anything that you can do for that tachycardia or is it just something you have to act quickly with? You have to establish if there’s any internal or external bleeding. So notice how you’re trying to assess and look at your patient. Use everything in your environment to try and work out what you can do to help this patient…

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