I look at my patient and consider my choices, either I act outside the policies that the LAS have set me in the best interests of my patient, or I follow the rules and provide sub-standard care.
What do you do?
Our patient is a fiercely independent woman – well into her eighties every morning she walks to the shops, has a potter around to buy her papers, has a chat to the shopkeepers and then returns home.
She'd had a fall because the strong wind that day had blown a door into her, one of our first responders was already there and had patched her up. We took her to the ambulance and completed the assessment. She had a cut like half of a 50p piece on her shin. Sometimes you can get quite nasty skin tears, but in this case it was more of a gouge, and therefore easier to fix up.
There was one problem, our patient didn't want to go to hospital and after she told us why, I cold only agree with her.
No problem, it would be a simple job to steristrip the wound closed, something our ECPs are well equipped to do.
Except there wasn't one working on this shift.
Now, as long time readers will be aware, I used to be an A&E nurse. Wound closure of this sort is something that I would do regularly when working in the minor injuries department. I could easily do ten such closures a day, all without supervision. Our doctors would tell me to clean, close and dress the wound and the choice of how to do this was down to me.
But with this lady, if I were to follow our policy, she'd be left with a cut that would be left open with little more than a bandage over it. This would not only cause scarring, but would also have a higher chance of becoming infected.
It just so happens that I carry some steristrips in my personal bag.
So, of course, I used my nursing knowledge and closed the wound using my steristrips. It is a low risk, high outcome intervention that I am competent in. At the end of the day I can justify taking this course of action to anyone who questions me, and more importantly, to myself. I can guarantee that I've done more wound closures of this sort than any of our ECPs.
Us ambulance staff work under guidelines rather than the more restrictive protocols these days and this means that we can do pretty much anything, just so long as we can justify it. While I've been been told that I shouldn't use my nursing skills (like cannulation) I can't see anyone having a problem with my course of action.
I sure that my patient was happy.