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Making a good first impression is essential to establishing positive rapport with your patient. Within the first few seconds of that encounter, most patients will make a value judgment about whether they like you and whether they think you're competent to care for them.
You don't get a second chance to make a great first impression!

Studies show that people, including patients, are most likely to remember the beginning and the end of an encounter. This is called the "serial positioning effect."

That's why, in addition to a positive first impression, a positive ending encounter with the patient is also very important. Taking a moment or two to say goodbye to the patient and thank them for the opportunity to be of service leaves them with a positive impression of you.

With the serial positioning effect, the things that happen in the middle of an encounter tend to be a "blur," and details are often forgotten.

From a risk management standpoint, that can be very good. It means that if you're nice to the patient when arriving on scene and nice to them when you leave, the patient is likely to forget about the bumps (i.e., mistakes) that may have occurred in the middle-like that IV you missed! Typically, patients won't sue you if they like you-even if you do
make mistakes.

Here are nine tips for making a good first impression that will set the stage for a positive interaction with the patient-and reduce the risk of a lawsuit:

1. Recharge yourself. Take a deep breath before you enter the situation to clear your mind and to be ready to focus on the patient. Tell yourself you're going to make the patient feel better about the situation they're in.

2. Check your breath. As obvious as this is, bad breath can turn people off and sets up a barrier to communication. Always carry gum and mints and use them.

3. Have a confident physical approach. Move with purpose; look like you want to get to where you're going. Stand up straight with a confident gait as you approach the room. Start looking at faces to assess the situation and use a positive, clear tone of voice when speaking.

4. Look them in the eye. Focus on the patient. It helps you assess their emotions. It will also allow you to detect subtle changes in emotion, pain levels and distress.

5. Make an immediate introduction. Make sure you introduce yourself; explain who you are and why you're there. Avoid using clichés like "honey," "sweetie," or "buddy" when
speaking to the patient. Ask the patient if it's okay to call them by their first name. Acknowledge family members, too; they may have valuable information about the patient's past and present medical history that can help you.



READ THE FULL ARTICLE AT JEMS

By Matthew House, DHC, MSc, LL.B (hons) , Michael Jackson, MBA, MSc, DipIMC(Ed), FCPara , Joanne Dinning, MSc , Peter McMeekin, PhD

Transport of cardiac arrest patients entails substantial costs and involves risk due to emergency blue-light transportation. Photos courtesy North West Ambulance Service NHS Trust
In the United Kingdom, sudden cardiac arrest accounts for close to 100,000 deaths annually.1 Despite improvements in resuscitation practices,2 outcomes from OHCA remain poor, regardless of interventions utilized.3
In a one-year period during 2014-2015, approximately 30,406 out-of-hospital cardiac arrests (OHCAs) in England were transported to hospitals by ambulance, with a survival rate of 8.6%.4
Transporting patients with nearly certain poor outcomes represents an ineffective use of ambulance resources.5,6 Termination of resuscitation (TOR) clinical decision rules (CDRs) for OHCA exist and have been validated.5,7,8
These TOR CDRs reduce the burden on both the ambulance and wider healthcare system, and improve public safety by reducing blue light transports, which present an inherent risk.
The guideline proposed after reviewing the study data compared 
favorably with pre-existing termination of resuscitation guidelines.
Several studies have identified predictors of unsuccessful prehospital resuscitation, allowing for the development of evidence-based and validated TOR CDRs.9,10
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The BLS guideline predicts that the patient will not survive to hospital discharge if the arrest isn't witnessed by the ambulance clinician, there's no return of spontaneous circulation (ROSC) before transport and no shocks have been administered.
The ALS guideline adds that the cardiac arrest must not have been witnessed by a bystander and there must have been no bystander CPR. Although these rules have been independently validated, it's been shown that they're not universal for all patient groups.11
Moreover, these studies involved systems with no pre-existing TOR guidelines. In systems where clinicians already terminate efforts on scene, the ALS guidelines have been shown potentially to increase the numbers of futile transportations.12
U.K. ambulance services are able to terminate attempts that have resulted in asystole following ALS.13 Therefore, the majority of patients transported to a hospital in the U.K. will be those who persist with pulseless electrical activity (PEA) on scene. (See Figure 1.)

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READ FULL STORY at  http://www.jems.com/articles/print/volume-42/issue-8/features/derivation-of-a-termination-of-resuscitation-clinical-decision-rule-in-the-uk.html
Tuesday, 17 October 2017 14:09

Ambulance - West Mids

Written by

For eight weeks, BBC One series Ambulance has shone a light on the day-to-day work of West Midlands Ambulance Service. Here, some of the show's most recognisable faces talk about life on the front line.


"You are delivering a baby one minute and trying to start someone's heart the next," says paramedic Natalie Greaves.

"You never get two days the same which is why I love the job so much.

"You can go home thinking 'I don't know whether I can do this' when you see something upsetting, but then the next job may be different and you have got somebody saying 'where would they be without you?'"

Mrs Greaves, from Stourbridge, retrained as a paramedic aged 34, having worked in care.

Her own experience of the ambulance service, which cared for her disabled daughter Jessica, prompted the career change."You see so much sadness in our job."

She recalls one of her hardest jobs: responding to a call of a 17-year-old girl who went into cardiac arrest and later died.

"[Her] mother thought she had just got a cold," she says. "Within an hour her world had changed.

"I've got a 17-year-old myself and I remember thinking, how can one minute you have your child getting up for college and the next they're not getting up anymore?

"I found that hard.

"It's hard to process lives totally destroyed in a matter of minutes, and I will never get used to that.

"You learn how to deal with it, but it's not something you get used to or hardened to, because if that becomes the case, it's time to not be a paramedic."


'Not built for normal jobs'"Last Christmas Eve I went to a horrible job," said Darren Neeld.

He was called out to a 29-year-old w