Not many of us put our skills to use outside of the traditional settings of EMS. We tend to employ them in an ambulance, hospital, maybe a helicopter, and patient's homes. However, rarely does the contemporary medic prepare herself for working in austere environments. To be clear, I am not sure a lot of us realize it is a possibility. One thing I can assure, it is a possibility, and you have the opportunity and want – seize it.
That said, here is what I have learned from traveling and working abroad, where the culture and language is not mine. Where the protocols do not dictate my actions, where the resources are limited and throwing away a syringe may have just been your last. These are only a few of the things I have experienced so far. I am sure there are far more to come, but let us touch on these.
First, not being proficient or having the ability to speak the language will hinder your ability to communicate. What I did not realize was how this impacts patient care. I mean, I have been on trucks and picked up patients where their language differed from mine. But never, has it been so prevalent that I required someone to interpret for me to find out where the patient was experiencing pain or when they last ate. The fix, learn the language, you do not need to be fluent, understand, learn the basics and practice. Not only does this show you care, but it will also improve rapport and allow you to communicate and interpret findings better.
Protocols, this is an animal we do not often think about. We have become so comfortable with what we are allowed to do that we fail to realize that abroad, physicians may have a different standard and expectation of your scope. Most companies provide guidance, but do not let this dictate your skillset. My suggestion, ask questions, ask the physicians and other staff who have been around. Get a lay of the land and what the routine patients are experiencing. Finally, if it is something traumatic, you should already know what to do and do not need to be afraid to treat this person appropriately and effectively. Just remember, speaking with the physician may require you to understand and speak the local language.
Finally, resource management; I have in my years of EMS become so accustomed to having anything I needed, syringes, flushes, medications, easy access to medicines, etc. In an austere environment or country outside of the United States, these may not be readily available to you. It is difficult to practice and train for this, so I would offer that you again talk with those who have been around. Ask about resources, read their supply lists, look for what is available, and if push comes to shove, do not just waste something. Ask, do we need this? But again, you have got to understand how to communicate effectively.
I guess the one important take away from all this is universal – communication. Be an effective communicator, ask questions, listen, and practice the language. Read, talk with your patients, and never be afraid to ask a stupid question.
Thanks for reading.
Regards, and as always be safe, and PragMedic,