A Walk In The Park For Us, Is The Great Unknown

Its dark out and she was woken from a sound sleep by an unfamiliar feeling. An uneasy feeling begins to set in as she gains her baring, readjusting her position in bed she closes her eyes. The sensation does not go away no matter which way she lays. Sitting up in bed she just cant shake this feeling, the sensation, the pressure as if someone is sitting on her chest. Not like reflux she has had before, but a feeling scary enough to call for help. 


The 3am call for chest pain is a walk in the park for most, but for the 65 year old female who has never experienced this feeling a day in her life its not just a walk in the park. Its the change of a life time, its scary, its not normal, its new and unfamiliar. We in EMS assess, treat, reassess, repeat; its what makes good providers. What makes better providers is the ability to ease and calm by voice, the ones who reassure the patients through the process of our skill set. Informing our customer of the next step we will take, the multiple things that will be going on all at once all around her.


Not including the frequent flyers, EMS typically knows a lot more than the average person of what goes on in the Emergency room in the first few moments of the ambulance's arrival. Its simply a matter that we get exposed to the initial greeting and assessments of the patient by the ER staff, the annoying wait times for a room, the feeling of udder avoidance by staff, or the paparazzi like attention patients get. As with anything repetitive it begins to be ingrained with in or such common place for us ambulance folks we don't bat an eye at the process. We have become use to it, or if your still a wet tag you'll get use to it and understand everything that goes on and even what to expect from the staff, depending on your patient .


The ones who don't understand are our patients, who already are scared for calling over their personal emergency. We have talked them through what we will do but have we talked them through what will happen?


Recently I have been complimented by coworkers and recent patients on my inclusion of what will occur once the rig stops and the off loading begins. I find it odd that it may not be common place for providers to share their gained knowledge and continue to ease our customer through the transition into the hospital. I'm no expert of what will happen step by step but I know that the process in my region is strangely similar to our first few minutes with a patient. 


So if you know that there is a chance of waiting for a room let the customer know that you'll be with them waiting and they wont just be moved into a chair and avoided. If you know their injury or illness is considered minor and that they will be placed in triage inform them of how that process works. If you know that the customers condition is one that will gain the ER's entire attention tell them of how many people will be swarming around them. 


After all its the least we can do for our customers to help them through the transition.


Be Safe
Ambulance Junkie

Trauma note taking

We all have different techniques for keeping track of pertinant assessments. Many people have these Tricks of the trade they do with out second thought. I'd like to share one that I find most useful for the trauma call.

I typically scribe on my left glove all my findings from assessments, so I have the info readily available for a patch report to the ER or nurse report. I found scribing this way inauspicious during a trauma call because of all the dirt, grime, blood and various other substances that typically get on gloves. Also during a trauma I am more likely to change gloves and then lose any info I have scribed.

This Scenario is assuming that your rapid initial assessment has determined that the best course of action allows you to remain on scene with your patient. Let me repeat myself, this is not the proverbial "load and go" yet rather you can "Stay and Play" we are talking about. This technique is rather helpful when remembering all those injuries for later on in the call or after all said and done.

Once the Pt is in the rig and you can focus on your primary detailed physical assessment take a roll of 3 inch tape over lapped vertically 2-3 times. Sectioning it into three areas and place on the cabinets along the patient or the wall/ cabinets behind you. The three sections represent the three sections of the body to focus on in a trauma. Head/Neck, Chest/Arms/ABD and Pelvis/Legs. Now every time you find a injury during  your primary assessment you write the findings on the tape, allowing you to re-evaluate systematically on secondary assessments. This technique also lets you take the findings on these sections into the ER for the staff to see and use.

This is an easy skill to get a young provider to do while you preform the assessments. In the case you are with a driver only, you can use them to scribe for you to help out.

By breaking down a trauma assessment from head to toe you have a record of all the DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling) for all the Non EMS'ers. This will alleviate forgetting any injuries when documenting or when sharing during a report to a nurse.

Now not to say this couldn't be done during a "load and go" depending on various factors, such as transport times, Multiple providers in the back Ect. During those times more important life saving interventions of course  take presidence.

I'm glad to pass this off to my readers for I was passed onto me from a great mentor. She's no longer on the streets but misses it greatly. I hope this bit of info helps, I know it has for me.

Be Safe
Ambulance Junkie