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

A Mid Fall's Night

The sun has set some time ago,

The night before last,
And all through county not a call was being placed, not even an "I've fallen" 

Ambulance plugged in, wheels ready to roll, hopes of a stroke emergency will soon be here.
EMS providers comfy are all snug in their seats.

Thoughts of diabetics and traumas of past were dancing through medics heads. 

Suddenly with out much warning, came a tap tap tap at the window. 

Waking the snoring dispatcher in such a startle. 

Getting up from my desk, eyes filled with joy, I head to dispatch to see what was the matter.

The glow from the neon light shows us what the noise had been.
Could it be, A patient in need?

A call for help? maybe it is an assault? 

Or maybe a chest pain

But no, it is none of these
Twas a drunk cold urban nomad slurring as he speech.
"Its Nisss un.....warmth and conthy."
Looking for a warm place to stay no doubt on this chilly fall night.
The aroma of booze lingered off his breath
Before we had a moment to think the door opened again
In came the officer to escort our late night visitor away to his sleigh
"I'll take him" he said with a jolly chuckle
With a spring in his step, and away with his catch
"Sorry to disturb you and have a good night"

Be Safe
Ambulance Junkie

What Would I teach Lizzie?

-The Handover-EMS Blog Carnival Aug. Submission-

So your proficient in your skills, able to back board with the best of them. Fully capable of putting on a traction splint, vacuum splint and can sling and swath a shoulder. You've studied all the acronyms needed, DCAP-BTLS, PERRL, SAMPLE, and have a solid understanding of their use as it pertains to the patient.

You have a sound understanding that majority of calls will fall in the "grey realm". You'll have some black & white calls laid before you, but over all you'll have an unproportional amount of grey calls. Understanding that once on the streets the clinical decision making is in your hands. You do not solely rely on your initial education, rather the trends in EMS you have been continually researching and the Con Ed classes participated in.

When all else fails Lizzie, you know when to call for help. People become afraid to show weakness in this line of work, but don't be. The simple fact is the nature of the beast that is medicine is ever changing and progressing. It is impossible to be on the cutting edge of every single change in EMS, but hopefully some one else may have the knowledge where you haven't gotten to yet. We must never forget that we are serving for one single reason, and that is to do whats best by the patient. Sometimes that means to ask for help, but you know that already.

Solid fundamentals, capable clinical decision making skills, and the ability to admit to one's self that you need help. That pretty much covers the whole lot of attributes a newly carded EMT will need for the field, and you have them.

So what do I hope I've taught Lizzie? Keep your sense of humor girl! This Career/Stepping stone/Hobby/Calling surrounds us with people having the worst day of their life potentially. We are always in the thick of their crisis, and are the ones they have summoned to help. That is a lot of pressure on an individual, to be the sole saver of life, the Grand Puba of help. the Sultan of Assistance. In order to maintain our sanity we have to be able to keep our sense of humor. Humor is really just a matter of perspective after all. When in the appropriate times it lightens our moods and gives us that little extra to make it another call.

But I'm sure you already knew that Lizzie, you were always a great student.

Be Safe
Ambulance Junkie

A Black and White or a Grey Affair??

"Everyone thinks when they get out of the academy, everything is black and white.  Well you know what? It isn't.  We live in the gray." Southland. 

There is no amount of training or schooling that will prepare you for the gritty realization of life on the streets. There is the obvious right thing to do and the obvious wrong thing to do, but that only covers the extreme polar ends. What do you do the rest of the time? What would you do in the moment when none of your training and none of your schooling seems applicable? The moment you enter the Grey Zone?

Your presented with a Frequent Flyer drunk, we all know the one, you pull up on scene and know his Name, DOB, SSN, Medical Hx, his wife's name, and their pet cat named Fluffy. He's a block away from his apartment, and is shit faced. He left the bar the block back and has been fighting the ever ominous force known as gravity the entire time. A good Samaritan saw him fall while driving and called 911, though never felt the need to stop and help him.

So Black and White would say a male Intoxicated fallen is a transport to the ER, right? He has consumed alcohol and thus not allowed to refuse medical aide and transport because he has a mind altering drug on board. He is adamant in not going to the ER, and it will be a struggle the entire ride in to keep him relaxed and on your stretcher.

Grey would say that he was heading home, He's a block away, and he needs to sleep this off. Yes he is drunk but if he shows no signs of trauma after a full assessment and is capable of appropriately answering person, place, time and thing than he has the right to refuse Medical aide and transport. You can't take a man against his will and you know his non driving wife is home awaiting his eventual arrival.

So what do we do? In this exact situation it comes down to your way of thinking, which I have done both:

Black&White- You get your Malnourished Morgan Freeman look alike patient and sit him on the stretcher. He banters on about being taken against his will as you put his lap and leg belts on. He emanates enough booze out of his pores for you to inhale a contact buzz. You wrestle to keep him on the stretcher and avoid his misguided attempts at a punch. You use all EMS Mind tricks to distract him and take his attention off his disgruntlement.

Grey- I've signed off my local drunk and given him a courtesy ride home. Walking him to his door and helping him to his front door where he lets himself in. Seeing his worn and weathered wife looking with shame and embarrassment of the spectacle he must have caused from with in the house. We bid our patient ado, and reassure the wife that bringing him home was no problem and it'd save them some money from the ER bill. No doubt leaving the patient to crash on his couch and sleeping off his alcoholic induced life style.

No one prepares us for the split second decisions having to be made on the streets. No one prepares you for the second guessing you'll do the moment the call is over. EMS is Black and White except for when its grey. EMS is truly a conundrum.

No matter your decision, use you clinical assessments and sound medical judgment and stick by it; but always be able to learn from your mistakes.

Be Safe
Ambulance Junkie

Down Time

We have all been there, sitting around in our bus at 200 hours waiting for the hand of the clock to click a second closer to the end of our shift. Surrounded by the darkness of the night, our partner snoring away and the soft gentle glow of a street light far off in the distance. We spend countless moments Stumbling through the vast emotional emptiness of the Internet, grinning at the occasional viral video of a hit in the junk while listening to the chirp of the occasional radio transmission. Watching urban nomads settle in for the night on their park bench bed's and the ladies of the night turning tricks a corner away. Maybe we sit in the confines of a station, flipping channels because we have seen the oxyclean infomercial enough to recite it by heart. Listening as the Fire Ambulance signs off yet another assault victim, we pace to the vending machines to tame a late night hunger. The hum of the air conditioner like a lullaby we fight the need to sleep some of us give in to this desire while others review yet another pile of charts.
When we are left to our own devises and are feeling rather creative we can truly come up with some great and memorable time killers. An impromptu snow ball fight employees V.S Supervisor (which I was on the receiving end of) or sledding down a hill with the backboards at the park. In the summer months we kick back and cast our lines in the river and wait for the bass to bite, or maybe work on our drive with a bucket of balls on the range. Grab a Ball and head down to the courts to play a quick two-on-two game of basketball or even a game of horse. Creating a dance atmosphere with the rigs lights and a radio station. Creating an ambulance dance which much like it sounds reenacts the unloading and reloading of the stretcher.
When it comes to the best down time I have ever had; it is hands down the simplest yet most gratifying moments of sitting around the kitchen table in the station late at night telling stories and rolling off each others jokes. Standing in the kitchen reenacting the story of "The Ambulance Chaser" or chuckling over our Brit and his love of Quiche and meat pie's. Laughing at NH's cat book page only to have NH unable to sarcastically defend his love of cats/ Reminiscing about old school toys like lawn darts, Pogs, and intellivision and than having to explain to the nineteen and twenty somethings what they are. Explaining how it really was a lady on a horse we got directions from, and how much better things really are on this side of the river.
The kitchen table talks have to be the greatest time to bond amongst the crews in the station. Interweaving our personal humors and sarcasms into a gut wrenching conversations. Only to be interrupted by the inevitable squawk of the radio...County: "Have a rig for the city"....Dispatch: "That's affirmative"....County: "stand by one"
Be Safe
Ambulance Junkie