By: Jess Metlay, Captain, 2013
As EMTs we do not provide official diagnoses for our patients but in EMS care it is important to recognize and differentiate between different call types. In this spirit, each month I’ll present a short scenario and either ask you to provide a treatment plan or tell me what’s wrong. So, without further ado…
You drew the short stick this year and ended up on call during Thanksgiving. Luckily today has been pretty unremarkable and call volume is low. You are in the middle of dinner at the station when you notice that your partner, a 35 year old male, just returned from using the bathroom for the fifth time in an hour. In fact, he has been going to the bathroom rather excessively throughout the day. You are a bit concerned, especially since he just recovered from a pretty bad respiratory infection, so you ask him about how he is feeling. Your partner reports that he feels okay right now, although he has been thirsty all day, so could you get him a glass of water? You come back with a cup of water and continue talking. He is generally cooperative and forthcoming with information although after a while he begins to become irritable with your questions since you interrupted dinner and he is still quite hungry. You ask to take his vitals and find that they are normal, except that his pulse is slightly elevated at 110 beats per minute. A quick physical examination is unremarkable save for the fact that his skin is dry and his breathe smells a little odd although you cannot quite place the smell. You have been with your partner all day, so you know that it has been a pretty typical Thanksgiving. Call volume has been slow, so you both have been hanging out most of the day – eating a lot of food and watching TV; essentially the ideal Thanksgiving. After some consideration you think that you have figured out the problem. To be safe, you ask your partner one last question about his medical history and then transport him to the hospital.
What was the question and what’s wrong with your EMS partner? Send your thoughts to firstname.lastname@example.org.
By: Kate Pula, Training Officer, 2015
The keys for patient assessment are SAMPLE (Signs and symptoms, Allergies, Medications, Pertinent past history, Last oral intake, and Events leading to injury or illness) and OPQRST (Onset, Provokes, Quality, Radiation, Severity, and Time). If all of these questions are asked or observed, you’ll get all the important information you need to treat your patient. But once you have this information, you need to make sure you interpret it and use it correctly. For example, with signs and symptoms, you aren’t just finding the chief complaint but also trying to see the whole picture. The patient could have multiple illnesses or injuries, and everything needs to be taken into account. The allergies and medications a patient is taking can complicate injuries or illnesses. For example, a drug that can thin the blood can complicate a patient’s injury. Past medical history can be incredibly important, especially in a situation where the patient has an unknown problem. Past experiences or family history can also give clues to the problem.
OPQRST also helps EMTs look at the bigger picture. You find out when the pain actually started and when it got bad enough to call EMS. The type of pain can change depending on what the actual underlying problem is. It’s also important to pay attention to any changes in the pain while on scene. The key to remember is to treat the patient not the symptoms; you have to see the big picture.
By: Kate Pula, Training Officer, 2015
There are now several areas in the United States, and in the UK where EMTs and paramedics are using cooling techniques to help increase survival for cardiac arrest patients. Cooling methods, which induce hypothermia, are the same that any hospital implements as soon as they receive cardiac arrest patients. Inducing hypothermia consists of administration of IVs that are stored in coolers and ice bags placed in all the major artery areas. The cooling lowers the patient’s body temperature in order to slow blood circulation and decreases the brain’s need for oxygen and therefore decreases brain damage. By the time the patient arrives at the hospital their body temperature has already been lowered a few degrees, so it doesn’t take much time for the hospital to get the patient’s body down to the ideal temperature, which is 89.6 to 93.2°F.
Hospitals across the country encourage EMS agencies to use inducing hypothermia protocol and start the cooling of patients en route to the hospital. It improves the patient’s neurological status and gives the hospital more time for diagnostics and treatment. Since cooling methods have been implemented survival rates have improved above the normal survival rate.
By: David March, Training Officer, 2014
A Pre-hospital Care Report (PCR) that describes the call in the broadest strokes possible may exclude useful information that could have an impact on treatment and diagnostic decisions. On the other hand, voluminous reports for every call end up burying useful information in a pile of irrelevant details. Although when in doubt it is always better to include questionable details, it is worth investigating what ideally belongs in a PCR.
A good PCR covers the entire time-line of the call; including as good a history as possible, a detailed description of your time on scene, and a short note about the patient’s disposition. An extensive history is vital for most medical calls, while trauma calls more often only need an explanation of the events leading up to the incident and an on-scene description. Be sure to note who provided which details and their relationship to the patient. The description of your time on scene should include everything that seems relevant to the patient’s condition, as well as anything very unusual. Summarize repeated behavior; if the patient responds inappropriately to your questions, note this, not all of their responses. Brevity here will help highlight the crucial facts about the patient’s condition.
Dispositions are straightforward, but are crucial from a liability standpoint. As a patient advocate, it is your responsibility to ensure they will be taken care of. Note what agency took control, what they’re planning to do with the patient, and if any difficulties arose in transfer. In addition to providing details about the patient, a PCR provides an explanation and justification for your decisions on scene. If a patient is RMA’d make sure anyone reading the report can tell you had good reason to feel comfortable leaving them on their own. A PCR is a record of your decisions on scene, and anyone reading it should understand your thought process. This is impossible if you don’t include the necessary facts of the case, but it also is severely hindered by unnecessary, irrelevant details.
Completeness comes before conciseness. Always include any details that you think are pertinent to the call. However, whenever possible, ask yourself if a particular note adds anything to your report or if it simply fills up space. All those who need to consult your notes further down the line will appreciate it.
By: Sarah Mincer, Assistant Captain, 2015
It’s that time of year: flu season. Fever, chills, chest pain, and coughing are all indicators of the flu, and they can come on quickly. It can also cause dehydration, nausea, and, in severe cases, pneumonia. As an EMT, you need to protect yourself from getting and spreading influenza from patients you come in contact with. One of the most important things to be able to do is to recognize the differences between the common cold and the flu.
Symptoms can be similar between the two, but there are some distinct differences that can help you tell them apart. A cold comes on gradually, over the course of a few days, and consists of sneezing, cough, stuffy nose and sore throat. Fever is very rare, and there are mild headaches and fatigue. The flu, on the other hand, can begin to affect a person in just a few hours. Patients will experience fever, chills, severe aches and chest discomfort. The common cold normally affects a person for just a few days, but the flu can infect people for a week.
What can you do to protect yourself this flu season? The most important first step is getting a flu shot. Immunized healthcare workers are less likely to get sick them- selves, are less likely to spread the flu amongst their patients, and are less likely to bring the virus home to their family and friends. Flu shots are available through Baldwin and at many other locations as well. Another important thing is having the proper PPE/BSI. If you suspect your patient does have the flu, both the patient and the EMTs should wear surgical masks. Care providers should always wear gloves as well. After being in contact with a patient who has the flu, your hands should be washed and any equipment used should be properly sanitized. At Vassar, patients do not necessarily have to go to the hospital unless their condition is life threatening. Instead, they can be advised to go to Baldwin in the morning to possibly be put under health watch and to be able to stay home from classes. Patients should also be advised to keep themselves hydrated by drinking water or Gatorade, and to simply rest until they are free of fever for at least 24 hours. If you begin to feel flu-like symptoms, do not go on call as that can easily spread the virus to your patients. Stay home from classes and work until you are fever free for 24 hours. Your job as an EMT is to take care of your patients, but you must not risk yourself in the process.
For the inaugural interview, our choice was obvious: Sam Black graduated Vassar last year with a major in Neuroscience & Behavior. Sam was assistant captain his sophomore year and lead VCEMS as captain in his junior and senior years. We caught up with Sam, who is working as a Research Study Assistant at Memorial Sloan-Kettering Cancer Center in New York City.:
VCEMS: What made you decide to join VCEMS and what did you enjoy most?
Sam Black: I took EMT training the summer before attending Vassar in the hopes of gaining some medical experience before going to medical school […] I was eager to get involved with EMS not only to further my development as a medical professional, but as a way to support my school and fellow classmates. EMS is an inspiring organization that allows students to lend their time and medical knowledge to help others. I found the experience of helping out other students to be extremely rewarding, this was certainly instrumental in my continued participation throughout my time at Vassar.
V: How has your experience volunteering with and leading VCEMS influenced your current work or future career plans?
S: VCEMS was an excellent way to explore my interest in healthcare and a way to glimpse what my future professional career might be like. VCEMS helped promote my interest in becoming a doctor and currently helps with my healthcare-related position.
V: Any funny stories?
S: It was particularly amusing the Halloween we were “grounded” because of the snow storm and ended up responding to the calls that we could on foot. That was certainly a change of pace and a great way to see the adaptability of the crew and their ability to make light of a unique/challenging situation.
V: Any words of alumni wisdom?
S: Challenge everything (within reason). Just because something has always been done a certain way, doesn’t mean that’s how it should be done. If you see room for improvement, make it happen or find someone who can.
V: I have to ask, what’s your spirit animal?
S: A pelican
V: Anything else you would like to add?
S: I just want to say how much I enjoyed being a part of VCEMS and am truly grateful to everyone I had the opportunity to work with, as well as those that worked with VCEMS before me and made VCEMS the amazing organization it is today.