By: Peter Florio, Equipment Officer, 2013-2014
One of the more common medical instruments you may encounter is an Epi-pen. These are epinephrine shots most commonly prescribed to those at risk of a severe allergic reaction. While normally carried by EMS, they are not currently carried with us, as a certain certification is needed which we do not have, but are working toward. VCEMS has been working with Baldwin for several years to obtain this certification, and we are nearing our goal. We hope to be able to begin carrying Epi-pens within the next year.
We’ve also been talking about designing a logo unique to VCEMS, something like you might see between different police or fire departments. These could be sewn onto future uniforms, jackets and jump bags. Our patch is still in the early stages, so feel free to email any of the officers with designs or ideas.
Lastly, while not technically something new, cold and flu season is upon us once again. Remember to take extra precautions in the next couple of months. Wash your hands frequently, bundle up outside and get plenty of rest (or…as much as college students can, anyway).
By: Kate Pula, Captain, 2013-2014
As EMTs we do not provide official diagnoses for our patients but in EMS care it is important to differentiate between 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 receive a dispatch on a Friday evening for a semiconscious 19 year old male patient. When you arrive on scene you find your patient awake, but confused on the floor of his room. Bystanders report that they came in and found the patient asleep on the floor. Your patient originally started out confused and stated “it’s hard to concentrate right now”, but is now answering questions slowly. He reports while he feels a little sleepy, he is starting to feel better. Your patient does not report any nausea or vomiting (nor is there any present on scene). Your patient is having trouble remembering, but believes after going out tonight he had only a two beers, which is below his usual limit. The bystanders cannot confirm prior events because they were not with the patient earlier tonight.
Your patient is allergic to dust mites and reports taking no medications. You take vitals and everything is normal, except breathing is fast at 20 breaths/min and he is hypertensive with a blood pressure of 140/90. You again ask how your patient is feeling, “it’s still hard to think” and he reports a slight migraine. He also reports it’s still hard to remember tonight’s details. However, he is feeling more awake and is answering questions faster. There is no trauma present and your patient reports he doesn’t feel any pain besides the migraine.
The events and symptoms of your patient don’t seem to add up. You ask a few more questions about your patient’s past medical history and he does mention some past injuries (concussions) from playing soccer, one of which happened quite recently. You think you have your patient’s problem figured out and ask one more question about your patient’s family medical history, and decide immediately that he should go to the hospital.
What was wrong with your patient? Send your thoughts to email@example.com.
By: David March, Training Officer, 2013-2014
Different calls will have different forms that most effectively get the information across. However, a good general form emerges from the popular acronym SOAP: Subjective, Objective, Assessment, (treatment) Plan. Here’s a summary:
Subjective: Introduce the patient and their condition. Include relevant history given by the patient and by bystanders (always noting the source of the information), and everything that led up to EMS being called. This information is likely to be the least scientific on your report, but it also can be absolutely critical to assessment of the patient further down the healthcare chain.
Objective: Here’s where you get to strut your EMS stuff. What examinations did you perform, and how did these turn out? Running through DCAPBTLS, did you notice anything odd about the patient, or is there anything that you would have expected to be unusual that turned out to be unaffected? This section is where you prove that you did you job thoroughly examining the patient for symptoms.
Assessment: We don’t provide diagnoses in EMS, but that doesn’t mean that were clueless about what is going on with a patient. If you suspect that something in particular is off with a patient, and it ties into your treatment plan, note it.
Plan: Once you gathered all your information about the patient’s condition, what did you do about it? Don’t forget that treatment plans can include everything from administering oxygen to moving them into a seated position. Your treatment plan should also include the patient’s disposition, as turning control over to a different agency should come from your expectation that there is something that agency can provide that you cannot.
PCRs are a record of all the information about the call, but this information will be confusing and misleading unless you organize it in a sensible fashion. Use your best judgment when organizing your narrative section, but if you’re unsure of how to proceed, SOAP is a good generic template. And please, take some time before you start writing. Talk to the other EMTs involved in the call, read over your notes and run through the call in your mind. Taking a few moments before you start can radically improve the quality of your report, as it gives you time to remember the details of the call, and to put them into an understandable order.
By: Dana Convissar, PR Officer, 2013-2014
Jess Metlay graduated in May 2013 with a major in Sociology and a minor in Chemistry. She was involved with VCEMS for three years of her Vassar career, and served as Captain her senior year. Jess is currently working EMS in Philly and applying to medical school.
VCEMS: What made you decide to join VCEMS and what was your favorite part?
Jess Metlay: I signed up to take Vassar’s EMT training course my freshman year on a whim. The course description said something to the effect that students were expected to join VCEMS after completion, so that’s what I did. Although that’s a pretty boring story, so feel free to make up a different response before you publish this.
My favorite part was driving the van and abusing any small amount of power that I came across…Okay, my actual favorite part was getting to meet and hangout with everyone in VCEMS. In my unbiased opinion, we’re a pretty rad group. The van is nice too though.
VCEMS: What is the most important thing you learned from VCEMS?
Jess: Getting serious for a moment, I learned a lot about being a leader; especially how important it is to set up a group dynamic where everyone feels comfortable contributing, taking risks, and is able to maximize their potential. This held true both on call and in VCEMS as a whole. I also finally learned how to activate a cold pack.
VCEMS: How has your experience volunteering with VCEMS influenced your current work or future career plans?
Jess: I started college very decidedly not pre-med and now I’m applying to medical school, which I very much credit and blame on VCEMS.
VCEMS: Any funny stories?
Jess: During a shift last year, I got a call late one night, which in and of itself is typical. But as I was gathering my stuff to respond, I realized that I couldn’t find my glasses. I looked around my room without success and grew increasingly frantic running up and down the stairs of my TA several times looking for my specs only to realize that I was already wearing them. I definitely had a good laugh at myself for that one.
VCEMS: What’s your spirit animal?
Jess: Currently, ‘Moby-Dick’ who is the squirrel nesting in the ceiling of my apartment.
VCEMS: Words of advice to current members?
Jess: If you haven’t already, watch the ‘Spice World’ movie. I saw it when it was first released in theaters and it has had a profound effect on my life.
VCEMS: Anything else you would like to add?
Jess: My actual advice is to seek out and remain open to new ideas. Also, find time to hang out with friends, don’t take yourself too seriously, develop a regular sleep schedule, and call your relatives more (this last sentence is for me).
By: Kevin Lee, Training Officer, 2013-2014
This scenario is meant to inform brand new EMTs and First Responders of how VCEMS goes through a call. While this is by no means a thorough overview of how to lead a call, this is a good guide to what happens during a call. Enjoy!
So the tone goes off at 3:30AM. CRC tells you to head to the SoCos for a patient with abdominal pain. And you live in Jewett. As you groggily make your way down the stairs, you remember to take your time because while you’d rather be sleepwalking, you don’t want to fall down the stairs and become a patient yourself! Always walk to your calls rather than risk an accident. Travel down well-lit paths and next to campus roads if you can. Who knows, maybe a passing security car will give you a lift if you ask nicely!
After a chilly walk outside and now wide-awake from the cold, you and your partners finally reach the scene. One of the patient’s housemates lets you guys in and shows you to the patient’s room. The door is closed and apparently the patient is in too much pain to move and open the door. You knock and the patient allows you to enter. As you position yourself to the far side of the door, you motion your partner to the other side of the door, closest to the handle. Then you open the door slowly, as you and your partner search for any signs of danger. The room is dimly lit so you stop your partner for a second and reach for your flashlight. You confirm the room is free of dangers and you move in to see a male sitting up on the bed but bracing his stomach. As you approach the patient, you put on a pair of gloves, just in case.
Now it’s time to introduce yourself! With a smile you say to the patient, “Hi, my name is Kevin and I’m with VCEMS, how can I help you?” You are relieved when the patient clearly tells you what the problem is, since you verify that he is alert and oriented, has a clear airway, appropriate breathing to complete a sentence and that circulation is present and not at risk. Confirming that the patient is stable, you ask questions appropriate to the problem ruling out possibilities such as an exposure to allergies, appropriate food intake and drug interactions. You also physically assess the patient, palpating the four quadrants of the abdomen and asking the patient to describe characteristics of the pain. As you lead the call, your partners are taking baseline vital signs, including blood pressure, pulse, respiration, eyes and skin, and jotting down important notes on a notepad.
Based on the patient’s responses and your assessments, while the patient is in discomfort, it is not serious enough to warrant a transport to the hospital without the patient’s consent. You ask the patient if he wants to go to the hospital but he says no, saying he does not believe it is necessary and that the pain is subsiding. You then inform him the dangers declining a transport and ask him to confirm his decision. After he confirms, you inform the patient to perform to a follow-up with Baldwin the next day and to contact EMS if his condition becomes worse. After the patient signs the RMA agreement, you head back into the EMS van for the trip back to Baldwin.
At Baldwin, you dispose of any equipment you used that can be disposed of. You wash your hands and refill your bag with any equipment you used, and then record your call on the PCR log, remembering the call number. You then diligently write your PCR, clarifying facts about the call with your partners. Once done, your partners peer review the PCR looking out for any possible errors or omissions. After everyone approves and signs, the PCR is submitted to the Baldwin box and everyone goes home to a warm and cozy bed.
Even though not every call will happen in a similar manner, it is important to notice how the crew was a well-operating team. The scene was consistently assessed for possible dangers and appropriate body substance isolation precautions were taken. There was a clear leader for the call and the other EMTs involved understood their roles and performed optimally to provide and record detailed information for the lead EMT. Finally, it is the lead EMT’s duty to appropriately debrief the crew of the call and ensure all questions and lingering concerns have been answered. These factors are necessary to ensure high-quality patient care can be given to any patient during any situation. Practice makes perfect and you cannot improve yourself if you have nothing to improve on. So sign up for shifts, go on calls and always strive to become better EMTs and First Responders!