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!