SAR-EMT40
Well-known member
Since there seems some interest in this I will mention a few thoughts:
In any medical/trauma emergency you need to check the following things in this order.
The three first things that you do are: Make sure the scene is safe then you make sure the scene is safe and then make sure the scene is safe. Does everyone understand the first three most important things that must be done? Your patient doesn't get better because you die attempting to help him and you becoming another patient at the scene does not help the situation in any way, shape, or form either.
Now that we are sure the scene is safe we look at the patient as we approach them. Your assessment of them is already starting. Do they look OK? Do they look sick? What looks wrong about them? What is their color like? How are they breathing? Are they protecting any limbs from further injury, etc. Are they conscious? Are they looking at you as you approach and alert? Get a general overview of the scene.
Then check:
A – Airway - If it is blocked it must be cleared. If it is blocked by the tongue then do a head tilt to clear the blockage. If you suspect head/neck injury then do a jaw thrust. Note: everyone has a head/neck injury until proven otherwise. If it blocked by vomitus or other material use a gloved hand (you do have several pairs of gloves in your medical kit I hope
) to clear it after turning the patient on his side with a log roll while someone stabilizes the head. This will take at least three of you, four is better. If you cannot do this properly by stabilizing the head do it anyway. A patient without a patent airway is a dead patient. You can only do the best you can with the tools and people that are available.
B – Breathing – If they aren’t doing it then you need to do it for them. I am not putting my mouth on anyone I don’t know so carry a barrier that you can use. If their breathing is less than 12 or greater than 20 per minute then they have a problem. Try to correct it if you can. You will not have O2 and a non-rebreather so this my be difficult to accomplish.
C – Circulation – Do they have a pulse? If they don’t then you need to try to help them. You can’t learn CPR over the internet or by watching reruns of ER. Take a class. The honest truth is if they have a cardiac crisis (their heart has actually stopped) in the woods, they are probably (certainly) going to die. Make sure you understand that. You perform CPR to the best of your ability as long as you physically can, but the patient is going to die. Why bother doing CPR at all? If it was your father or wife or son, wouldn’t you want to know that the people that found them did everything they could? If a patient’s heart stops because of trauma, you are almost certainly not going to be able to restart it. Why? Trauma patients usually die of things like hypovolemia (low blood volume). They bleed internally, they bleed externally. In order to bring them back, you need to correct where they are bleeding from and then replace the blood and then restart their hearts. This is what we pay trauma surgeons for. Trauma dead is usually (always) dead, dead. Caveats: Cold people (hypothermia cases) are not dead until they are warm and dead. Do not do CPR on hypothermia patients. Do not even jostle hypothermia patients unnecessarily.
I hope that this doesn’t make me sound cynical, I’m not. I just want people who come across situations like this to realize that people die. You can do everything correct and those people will still die. Realize that you did the best you could and that was all you could do. Since for most of you a situation like this will be happenstance. You will not have the resources that professionals have to deal with a call that really bothers you, emotionally. Someone once said there are two rules in emergency medicine. Rule 1 is that people die. Rule 2 is that sadly, doctors, nurses and EMTs cannot always change rule number one.
Things that the medical responders want to know that you can find out:
AVPU – Are they Alert (Alert)? Do they respond to you talking to them (Verbal). Do they respond to pain? i.e a sternal rub or with a woman pinch on the back of the hand? (Pain) Or do they not respond at all (Unresponsive).
If they are alert. Are they oriented to Person (what is their name)? Place (where are they)? Time (what time/day is it)? And the event. (What happened)? If so then they are said to be alert and oriented times 4. If not, how alert are they. Times two or three etc. A very important question, is the question, is their mental status changing? Is it getting worse or better?
Find out what is their chief complaint. What are their Signs/Symptoms? Do they have allergies, what are they? What medicines do they take? Did they take them today? Have they had this happen before? When was the last time they ate something? What where the events that lead up to this problem? If they cannot answer you, what can his/her friends or bystanders tell you. This is called a SAMPLE history.
What caused this onset of symptoms? What makes this feel better or worse? What does the pain feel like, does it radiate? How bad is the pain on a scale of 1 to 10? When did it start?
Can this person move on his/her own? How much do they weigh?
Things you can do even if you are not a medical responder. Get a pulse rate. Learn how to properly take a pulse. While you get this you should also note what the skin is like. Is it warm and dry or cold and clammy or hot and dry? Is the skin color pink or is it red or blue or gray? Especially the finger and toe nail beds. Try to check these things every 10 minutes if you can. Write this information down with the times and also any changes in mental status.
Learn to control bleeding. Where the pressure points are on the body and how to apply direct pressure or diffuse pressure to stop bleeding. Raising the wound above the level of the heart. These measures are almost always enough to stop bleeding. Tourniquets are almost never, ever needed. Applying a tourniquet almost guarantees the loss of the limb from that point down. If you do use one make sure it is wide and as far down the limb as possible. Once applied it shouldn’t normally be removed. Doing so could release blood clots that can have very dangerous implications.
Splinting. Learn how to make a splint. Learn how to pad and apply a splint properly for both bones and joints and how to check CSM (Circulation, Sensory, Motion) before and after you apply a splint.
There is obviously more I am not mentioning. Much, much more. So much more I really wonder if I am doing a service mentioning this or if it will cause more confusion then help, but here it is. If there are any questions I will try to answer them as best I can.
Obviously taking a first responder class would be a great idea but more then that you really need to practice these learned skills often to keep all this stuff from just leaking out your ears. Like it does with me all the time.
Keith
In any medical/trauma emergency you need to check the following things in this order.
The three first things that you do are: Make sure the scene is safe then you make sure the scene is safe and then make sure the scene is safe. Does everyone understand the first three most important things that must be done? Your patient doesn't get better because you die attempting to help him and you becoming another patient at the scene does not help the situation in any way, shape, or form either.
Now that we are sure the scene is safe we look at the patient as we approach them. Your assessment of them is already starting. Do they look OK? Do they look sick? What looks wrong about them? What is their color like? How are they breathing? Are they protecting any limbs from further injury, etc. Are they conscious? Are they looking at you as you approach and alert? Get a general overview of the scene.
Then check:
A – Airway - If it is blocked it must be cleared. If it is blocked by the tongue then do a head tilt to clear the blockage. If you suspect head/neck injury then do a jaw thrust. Note: everyone has a head/neck injury until proven otherwise. If it blocked by vomitus or other material use a gloved hand (you do have several pairs of gloves in your medical kit I hope
) to clear it after turning the patient on his side with a log roll while someone stabilizes the head. This will take at least three of you, four is better. If you cannot do this properly by stabilizing the head do it anyway. A patient without a patent airway is a dead patient. You can only do the best you can with the tools and people that are available.B – Breathing – If they aren’t doing it then you need to do it for them. I am not putting my mouth on anyone I don’t know so carry a barrier that you can use. If their breathing is less than 12 or greater than 20 per minute then they have a problem. Try to correct it if you can. You will not have O2 and a non-rebreather so this my be difficult to accomplish.
C – Circulation – Do they have a pulse? If they don’t then you need to try to help them. You can’t learn CPR over the internet or by watching reruns of ER. Take a class. The honest truth is if they have a cardiac crisis (their heart has actually stopped) in the woods, they are probably (certainly) going to die. Make sure you understand that. You perform CPR to the best of your ability as long as you physically can, but the patient is going to die. Why bother doing CPR at all? If it was your father or wife or son, wouldn’t you want to know that the people that found them did everything they could? If a patient’s heart stops because of trauma, you are almost certainly not going to be able to restart it. Why? Trauma patients usually die of things like hypovolemia (low blood volume). They bleed internally, they bleed externally. In order to bring them back, you need to correct where they are bleeding from and then replace the blood and then restart their hearts. This is what we pay trauma surgeons for. Trauma dead is usually (always) dead, dead. Caveats: Cold people (hypothermia cases) are not dead until they are warm and dead. Do not do CPR on hypothermia patients. Do not even jostle hypothermia patients unnecessarily.
I hope that this doesn’t make me sound cynical, I’m not. I just want people who come across situations like this to realize that people die. You can do everything correct and those people will still die. Realize that you did the best you could and that was all you could do. Since for most of you a situation like this will be happenstance. You will not have the resources that professionals have to deal with a call that really bothers you, emotionally. Someone once said there are two rules in emergency medicine. Rule 1 is that people die. Rule 2 is that sadly, doctors, nurses and EMTs cannot always change rule number one.
Things that the medical responders want to know that you can find out:
AVPU – Are they Alert (Alert)? Do they respond to you talking to them (Verbal). Do they respond to pain? i.e a sternal rub or with a woman pinch on the back of the hand? (Pain) Or do they not respond at all (Unresponsive).
If they are alert. Are they oriented to Person (what is their name)? Place (where are they)? Time (what time/day is it)? And the event. (What happened)? If so then they are said to be alert and oriented times 4. If not, how alert are they. Times two or three etc. A very important question, is the question, is their mental status changing? Is it getting worse or better?
Find out what is their chief complaint. What are their Signs/Symptoms? Do they have allergies, what are they? What medicines do they take? Did they take them today? Have they had this happen before? When was the last time they ate something? What where the events that lead up to this problem? If they cannot answer you, what can his/her friends or bystanders tell you. This is called a SAMPLE history.
What caused this onset of symptoms? What makes this feel better or worse? What does the pain feel like, does it radiate? How bad is the pain on a scale of 1 to 10? When did it start?
Can this person move on his/her own? How much do they weigh?
Things you can do even if you are not a medical responder. Get a pulse rate. Learn how to properly take a pulse. While you get this you should also note what the skin is like. Is it warm and dry or cold and clammy or hot and dry? Is the skin color pink or is it red or blue or gray? Especially the finger and toe nail beds. Try to check these things every 10 minutes if you can. Write this information down with the times and also any changes in mental status.
Learn to control bleeding. Where the pressure points are on the body and how to apply direct pressure or diffuse pressure to stop bleeding. Raising the wound above the level of the heart. These measures are almost always enough to stop bleeding. Tourniquets are almost never, ever needed. Applying a tourniquet almost guarantees the loss of the limb from that point down. If you do use one make sure it is wide and as far down the limb as possible. Once applied it shouldn’t normally be removed. Doing so could release blood clots that can have very dangerous implications.
Splinting. Learn how to make a splint. Learn how to pad and apply a splint properly for both bones and joints and how to check CSM (Circulation, Sensory, Motion) before and after you apply a splint.
There is obviously more I am not mentioning. Much, much more. So much more I really wonder if I am doing a service mentioning this or if it will cause more confusion then help, but here it is. If there are any questions I will try to answer them as best I can.
Obviously taking a first responder class would be a great idea but more then that you really need to practice these learned skills often to keep all this stuff from just leaking out your ears. Like it does with me all the time.
Keith
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