Using your senses–sight, sound, smell, and touch–and combining this data with that given by the patient and the clues at the incident scene was the focus of the Friday morning FDIC 2013 classroom session, “Are You an EMS Detective?”
EMS Systems Planner Tim Perkins of the Virginia Office of EMS was the presenter.
Consider the type of calls you receive and relate them to day of the week as well has the location. Where are most of your responses on Friday and Saturday night versus Monday morning, and what are they likely to involve? Perkins said consider whether you might have responded there before and recall the medical issue involved. On arrival, assess the scene to ensure responder safety, because “the safety of your personnel is paramount.” Look for clues that might indicate what the incident might involve. In the case of someone who has been assaulted, could the perpetrator still be in the area? If it’s an overturned propane tanker, what’s that fluid leaking from the vehicle? At an incident involving an injured child, are there clues that might indicate whether the injury was due to an accident or abuse?
According to Perkins, visible clues to the patient’s medical issues might be at the scene. An empty prescription bottle could be a sign of a possible overdose, or just the need for a refill. The type of prescription medicines present also provide clues to the medical issues involved–e.g., cardiac, diabetic, or seizure issues. An oxygen tank and tube would be a sign of a possible respiratory condition as would an asymmetrical chest.
The sense of smell can also clue responders in as to the patient’s condition, Perkins said. Gastrointestinal bleeding, urinary tract infection, gangrene, necrosis, and other conditions have distinct odors.
Using one’s hearing, one may discover that the patient has a broken bone, a subcutaneous chest injury or other respiratory condition, or the presence of an automatic heart valve.
With the sense of touch, an EMS responder may find rigidity, deformity, excessive heat, sensitivity–all clues to the patient’s medical issues.
A patient interview will provide more clarity as to their emergency. Ask who (the patient’s identity), what is the medical issue, where does it hurt, when did it start, and how did it happen. Perkins emphasized such an interview should performed at every call in the same fashion, “Any time you talk to a patient, you have to be consistent.”
Perkins concluded the class with a slide show of EMS patients and on-arrival scenes, quizzing the students as to the medical condition present, how to treat initially, and what possible underlying medical issues need to be considered.