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Author Question: The Pesky Reporter and the Wildfire
Charise’s question is very pertinent particularly with so many wildfires burning in my home state of Colorado right now. How does EMS handle it all? Charise asks: I’ve got a forest fire happening and a news photographer out trying to get the best shots. She’s walking around recently scorched areas. Her car is parked on black top. It’s still pretty hot and smoky but she is there without an air tank so it can’t be too crazy. I need her car to be inoperable but nothing too crazy like exploding. Is it possible that parked on asphalt, the tires would blister or begin to melt (but a person could still be okay walking around on the dirt)? It seems the way heat is conducted in the earth vs. pavement makes this plausible? Also, I know animals flee a fire but do they get caught sometimes? Is it possible she’d come across a dead deer? After she leaves the area, it’s normal she’d have some smoke inhalation problems? Coughing, hacking, etc? Does that require medical treatment or would she be left alone since she’s lucid and otherwise healthy? Dianna says: My first thought is that rescue personnel (fire, EMS, law enforcement, haz-mat, etc.) form a perimeter (boundary circle) of three areas: the hot zone, the warm zone and the cold zone. Hot zone is where the actual emergency event is occurring (in your story case, the forest fire). Warm zone is the surrounding area next to the hot zone; it’s for rescue personnel to enter and exit the hot zone and for decontamination. Cold zone is the area beyond the warm zone and is the only area okay for civilians, including the media. That said, your character wouldn’t be allowed in an area that her car would experience the damage you stated. Now, of course, sometimes the media and other civilians enter a restricted area like the warm zone (they wouldn’t enter the hot zone unless they’re willing to die). So, you could certainly add that into your story, but she would have charges brought on her, so your story needs to reflect that. It sounds like you have your reporter character staying with rescue crews, and that’s not accurate. We ”deal with” the media this way — we tell them exactly where they can stand and set up their equipment, we keep them informed and updated, and we monitor their whereabouts, but we don’t hang around with them since our job is to work the scene (not watch it unfold), and we certainly don’t allow them to travel around with us at a scene. Sure, we talk with the media, even joke around and share information as appropriate (sometimes just to emotionally handle intense situations), but it’s kept to a minimum and very professional. Good conflict for fiction, though, would be for a rescue personnel to deviate from this, but make sure that person has strong reason for doing so. It’s highly unlikely she wouldn’t be caught (the boundaries are well monitored), especially since you say she suffers with respiratory issues, so the authorities would know she entered the warm zone (we’d hear her coughing). As for the medical issues she’d experience, it depends on where exactly she traveled at the scene and it depends on her signs and symptoms. She wouldn’t be covered in ash unless she was actually in the hot zone. If she does experience any respiratory distress, she’d be unwise not to seek medical treatment, and the treatment...
read moreDecompresion Illness
If you ever write a scuba diver character, a deep sea diver, a search/rescue/recovery diver, a Navy submariner, etc., you’ll need to understand Decompression Illness (DCI), a serious illness caused by trapped nitrogen. There are two mechanisms of DCI: 1) Decompression Sickness 2) Arterial Gas Embolism SCUBA (Self-Contained-Underwater-Breathing-Apparatus) divers breathe a purified air mixture of 79% nitrogen and 21% oxygen. The longer a diver is breathing this mixture and the deeper he/she descends, the more nitrogen will be absorbed by the body. A slow ascent and a safety stop at about thirty feet for three minutes, allows the diver to efficiently exhale the nitrogen. Dive tables set limits for dive times and depths. Decompression Illness is caused by tiny nitrogen bubbles forming (instead of being exhaled) and becoming trapped in the blood and tissues. There are two types of Decompression Illness: 1) Type I 2) Type II Type I: 1) Skin capillaries fill with the nitrogen bubbles, resulting in a red rash. 2) Musculosketal: Joint and limb pain Type II: 1) Neurological decompression sickness: Tingling, numbness, respiratory problems and unconsciousness. 2) Pulmonary: Bubbles interrupt blood flow to the lungs, causing respiratory distress or arrest. 3) Cerebral: Bubbles travel to arterial blood stream and enter the brain, causing arterial gas embolism and symptoms of blurred vision, headache, confusion, unconsciousness. General Decompression sickness symptoms: Extreme fatigue, joint and limb pain, tingling, numbness, red rash, respiratory and cardiac issues, dizziness, blurred vision, headache, pain with swallowing, confusion, loss of consciousness, ringing in ears, vertigo, nausea, AMS (altered mental status), pain squeeze, SOB (shortness of breath), chest pain, hoarseness, neck fullness, cough. Factors that increase the risk of getting decompression illness: Dehydration prior to dive, stressful dive or rapid movements during dive, alcohol intake prior to diving, flying too soon prior or post diving, not following dive tables. As every patient is different, every diver will have their unique combination of symptoms and reaction to both the illness itself and the treatment. Decompression illness is treated by hyperbaric recompression chamber therapy. Only certain hospitals in the word have a hyperbaric chamber. The severity of the patient’s condition and his/her symptoms will decide the length of time the patient is treated inside the chamber. Nitrogen narcosis is also caused by trapped nitrogen, but this is a simple fix and isn’t serious if resolved. The diver simply ascends to a shallower depth until his/her symptoms clear. Symptoms include: An altered state of awareness and gives the diver an intoxicated state of feeling, incoherent reasoning and...
read moreUnbelievable Real Life, Believable Fiction
When I hear a reader say: “That’s not realistic; all of that couldn’t happen to one character.” I think, “That reader has skirted through life with little trial.”Spring 2009, a cop barreled into our car, injuring my oldest daughter, my son and myself. My husband and our youngest daughter escaped uninjured. The two kids healed; I suffered a shoulder and cervical injury. Actually, those injuries initially occurred when I was in a bicycle accident (a driver ran a stop sign); the car accident worsened those injuries. A few months following the car accident, my husband’s biopsy on an enlarged lymph node was negative, but a few months later he was diagnosed with head and neck cancer (the biopsy results were wrong). In 2009 and 2010 he endured two surgeries and cancer treatments. During this same time, our son battled a mysterious illness I suspected was Lyme disease since he had fourteen Lyme’s symptoms, but Curtis didn’t test positive so no physician would listen—see Brandilyn Collins’ posts May 2011 titled: The Lyme Wars. Most Lyme’s patients don’t test positive. For the love of hockey, Curtis fought the pain and continued to play; unfortunately, he suffered a shoulder separation during a game. In a sling for that injury, he had a MRI on a large cyst behind his knee; it tested benign. Hoping I was wrong about Lyme, I agreed to allergy injections to treat Curtis’ allergy-like symptoms. Days after the injections started, he developed a systemic rash. The allergist responded, “There’s an underlining cause.” So, I told an infectious disease MD, “Don’t think of me as a mom; as an EMT I’m telling you this patient has Lyme disease. Please help him.” After several months of Lyme’s antibiotics, Curtis improved but still battled bilateral knee and ankle arthritis. My orthopedic surgeon (explanation later in this paragraph) diagnosed Curtis with Lyme arthritis saying, “Bring on the CDC; this kid has Lyme disease and I’m treating him as so.” During the several months of Curtis enduring tons of doctor appointments (pediatrician, allergist, dermatologist, infectious disease, rheumatologist and orthopedist) plus countless tests, my shoulder worsened to the point I needed surgery to repair a labral tear. To date, Curtis still suffers with Lyme arthritis and may for years. Unbelievably, fall 2011 he suffered a severe concussion from head trauma in a hockey game and was out of school for three weeks. As for my daughters: In 2010 my oldest was being recruited by countless college swim coaches. They were in and out of our home and Sabrina traveled on college recruiting trips; exciting yet stressful. My youngest, Fiona, dealt with anxiety from watching her family endure this mess. How can one family battle all that in two years? For starters, God carried the five of us. Plus, Leo and I are well practiced in dealing with life’s mountains. Leo’s brother committed suicide when I was pregnant with Sabrina; I went into labor at the funeral. When Leo was sixteen, his dad suffered a heart attack; Leo drove him to the hospital in time. At age seventeen, I lost my family when my dad was killed in a bicycle accident. Also, Leo and I lost three babies, one of them in my second trimester due to a disease that prevented the development of limbs and...
read moreDiabetic Emergency
EMS 4 diabetic emergency at 123 Fox Street, at 123 Fox Street on TACH Channel 12 I stuff the rest of my sandwich into my mouth and gulp down some water as I rush out of the fast food joint to hop into my ambulance. As my partner signals RESCOM (dispatch) we’re en route to the above (sample) call, I speed our ambulance down the road, lights and sirens. I won’t discuss the full assessment and treatment we’d perform on a diabetic patient, but if you want clarification or further explanation for your fictional writing needs, please ask me. On scene we find first responders assisting an unconscious male sitting slumped over in a Target bathroom. “His blood sugar is 12,” one of the firefighters tells me. “He works here and his co-workers say he takes insulin daily.” “Sir?” I say to the patient. “Can you hear me?” No response. His eyes are half open. His pupils are dilated and sluggish. My partner and I insert a line (IV), and push one 25g AMP (ampule) of D50 (dextrose 50% in water). I attach him to our cardiac monitor via a 12-lead (ECG patches), and assess his heart rhythm and all his vital signs. He’s in normal sinus rhythm and all his vits are within normal range; however he’s slightly tachycardic (heart rate too high), but an elevated HR is the body’s defense to survive a hypoglycemic episode (low blood sugar). “Sir?” I place my hand on his shoulder. “Hey, buddy, talk to us.” The patient remains unresponsive, so my partner and I push another 25g AMP of D50. Via a glucometer, we test his BGL (blood glucose level). It’s now 43. We’re headed in the right direction, but the patient is still unresponsive. We administer 1mg of glucagon IM (intramuscular injection). “Sir?” I squeeze his hand. “I need you to talk to me. Okay?” He stirs, his eyes attempt to focus. We load him onto our stretcher and wheel him inside our ambulance. Within a few minutes, he stares at me. “Where am I?” “You’re in an ambulance, sir. I’m EMT Benson.” I finish retaking his BGL again. It’s now 98 (within normal limits). “Do you know what happened?” He nods. “Yeah. It happened again. Twice this week. Stupid blood sugar.” Can you tell me your name?” I ask, even though I know his personal information via his co-workers. I start this line of questioning to assess the patient’s mental status. “Bob.” “Okay. Bob, what’s your birthday?” “Ah…February 3, 1972.” “Uh-huh. Gosh, Bob, my math is horrible. How old does that make you?” “Thirty-nine, but don’t tell my girlfriend. She thinks I’m thirty-one.” I laugh. “I won’t say a thing, but you may want to tell her yourself soon, what do you think?” “You’re probably right.” “You take insulin, I hear. Did you take any today?” “45 units, early this morning.” “45, huh? Have you eaten anything today?” I note the time is twenty minutes past noon. “Two graham crackers.” “You need to eat more than that, you know? Especially after 45 units. Breakfast is the most important meal of the day. Promise me you’ll eat breakfast everyday.” He nods as he smiles at me. I radio the hospital. “Wake Med, EMS 4 en route with pt (patient) initial BGL 12, then 43,...
read moreEMS Call: Respiratory Arrest
Dianna is back for her monthly EMS post. I’d like to pass along my congratulations to her for winning in the ACFW Genesis contest this year! This is a much sought after award and will turn the heads of editors her way. I know we will be seeing her books published in the coming years. Today, she focuses on the aspects of a respiratory call. This will help add those factual details for your scenes. EMS 18, respiratory distress at 1234 Greene Road, at 1234 Greene Road on TACH channel 7. joeyvest As we climb into our ambulance posting (parked) at our station, my partner and I radio in we’re en route to the above scene. Lights and sirens, we rush out of the garage. En route, we’re notified via our computer that the patient is a 24-year-old female and is conscious and breathing. Once on scene, we find the scene is safe and no dispatched law enforcement. Typically a fire crew arrives on scene first (prior to us) since there are about three times more firehouses thanEMS stations globally, thus they’re closer than we are. However, fire is not always dispatched along with EMS, so for this sample EMS call we’ll say fire wasn’t dispatched. Upon our arrival at the patient’s side, my general impression of her is she’s SOB (short of breath) and in respiratory distress (dyspnea). She’s sitting in the tripod position (leaning far forward with her palms on her kneecaps) and she’s breathing shallow and fast (tachypnea). She’s not cyanotic (blue lips or fingernail beds), so she’s perfusing fine at the moment and not hypoxic (lack of efficient oxygen), but that can quickly change. I won’t discuss everything we’d do on a respiratory call like this, but if you need clarification or further explanation for your fictional writing needs, please do not hesitate to ask me. julezcourt As my partner whips out a non-rebreather mask and connects it to the oxygen tank at 15 lpm (liters per minute) then slips it over her mouth and nose, I assess her breathing rate and quality and find it definitely out of range, certainly labored and not efficient to sustain life, so I assemble a BVM (Bag Valve Mask), and my partner bags her. As I continue with my patient assessment, and notice she’s diaphoretic (cold and clammy skin) I consider assembling a nebulizer (I’d squeeze atrovent and albuterol into a tiny circular plastic cup and attach the nebulizer contraption to the NBR (non-rebreather). I attach her to our cardiac monitor via a 12-lead (ECG patches) to interpret her heart rhythm and heart rate, and I slip a pulse-ox on her finger (pulse-ox is attached to the monitor) to obtain her blood oxygen level. I won’t go into any detail about heart rhythms, but I’ll simply say she has a dysrhythmia, her heart rate is at 118 (tachycardia = too fast), and her SAT is 87% (blood oxygen saturation), which is too low. Via my stethoscope, I auscultate her lungs and heart. I hear normal heart sounds, but I hear rales in her lungs. We insert a line (IV). Our patient falls unconscious, and remains unresponsive. Cyanosis (blueness) begins to appear. She still has a pulse, but she’s no longer breathing, so she’s in respiratory arrest (apnea). Based off my assessment and what...
read morePersonal Protective Equipment (PPE)
Dianna Benson is back for her monthly post discussing the different types of personal protective equipment healthcare professionals wear in different types of situations. As a writer, these will help you write authentically. As an EMT, a Haz-Mat-Operative, and a FEMA Mass Casualty Incident Operative, PPE (Personal Protective Equipment) is vital to my safety and health. At a bare minimum, I wear medical gloves and wash my hands post removing those gloves. At a maximum, I wear my bio hazard suit, head to boot, complete with full face respirator, air tank and haz-mat outer gloves. Depending on the type of EMS call and the situation, I could wear one, all, or a combination of the following PPE: long armed and legged paper gown, plastic face shield, plastic eye goggles, a HEPA or N95 (mouth and nose surgical mask), and a helmet. In a MVC (motor vehicle collision) I wear a bright yellow traffic vest stamped with EMS on the back. If I need to climb inside a damaged vehicle on scene to medically examine, assess, and treat a patient as well as help extricate them onto a backboard and stretcher, I wear my turn out gear: heavy thick pants, coat and gloves over my EMS uniform and medical gloves, plus I wear a helmet with a thick plastic face shield and I slip the yellow traffic vest over the coat. If I have a blood borne pathogen exposure via a contaminated needle or a patient’s mucous membranes, blood, urine, vomitus, feces, etc. or an airborne pathogen exposure, I immediately contact my district chief 24/7. Within minutes, my district chief will inform theEMS medical team and they will advise me on how to proceed in seeking medical care for myself. Never in the history of EMS, fire or law enforcement have any of us contracted HIV while performing our duties due to the fact the HIV virus dies once it’s exposed to either air or light. Hepatitis C and MRSA (Methicillin-resistant Staphylococcus Aureus) are two diseases I’m concerned about contracting from a patient. Unlike Hepatitis A and B (both of which I was vaccinated against before my first EMS shift back in 2005) there currently is no Hepatitis C vaccination. Along with about most of the rest of the world, I probably already have MRSA cells in my system and they’ll never cause me any harm, but if I do become systematic with MRSA, it could be an arduous process to heal or I may never heal. However, I just follow PPE guidelines and leave it in God’s hands. On the start of my every shift, I attach my tiny blue plastic name plate to the ceiling of my ambulance via Velcro. The name plate says: D. Benson. This name plate is mostly for a MCI (Mass Casualty Incident) or a structure fire, but can be helpful in any situation and is used for the following reason: When I enter a scene, my name plate will inform all other rescue personnel, especially EMS, who exactly went into a structure or scene without anyone having to waste precious time researching that information. Can you think of specific situations where I’d wear certain equipment? Hint: A long armed and legged paper gown I’d wear when I deliver a...
read moreMedical Question: Submerged Vehicle Part 1/2
Mart asks a fairly detailed medical question so I’m going to split this post up over two days. Today, our resident EMS expert, Dianna Benson, will offer the EMS response. Next post, I’ll cover the emergency department treatment. Mart asks: This is the scenario: Ruby, Gio and their parents are in a car that submerges in the river. Some of the things I need to know: 1. What happens when paramedics get to them? 2. Do they do CPR and if so for how long (with no pulse of a drowning victim and one that has a pulse but ends up being in a coma) 3. Who declares them dead? I’ve read that it depends on the state. Sometimes the doctor does. This takes place in NY. Ruby is the only one conscious. Do they treat her in any way? What happens to her sister if she is in a coma? Is that possible? What happens to her dead parents? Dianna(EMS Response): Clinical Definitions: Drowning: An incident in which a victim has been submerged in water and dies within 24 hours of submersion. Photobucket/Moonstruck1977 Near-drowning: An incident in which a victim has suffered a submersion but has not died or dies more than 24 hours after the incident. A near-drowning patient must be treated for at least one submersion-related complication or it’s not considered a near-drowning. Submersion: An incident where a victim is submerged in water and requires some type of emergency care due to the submersion. When we (EMS) are dispatched to a water-related emergency, we often suspect a possible spinal injury. In the case of a car landing in water somehow, we’d definitely take spinal precautions, and thus apply a neck collar and strap the patient onto a backboard while the patient is still in the water. Cold water and warm water emergencies are different. If a victim goes into cardiac arrest in cold water (68 degrees or colder), the mammalian diving reflex may prevent death even after prolonged submersion (even 30 minutes) – a body could be frozen in cold water temperatures to the point all the systems go into a hibernation-like state. Firefighters do not extricate victims from submerged vehicles unless they are trained in water extrication. I’m a scuba diver and trained in water extrication, so when I arrive on scene of a water-related incident, I’d be one of the emergency crew members extricating. Emergency crews include: firefighters, EMS, law enforcement, forest ranger, etc. However, if no one on the scene is trained in water extrication, then whoever is there improvises until someone with training arrives, but risking your own life in ways you’re not trained for causes more chaos to the situation. PhotoBucket/firefighter8069 A dry team works on shore and a wet team is in the water extricating (removing from vehicle) and immobilizing (collar and backboarding) the patient. The wet team doesn’t just jump in the water (unless it’s safe for us to do so) – we throw the victim a floating device and pull them to the boat we’re in, or dock, or shore (or whatever). For EMS – we first focus on a patient’s airway, breathing, circulation, and any hemorrhaging issues (bleeding). If Ruby is breathing efficiently, if she has a solid pulse, if she’s A&O X 4 (alert and oriented times four), and if...
read moreDangerous EMS Scenes
When Safe Scenes Turn Dangerous Unlike inside a hospital, EMS operates in uncontrolled settings and environments. At any given moment a scene can and does suddenly become unsafe for us while we’re in the process of medically treating a patient. As an EMS crew is enroute, responding to a 911-Call, if Dispatch informs us PD (police department) or LEOS (law enforcement officers) are also being dispatched, a crime has possibly been committed or the scene may somehow be unstable or unsafe. However, all rescue personnel on scene is responsible for his/her own safety. We can’t depend on PD or LEOS to protect us; instead, we must follow our own protocols and work the scene with all other rescue crews effectively. Regardless if PD or LEOS are on the scene with us or not, safe scenes can and do suddenly become unsafe in various ways with little to zero warning as we’re at the patient’s side giving medical care. The patient, the patient’s loved-ones, or bystanders can suddenly become violent or their behavior can drastically change due to: mental illness, fear, anxiety, drugs or alcohol, declining medical condition, they’ve committed a crime on scene, they’re a desperate criminal with a concealed weapon, etc. altering the safe scene to a dangerous situation. I can’t go into detail, but I’ll share the basics of two scenes that turned unsafe for me and my partner: 1) An attempted suicide patient – a prison inmate – grabbed a police officer’s weapon. We physically and then chemically restrained the man without anyone getting injured, but it wasn’t easy or quick. 2) Adult children of a bi-polar patient called 911 because their father became disoriented and agitated. After our arrival, the patient turned aggressive and combative. I called for PD back-up, but instructed them not to use force unless absolutely necessary. I used the talk-down technique to calm him as I also reassured and counseled his adult children. After an intense hour, I finally had the patient physically and chemically restrained in my ambulance. Hazardous material are another safety concern – if an EMS crew is dispatched without the knowledge haz-mats are on scene, our lives and health are at risk. Immediate recognition of haz-mats and following of procedure is essential, but at times haz-mats are disguised and sometimes a human (for various reasons) is setting up and controlling that disguise. Can you guess why an individual(s) would do this? I’ll give you one idea to get the ball rolling – meth labs (which are easy and cheap to construct) can easily explode. EMS crews use code phrases to alert each other of danger. One old code phrase: “Let’s get the red oxygen cylinder out of the ambulance.” After speaking a code phrase or hearing it, I evacuate the area, notify Dispatch of the situation, and request for additional resources as necessary. Severe weather creates a large range of dangers as well as hindrances for anEMS crew, including: hurricanes, tornadoes, earthquakes, floods, blizzards, downpours, intense wind gusts, extreme lows or highs of air temperature, etc. A darkened mile-long tunnel when electricity is not functioning causes additional issues; so does nighttime darkness, especially if the emergency situation is on a back country road with only the half-moon above lighting the scene. Weather related issues can be on-going during a shift and worsen, or...
read moreHaz-Mat Decontamination
Dianna’s back for her monthly blog post. Today, she focuses on HazMat Decon (otherwise known as cleaning gross stuff off of you that could kill you). I particularly love the photos she included to help aid the writer with those accurate descriptive details. Don’t forget, leave a comment this month and be eligible for Brandilyn Collin’s book Over the Edge. Winner announced June 1, 2011. This is amazing fodder for any author to add conflict and tension to a disaster situation. Decon can also be used on a very small scale as Dianna mentions. Possibly only one patient. Imagine a patient drenched in gasoline. Not only can the gas be caustic to the patient’s skin, but if that patient is brought into the ED, the fumes will permeate the department. This can pose a risk to other patients, particularly those with respiratory complaints. Welcome back, Dianna! HAZ-MAT Decontamination OSHA definition of decon: The removal of hazardous substances from employees and their equipment to the extent necessary to preclude foreseeable health effects. NFPA (National Fire Protection Agency) definition: The physical and/or chemical process of reducing or preventing the spread of contamination from person and equipment. Inclusive definition: The systematic process of removing or chemically changing a contaminant at the scene to prevent the spread of that contaminant from the scene and eliminate possible exposure to others. Contaminants are any chemical or biological compounds or agents capable of causing harm to people, property, or the environment and includes: 1) Bloodborne pathogens 2) Common chemicals 3) Warfare agents 4) Etiological agents 5) Radiological agents Decon is located in the warm zone of an emergency incident, which is in between the cold zone and the hot zone. Once rescue personnel exit the hot zone, we must enter the warm zone and decon before entering the cold zone. Haz-mat trained and credentialed EMTs wear head-to-toe biohazard suits and enter haz-mat areas/situations to assess patients, give them medical care, and extricate them out of the hazardous hot zone to the decon area. There are five decon stations. 1) Initial entry: I drop my loose (not attached to me) instruments and tools in buckets. 2) Gross Rinse: While I’m still fully clothed in my bulky biohazard suit, another person thoroughly rinses me off (and everything on me) with a wand (think: high-powered spray hose). Rinsing off includes the bottom of my boots, my hooded head, my SCBA tank (self-contained breathing apparatus) etc. That person basically sprays me with water while I lift each foot one at a time, turn around, lift my arms, etc. 3) Wash and Rinse: I’m still in my suit when yet another person first thoroughly scrubs me with a brush wand filled with soapy water, then uses another wand containing water only. 4) I remove my biohazard suit and SCBA tank, place both in large buckets. 5) I remove my haz-mat gloves then my inner gloves (medical exam gloves) and place all in buckets. Each station is separated by wooden squares about the size of a washer/dryer unit and stands no higher than ten inches from the ground. Each square is lined with heavy polyethylene plastic (the wood is underneath the plastic), so the poly sheeting contains the run-off successfully. Set-up crews arrange the five stations by first laying down thick polyethylene sheeting flat on the ground, then constructing the wooden dividers into position over the poly, then spreading a...
read moreTypes of EMS Calls
It’s tax day! Are you suffering? Feeling the need to call 911? Dianna Benson, Redwood’s resident EMS expert, is back for her monthly post. Today, types of EMS calls… in case you’re feeling the need for a little 911 service. But more importantly, for accurate descriptions in your ms. This should give you lots of ideas. Hopefully, dispatch will be able to provide us with the type of EMS Call we’re responding to, and Calls fall into two categories: 1) Trauma: Injuries caused by trauma – Motor vehicle collisions, falls, bicycle accidents, motorcycle accidents, sporting incidents, gun shot wounds, stab wounds, burns, etc. 2) Medical: MI (myocardial infarction – heart attack), hypoglycemia (low blood sugar), seizure, hypertension (high blood pressure), dyspnea (shortness of breath), abdominal pain, etc. Medical is tricky because, for example, the causes of abdominal pain are numerous, ranging from abdominal aortic rupture to ectopic pregnancy, so it’s our job to place the puzzle pieces together to diagnose the medical condition in order to best treat the patient. On the other hand, trauma is difficult since we may treat multiple severe issues on one patient as well as treat multiple patients with an array of issues in a chaotic situation. Types of Calls: 1) Hemorrhage (bleeding) 2) Shock (hypoperfusion – lack of sufficient blood flow) 3) Fall (any type, from falling 50+ stories to slipping in the shower) 4) Stabbing 5) GSW (gun shot wound) 6) Burn 7) Soft tissue injury 8) Musculoskeletal injury 9) Head injury 10) Spinal injury 11) MVC (motor vehicle collision) 12) MCI (mass/multiple casualty incident) 13) Bicycle, motorcycle or ATV accident 14) Cardiac 15) Cardiac arrest 16) Respiratory distress 17) Apnea (respiratory arrest) 18) Anaphylaxis shock (severe allergic reaction) 19) Unconscious patient (and unknown reason to bystanders on scene) 20) Possible hypoglycemia (low blood sugar on a known diabetic patient) 21) Overdose (alcohol, drugs, and medications) 22) Poisoning 23) Hypotension (low blood pressure) or hypertension (high blood pressure) 24) CVI (cerebral vascular incident – stroke) 25) Seizure 26) Syncope (fainting) 27) Acute abdominal pain 28) Submersion, drowning and diving emergencies 29) Behavior/psychological/mental/AMS (altered mental status) 30) Obstetric and gynecology 31) Hypothermia or hyperthermia 32) Etc. In the times when inaccurate information is given to us by dispatch for various reasons (see my post – EMS and Dispatch), the type of Call dispatched may not be the true situation. For example: 1) Hemorrhage Calls can be anything from a simple nosebleed to multiple gushing wounds and an amputated limb. 2) A seizure Call: The patient (alone in a room) is suffering a MI (heart attack) and falls unconscious, hitting his/her head on an object on the way to the ground, and the head trauma causes a seizure. A bystander found the patient seizing, but when that bystander spoke with 911 they were completely unaware of the myocardial infarction, the fall, and the trauma to the back of the patient’s head. So, this Call is actually both a medical and a trauma Call. 3) The Call is dispatched as a cardiac, but on-scene we find the patient is suffering with chest pains and abdominal pains due to a serious fall, which caused multiple abdominal and chest injuries, so the Call is actually a trauma Call not a medical Call. 4) The patient is behaving as if he/she ingested, inhaled, or injected PCP, but actually they’re hyperglycemic (high blood sugar) Can you think of other scenarios where the Call dispatched is not the true...
read moreGoodreads Reviews
