# Worked a Code: Guess it wasn't right.



## MMiz (May 10, 2004)

Last night I worked the midnight shift.  Around 2:00 am we got a call for a MVC on the large interstate.  Being BLS, and only a few minutes away, we were dispatched Prioritiy 3 (lowest priority).  We were the second unit on scene, ALS was first.  Two minutes later the supervisor / Critical Care Unit arrives.  

No major injuries, mostly just bruising and generalized pain.  ALS walks up and points me to the police cruiser and asks me to do a trauma assessment.  I ATF a pt. sitting in the police car.  After questioning, we get through the whole body and determine her only pain is in her upper chest as she breathes in.  I tell her to hold on a second while I run ~20 to my unit and get my stethoscope to listen to breath sounds.  I grab them off the dashboard, and come back possibly 15 seconds later... ALS was pissed.

We were quickly given the task of sitting in our unit and waiting.  I got back to the garage in the morning to find a pissed off ALS unit wanting answers.  I told them my reasoning, but it seems they were asking for something different.  I apologized and asked for suggestions for future calls, but only got "We wanted a rapid trauma assessment."

I can only assume that they were also frustrated by the situation.  It was absolutely pouring rain and everyone was soaked.  I won't lose any sleep over the situation, the patient was always attended to by EMS, but I can't help but feel a bit frustrated.

Any feedback?


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## SafetyPro2 (May 10, 2004)

The rapid assessment we were trained to do in PHTLS is what they refer to as the ABCDEs.

ABCs are the standard ones, and of course can be quickly assessed just by talking to the patient. While doing this, do a quick pulse (quality/speed, not an actual count), skin signs and eye check. 

D is Disability or Deficit. Any obvious injuries or an ALOC . PHTLS stresses the Glasgow Coma Scale for the ALOC, with anything less than 8 being a major injury, 9-12 a moderate injury and 13 and up a minor injury. 

E is Expose/Environment. Another concept they stress is "trauma naked"...basically exposing the patient as much as possible and doing a quick head to toe looking for any obvious injuries (a bit faster than a standard head to toe). Also consider Environmental factors such as extreme temps that could affect the patient. 

Basically, you want to determine in 60-90 seconds (or less) whether the call's a "stay and play" or a "load and go". If it's the first, you can then go into the vitals, history, full head to toe, etc. If it's the second, you load and then do everything else once you're enroute.


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## MMiz (May 10, 2004)

Your post was quite simple, but I definitely skipped some of the basics.  Pupils, pulse.  Obviously I knew they were present, but I'm guessing they wanted actual numbers.  But after I say that, I question whether they did or didn't.  I approached the car with nothing but what I had on my belt / uniform.

As far as exposing the patient, once again this was bit of an issue.  I'm a college student, and this was a college-age female.  She was clearly uncomfortable with me doing the assessment, and I should have let me female partner do it, but ALS has approached me instead.

Once again, I can't stress enough how brief my treatment was with her.  I'd estimate no more than 15 - 30 seconds.  

I did the ABCs, she was talking, so obviously had a patent airway.  She only complained of the pain I described above.  She was AOX3 also.

I haven't memorized the Glascow Coma Scale, though it is a required portion on all county run forms (anywhere to hospital, or 911).  

It was a learning experience, and I'm confident I'll do better and be more comfortable if this situation happens again.

Thanks for the input though, It's clear that I could benefit from taking the PHTLS course.


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## SafetyPro2 (May 10, 2004)

Again, not knowing exactly what ALS was after I'm guessing, but I'd say they wanted a quick decision from you on whether or not she needed a rapid transport or if they could delay to treat on-scene.

The modesty issue is always a touchy one, and to be honest, most of the time I see patients left fully clothed. Having a female provider with a female patient can definitely help. Sometimes though you just have to tell the patient that it needs to be done and be as professional and quick about it as you can.

I always have to look at the cheat sheet for GCS too. Thankfully, it's printed on the back of our EMS forms. Doesn't help that LA County uses a different GCS than the rest of the world...same categories and numbers, but in a different order.


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## lastcode (May 20, 2004)

It is sad that some ALS feel they need to treat EMT-Bs like dirt.  I know many wonderful ALS people, and it is usually the few that give them the bad "paraGod" rep.  You were totally in the right.  ABCs come before the trauma accessment.  Her airway was patent, but her breathing needed to be looked into next.  Maybe she just had a flail segment, but then again she could have had internal bleeding, or a collapsing lunge.   Don't let those guys bother you.  You did your best, maybe it was just a miscommunication.


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