# first alone call



## c-spine (Sep 26, 2006)

So I'm 9 miles away from my mom's house, heading back to my dad's house so I could go to work this morning. I was on the road a little after 8:30. I had my radio in my car, and (as I said), I was about 9 miles or so away. I heard our tones go off so I pulled my car to a stop. All I heard was the county road and the township, recognized it is by my mom's and hauled arse (not speeding *too* much) to get there.

I had no idea what I was walking into cause I didn't hear most of the page. I had to wait for county to give me the address, about 5 minutes later.

I get on scene to find some woman on the phone, telling me that "she's in the bathroom." Grandma is in the bathroom, being sort of held up (on the toilet) by another woman. Grandma was "not feeling well," and so I was like "omgnervousomgnervousomgwhatdoido" and decided that I'd find out her name. So I did that and put her on 10 lpm non rebreather mask. I figured 15 would knock her over.

I got her pulse and got sidetracked from getting a BP while trying to get a SAMPLE because of the meds. About 5 minutes or so after I got there, so did another first responder and the ambulance. So I never finished my SAMPLE or my vital signs.

Did I do wrong to put her on 10 lpm nrb mask? Would you have put her on 15, or put her on a nasal cannula? Or left her off the O2, for that matter? While the ambulance was there, I wrote down her meds on my sheet thing and gave that, the meds, and the ambulance's glucometer back to the other first responder while I cleaned up my mess.

So all in all, I didn't do a whole lot... What did I do wrong, and what could I have done better?

((just please don't tear me apart too bad...this was my first call that I went to all by myself..usually I am a ride along, and have someone else there..))

:blink:


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## ffemt8978 (Sep 27, 2006)

I think you already know the answer to your question, but here goes:

1) First of all, you should have waited until you found out what the call was about BEFORE entering the scene.  The page could have been for a shooting with law not on scene yet.

2) Why did you give oxygen?  Around here, the philosphy is, "O2 good, give lots."  Our protocols specifically prevent us from giving O2 via NRB at a flow rate of less than 15lpm.  Personally, I disagree with this since not everyone needs high flow O2.

3) Knowing an ambulance is coming, what do you think will do them the most good?  A complete SAMPLE Hx (which they're going to ask again) or an initial set of vitals (which they'll never be able to recreate).  Don't get me wrong, because eventually you'll be able to do both at the same time.  That being said, some parts of the SAMPLE must be addressed so that you know what you are dealing with.

4) Writing down meds is important, but not that important if the meds are going with the patient.

5) As far as not doing a whole lot, you must look at this from the patient's perspective.  They called and you showed up in a few minutes, then did your EMT thing, then the ambulance showed up.  The actions and persona that you put forth during the initial patient contact can have a tremendous effect on how the patient views the encounter.  Sometimes, that's all they need.


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## BrandoEMT (Sep 27, 2006)

C-Spine, first of all…you did perfect!!!

I know that feeling, the first call on you own.  I’ve been there, adrenaline is rushing and your body makes it a bigger emergency than the PT feels it is.

Alright, you arrive on scene…scene must have been safe with no obvious problems.  You run in, get a quick informational “Hi and Hello” from the relative, I’d stop there a tad more just to find out history of present event.  You went to the PT’s side which is perfect.  

I will assume this PT was conscious and alert with an unobstructed airway?  Especially on elderly PTs you did fine giving an NRB at 10 Lpm!  For us in the first response world you need to know how long it will be before you get the cavalry…at 15 liters your tank would run out too soon if the ambulance got stopped up or whatnot…10 will not affect the PT adversely compared to 15.  

If you had a pulse oximeter I would have tossed that on just to see the O2 levels and that would determine nasal or not…but NRB is a safe choice.

Before your SAMPLE I assume you followed the ABC’s…yes this includes a BP…not a huge thing to skip if backup was there right away…

SAMPLE is awesome to get to hand to the ambulance crew when they arrive on scene, especially with elderly PTs have the relatives get the full list of meds and any medical crap they have laying around.

Other than that, it sounds like you did perfect!  And if you doubt yourself as this one question…”Did the PT die under my care?”  If the answer is No, then you did fine.


The problem with first response in a small community is that it takes time to get your PT rapport together and once you get that figured out after about 6-12 calls you’ll have everything down to a science.  Remember, check your pulse first before the PT’s on scene and to take a deep breath, slow down…

Everyone has their own way to do things….it’s not all like how the text book says, if you would have had more time on scene by yourself then you could have continued and played the fun game of “does it hurt here?”


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## BrandoEMT (Sep 27, 2006)

FFEMT- your #5 is awesome...i agree vitals are good, depending upon what this call was but half the time the ambulance doesn't care what first response around here does...all they care about "is the PT alive or dead" and start fresh all the time...having two SAMPLEs is good because many times the PT will remember something new to tell or when you ask if they have any heart problems or medical conditions they say "No" and only later to say "Oh yeah I have diabetes or I have a huge metal rod in my chest"  anyway...sounds good....


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## Jon (Sep 27, 2006)

C-Spine... it sounds like you did fine for a first call. As FFEMT said, an initial set of vitals is VERY useful. A basic SAMPLE history is good, but I often don't worry about medication names when I do a "quick" SAMPLE...I'm just trying to get an idea of why the patient is sick.

As for O2.... 10lpm sounds a little low, but you made the point that anything higher was un-needed. The big question... is the resoviour bag staying full, or is the patient having to breathe "outside" air?


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## oldschoolmedic (Sep 27, 2006)

*Not bad kid*

Ok, so you're driving along and the tones drop, you pull over, very good. The tones drop and you don't hear all of the call and go racing into a possibly hostile enviroment, not good. Unfortunately that could have been your last mistake, ever.

You have an elderly female sitting on the commode, probably less than responsive, maybe pale, diaphoretic, etc... This is where experience will point you in the right direction, think cardiac (vagal response). You will run this call again and again, the names will change, but the scenario never does.

Good choice with the O2, keep the bag inflated, simple as that. Just find out what happened, this will help differentiate between trauma and medical, or whether it is medical that became trauma. Did they find granny passed out on the commode, or did they find her on the floor and helped her back up onto the commode? Was she bearing down to have a bowel movement and became unresponsive? Forget the SAMPLE Hx, you know the responding crew is going to do it again. Get some baseline vital signs to include a blood glucose level and pulse oximetry(room air), those can't be duplicated, and will really be indicative of the patient's status.

Other than that have the family gather the patients meds, and insurance cards/id etc... This gives them something to do and gets them out of your way, kind of like in the old days of sending expectant fathers to boil water.

You did good, the patient did not suffer under your hand. You offered comfort to the family in time of crisis, and made your service look good with a quick response time. Can't ask for more than that the first time, just remember more will be expected of you with each call you respond to. That's the ems learning curve.


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## c-spine (Sep 27, 2006)

Grandma was responsive, a little slow to answer, but not feeling well. She was vomiting before I got there, but had stopped. I didn't feel that 15 lpm was necessary - I think it would have been too much for her. She denied difficulty breathing, but again, O2 isn't going to hurt. 

From what the people there said, she called them to her because her "foot felt funny," and just started not feeling well from there.

Under the license we have as first responders, we cannot do blood-glucose levels. We do not have pulse-ox's either. We're a very basic first responder unit.

The family/neighbors there weren't really in the way when I got there. The one woman was on the phone doing phone traffic and offering information to me when I asked. She informed me that Grandma has severe osteoperosis (sp?) in her spine, so be very careful. She did not feel that she could get into the kitchen with the help of me and the other person, so I left her where she was. The woman in the bathroom was partially supporting her; Grandma was hunched over (maybe her osteoperosis, maybe pain?) It was after the ambulance got there that people were in the way. Another 4 or 5 people were in the house - 2 ambulance crew, 1 other first responder, 1 son, and someone else, I think.

I was unimpressed with the other first responder. We live throughout the area - my mom and I handle County road B and the surrounding area since we live off of B. This woman came from town - approx. 15 miles out to take this call. She's the kind of woman who will barrel you over just to get to this patient. She pushed me out of the way (figuratively) and made it seem like I was an idiot for going. She glared at me when she came in the door - that look that says "what the f**k are YOU doing at MY call." I felt belittled. She didn't really do anything to make me feel that way except give me stupid looks that made me feel like I did something detrimental to my pt. She went out with the ambulance to take out the meds and other equipment I gave her to take out and came back in to "check up" on me (that's how it felt). "do you have everything? you ready to go?" etc. I felt like she was trying to prove something; but I don't know what it was. I stayed long enough to throw away the nrb and the ensuing equpiment and the plastic I threw on teh floor. I put my O2 tank back in my bag and left. She added as an afterthought "They told me to tell you thanks." (teh ambulance crew). That made me feel a little better; but her behavior seemed odd to me.

I don't know. Maybe I'm just paranoid cause I forgot half of my SAMPLE and all of what I was supposed to do in a medical scenario. I am horrible at medical assessments.


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## Tincanfireman (Sep 27, 2006)

I'm not going to go into detail; that's already been done by others more knowledgable than I. Let's do a big picture overview.  "First, Do No Harm" (Primum Non Nocere?) is one of the first things that ever came out of my very first EMT instructor's mouth way back in the 70's.  You accomplished that, albeit at the risk of your own bacon. Lesson Learned, and you won't forget it. The patient was in better (at least, no worse) shape when you left than when you got there; sounds like a positive thing to me. You did good stuff for the responding crews and made sure they had valuable information.  Next time you'll probably spend more time on vitals than history (given a similar situation), but that's still OK.  Sounds like you were a tad nervous at the time; we all were the first time and nothing's wrong with that, either.  You learned that it's easy to get distracted and lose sight of the ball; again, a learning experience. Patient was alive when you got there and was in the same condition when she was transported; I'd say you did good things and had a positive outcome to show for it. Congratulations!!!


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## Ridryder911 (Sep 27, 2006)

Like others that have pointed out. Especially as a first responder role, do not place too much emphasis on how in-depth as for your role. 

I use the "House of God"  comandment of taking your own pulse in a code; therefore be sure you are in control of the situation, not the situation is control of you. 

Far as oxygen, you as a first responder and only delivering oxygen for a few  minutes the delivery system is irrelevant on a non-respiratory distress patient. I do agree either place them above 10lpm or place them on a nasal cannula. One should not have to worry about levels of oxygen or running out.. if this is the case, either carry a bigger cylinder device or  EMS responses should be evaluated. 

Like others have stated, a quick c/c (chief complaint), brief hx. and an initial set of vital signs. 

Keep up the good luck!
R/r 911


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## c-spine (Sep 28, 2006)

Oh I was only a little nervous. I'm bad at medical to begin with, and then to throw me in there by myself... yeah. I was shaking like I was having DTs. or something. 

My pulse...would have been probably low-to-mid 90s, I think. I usually hover around 70-80. If it would have been a trauma call I would have been fine with it. I'm good at trauma - it's easy stuff. Ah well.


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