# Fall for newbie



## BADDLEGG (Mar 23, 2011)

Had a 84 y/o f fall. On route to call location (VFD) call was cancelled by security (private community). Security cannot cancell call. Anyways, just recently completed EMT course and NREMT pass. Show up to scene to find pt laying on floor by couch (laying on pillows by couch) waiting for ambulance to arrive. Non friendly security officer questions why I am there and he cancelled call (also vfd member). I stood there like a jackass and did nothing. This after standing outside wondering what I should do (wait for ambulance, or check on pt). Should I have gone in medical bag on shoulder and either requested vitals, or perfomed vitals myself? PT not in obvious pain, alert but did not ask AVPU, talking, breathing and in no obvious distress. Helped load and ended call. Should I have done more? I should have at least secured good vitals to make sure of no internal bleeding or possible shock?


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## Handsome Robb (Mar 23, 2011)

The only way we can cancel ALS support is if the *patient* leaves the scene, or if they are alert and oriented and refuse it. 

Was the patient refusing care? Personally I would have at least talked to the patient and found out more details, dispatch information tends to be very sketchy.

Thats a tough situation to be in though. One would think that the officer that's also in the VFD would realize the situation he was putting you in.


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## SeeNoMore (Mar 23, 2011)

My impression is that security officers, no matter their level of medical training, can not cancel calls. Personally I would have attempted to see if the pt was alert and ortiented, and if so, whether they in fact wanted to refuse tx/transport. 


Do you work for a private service? If so I imagine faciliites can in fact cancel calls and bear that responsiblity, if they made the initial call. Perhaps this was the case and the officer was relaying that info? Another possibility is that he is both a security gaurd and an EMT for the communtiy he works in, I've seen this in assisted living type situations. But the pt still has to refuse or at least be consulted.


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## BADDLEGG (Mar 23, 2011)

The pt wasnt refusing treatment. The security officer (who is on my VFD and took the same EMT class but failed his NREMT) is the one who was sitting down on the couch while the pt was laying on the ground and asked in front of the pt "what are you doing here, we dont need you". No one to my knowlegde secured any vitals. The patient was alert and orinted (not officially  avpuX4). I guess I could have at least checked that and maybe done a partial full body inspection to make sure she didnt hit her head or anything. I dont work for an EMS service. I just volunteer at the VFD and have recently started going on medical calls. Probably should have came in, introduced myself, asked some basic AVPU questions, get the story of what happened and SAMPLE and/or OPQRST. Make sure she didnt hit her head or have any other injuries. Still a little shy on scene. ANy other info would be greatly appreciated.


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## bigbaldguy (Mar 23, 2011)

I'm still new at this myself but I'm learning you sometimes have to be a little bit aggressive at times. It's tough to tell when you need to back off and when you need to stick to your guns and muscle in. This was probably one of those times when you should have blown the guard off and talked to the patient. Put it down as a learning experience.


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## Simusid (Mar 24, 2011)

BADDLEGG said:


> Should I have gone in medical bag on shoulder and either requested vitals, or perfomed vitals myself? PT not in obvious pain, alert but did not ask AVPU, talking, breathing and in no obvious distress. Helped load and ended call. Should I have done more? I should have at least secured good vitals to make sure of no internal bleeding or possible shock?



I'm going to assume you were dispatched to the call and didn't just show up on scene.  If so, it sounds like you should have done an assessment and yes you should have taken vitals.  

Also, I'm surprised you went in without a first-in bag.


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## firetender (Mar 25, 2011)

*What was the most important thing you missed?*

The starting point in the scenario as you described it is a simple question; "What did you find in your examination of the patient?" 

If the answer does not come quickly and easily and include vitals signs then all you have to say is: "Excuse me while I examine the patient!"

He can have the patient if he knows what's going on and the ambulance is on its way. But if he doesn't, your job is, at the very least, to make sure a THOROUGH evaluation of the patient is done.

In that case, you step in and do it. He doesn't make up your mind, the condition of the patient does.


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## AZnativeOne (Apr 1, 2011)

Pt care should have been initiated. There is no way security would stop me from atleast making contact with the pt to determine life threats. Only way I can be cancelled is if dispatch tells me I am cancelled or pt refuses transport. If he wanted to push the matter, I just would have PD respond to the scene.


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## orange20medic (Apr 3, 2011)

AZnativeOne said:


> \ If he wanted to push the matter, I just would have PD respond to the scene.



Exactly what I was thinking. If the patient looks in distress, you need to do what you can to make sure the patient gets help. Do you know why the security guard was refusing EMS when the patient was sitting on the floor? It would kind of be a different situation if you arrived and the patient was up and walking after being assisted off the floor by the guard.

Next time, take the medical bag with you. Being by yourself, you will never want to leave the patient to go get your medical equipment.


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## Lady_EMT (Apr 4, 2011)

BADDLEGG said:


> The patient was alert and orinted (*not officially  avpuX4*). I guess I could have at least checked that and maybe done a partial full body inspection to make sure she didnt hit her head or anything. I dont work for an EMS service. I just volunteer at the VFD and have recently started going on medical calls. Probably should have came in, introduced myself, asked some *basic AVPU questions*, get the story of what happened and SAMPLE and/or OPQRST.



First off, the fact that your patient was talking to you and alert means that you've already established her position on the AVPU scale.

*A*lert
*V*erbal (responds to verbal stimuli)
*P*ain (responds to painful stimuli)
*U*nresponsive.

Second, security can't cancel you. That has liability/neglect/abandonment written all over it. And I'm not sure why you weren't prepared with a first responder bag.

When I arrive on a scene with first responders, the BARE minimun I expect is a set of vitals. I'm not quite sure what you established between your arrival, and the ambulance's arrival. 

It's tough at first, but learn to be confident. That way, when people hear you're enroute to a call, it's a "Cool, they'll have the bases covered for me when I get there," response, not a "Oh, them? they're useless," response.


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## angrynuni (Apr 27, 2011)

AZnativeOne said:


> Pt care should have been initiated. There is no way security would stop me from atleast making contact with the pt to determine life threats. Only way I can be cancelled is if dispatch tells me I am cancelled or pt refuses transport. If he wanted to push the matter, I just would have PD respond to the scene.



This would be my answer.


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## ic2283 (Jun 20, 2011)

go by your protocols consider consent and what class has taught you. if it was me I would have gone in there told the guy to :censored::censored::censored::censored: off and focused on my pt assessment and findings. My company requires an assessment and set of vitals be obtained as well as a refusal of care for to be completed. always be the pt's advocate and don't get caught up in the distractions!


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## MrBrown (Jun 20, 2011)

If Brown and Black in the big white van with red lights (wow such colour diversity!) turned up here is how it would have gone down

- Tell rent-a-cop where to go
- Introduce ourselves to the patient, offer to sit her up and take a look
- If patient says no, negotiate with Nana until she agrees or its clear she really doesn't want us there
- Examine Nana, get vital signs and unless we are overly suspicious about cause of fall (e.g. neurogenic,cardiac, metabolic) or obviously requires further treatment or intervention Nana can be left at home.

Do not believe everything your poorly written textbook or 100 hour wonder course taught you.  Observations such as blood pressure or respiratory rate can be suggestive of internal bleeding (along with 400 other things) but have a very low specificity.


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