We studied this in school, but its be to long since we used it. I was just wondering if someone could point me in a direction now that I work I kinda want to organize a call a little bit. It always seems like I jump around with my assessment.
I still jump in and start with the ABC but after that its all up in the air. If someone could give me a refresher or a website to review with would be great =)
Your schooling was likely different from mine. But I don't remember anywhere, even as a medic, really being taught how to run a call in class. This was something I had to learn through doing a lot of calls myself, watching how other people ran calls, and copying things I liked from preceptors and mentors.
School tends to teach you (or at least taught me) to do things in a very linear manner, e.g. dispatch info, resources, scene safety, BSI, general impression, c-spine LOCABC, etc. Whereas real life, it seems like most of the work, especially at a "ALS" level is more directing other people to do things for you.
That being said, every call has a beginning, a middle and an end. If we accept that evaluation of our personal safety and that of the patient is a continuing and ongoing process, that carries on throughout the call and is constantly re-evaluated in light of any new information we obtain, I think we can dispense with that.
An approach to the patient includes getting an overview of the environment and any clues as to what's going on. This would include stuff mentioned in the previous paragraph, like, "Is that a handgun on the sofa next to my schizophrenic?" or "Are any more of those bricks likely to fall off the top of that scaffolding?", but might include noting the smell of crack, or the presence of a glucometer, oxygen tank, or numerous medications, etc. During this phase, you hopefully identify the patient and get a quick impression of sick / versus not sick across the room.
If they're sick you have a fairly linear sequence of events that has to take place. The whole +/-OPA/BVM/NRB/CPR/AED/IV chain, that you will have a good idea of once you've seen a couple of really sick people.
You're going to introduce yourself. "Hi, my names ____, I'm a EMT, how can I help you today?", elicit a chief complaint, delegate your partner to obtain vitals, "My partner, Guiseppe, is going to take your blood pressure quickly while we talk?". And you're going to get a history as you do your physical exam, right? "I'm just going to push down on your chest here, does this change the pain at all?", "Have you had these symptoms before?", "What did they do last time?", etc. And somewhere in this, you have a couple of judgments to make:
* Do I need to call for ALS? Or BLS backup?
* How is this patient getting to the ambulance? Are they walking out? Are we going to bring in the stretcher? Is this a better situation for the stair chair? Or do we probably need a scoop?
* Do we need extra hands to help extricate the patient?
These are probably your big on scene decisions at the BLS level, right? So if you can have some idea of the answers to these early on, you can get the things happening that need to happen. You can call for extra resources / backup, or you can direct your partner to fetch other equipment.
If you work in a large system, you might have other things to work out, like "Do I need to talk to a deployment coordinator to get assigned a destination hospital?", or "Is this patient suitable for hospital X, Y or Z?", or "Do I need to give them an early prenotification at the receiving facility?".
* In general, the more you can anticipate the direction the call is going in, the better. You can save yourself time by having a plan on how the patient is going to move and send your partner (or fire, or whoever) for the required equipment earlier on.
* In general, the less stuff you do yourself, the better. If you can have everyone else running around for you, you can keep a better control of the whole scene, so that you can make sure you don't miss any new information, and can be sure that everything is running efficiently.
* When you call for backup, it's good to have something for them to do when they arrive, and think before they get there as to whether there's an extra equipment you'll need once they arrive.
It makes no sense for them to come up to the fourth floor, only to be sent back for a spine board. In the same vein, if you call for help on a code, and don't have something for the next two people in the door to do when they arrive, you may find they start trying to reorganise your call for you, which is usually counterproductive.
