5 Parts of the Run

[KyleG]

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 =)

 

[JPINFV]

Does what you're doing work for you? That is the major question as there isn't one supreme way to run a call provided you're looking for signs of life threatening illness first.

 

[Zeroo]

I just got my emt cert a little while ago. The way we was taught was primary assessment first. Which is your ABCs to handle any life threatening bleed, not breathing etc etc. Then from that point on you make a transport decision. So the priority of the pt either 1, 2 or 3. Unstable, potentially unstable, and stable. Stable obviously being someone that you don't have to worry about as much vs unstable lets get him the **** to the hospital. Then once that is decided you move on to your 2nd assessment or focused physical assessment. This one depends on the scene. Trauma assessment vs medical assessment. Might be both who knows. Head to toe assessment for the trauma. Sample history. Baseline Vitals. OPQRST for traumas/pain? Perform any interventions, give meds and what not. Then when your on your way to the hospital and what not you do an ongoing assessment. Check your interventions grab another set of vitals. Umm I think thats about it lol. Mine seems to be kind of all over the place....

 

[Tigger]

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 =)

Real patients are what are going to make your assessments feel less scattered. There is no one way to assess a patient, despite the books protests to the contrary. You'll find what works for you over time, and what circumstances will make you alter the course of your assessment to any degree.

 

[truetiger]

^^ what tigger said...

As you get more experience, you'll clue in on things that will change what order you do things.

 

[systemet]

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.

 

[mycrofft]

And at the end, the run isn't over until the unit and personnel are ready for the next run and the paper work is complete. No coffee breaks, no "Miller Time". Restroom, clean off the blood, then go get back in service. If you don't do that, you will slide work to the end of the shift, and you will one day (maybe today) leave with either the unit or you or your co-worker unready to go out there and do it, maybe get to listen add the last of the O2 whisper into the pt and you say "Oh, excremento".

 

[Ip man]

This is how I learned it.

BSI
Scene Size Up
A
B
C

Rapid trauma or focused physical exam

Syjmptoms OPQRST
Allergies
Medication
Pertinent Hx
Last Oral Intake
Event before CC occured

Vitals:
BP
Eyes
Level of Conciousness
Lung sounds
Resp
Pulse

Full detailed exam if necessary and time allows enroute.

 

[Akulahawk]

About the only things I'd change in your sequence....

This is how I learned it.

BSI
Scene Size Up

• A
• B
• C
• C-spine??
• Level of Consciousness

Rapid trauma or focused physical exam
(simultaneously with SAMPLE below)

• Symptoms OPQRST
• Allergies
• Medication
• Pertinent Hx
• Last Oral Intake
• Event before CC occurred

Vitals:

• Level of Consciousness
• Pulse
• BP
• Resp

Full detailed exam if necessary and time allows enroute.

The stuff I highlighted in red are important. Lose ABC and your patient dies. Your patient is given something they're allergic to and their problems will only get worse. LOC is very sensitive to changes in circulation status. There's a reason I put it in twice. AVPU then more formally... "Eyes" and "Lung Sounds" are part of your physical exam, so I removed them as "vital signs."

 

[Aprz]

About the only things I'd change in your sequence....

The stuff I highlighted in red are important. Lose ABC and your patient dies. Your patient is given something they're allergic to and their problems will only get worse. LOC is very sensitive to changes in circulation status. There's a reason I put it in twice. AVPU then more formally... "Eyes" and "Lung Sounds" are part of your physical exam, so I removed them as "vital signs."

In some areas, they teach lung sounds and pupils as vital signs (ever heard of PRBELLS?). In both Alameda County and Santa Clara County, they didn't consider it to be vital signs, but DOT considers pupils to be vital signs, Chabot College in Hayward taught it to be vital signs and recently merged lung sounds and vital signs together.

How some schools teach how to go through and use AVPU, ask LOC questions (A&O questions), and lack of GCS is whacked out. On the skill sheet for Chabot College in Hayward, it says that AVPU is only to be used on unresponsive patients (it specifically says this), and the week before my last week at Chabot College as a volunteer skill instructor, another skill instructor corrected me saying that I was incorrectly teaching people to use both AVPU and asking A&O questions; AVPU only for unresponsiveness and A&O if they are responsive (as if A&O and AVPU don't contain the word alert in 'em and using both is inappropriate). In regard to order, it's very common for them to teach asking A&O questions in place of AVPU before assessing ABC.