Question for those with experience

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I am new and I have a question for those who are more experienced than I am. (my only experience thus far is clinicals)

In class, we always practiced assessment with one of us just sitting in a chair. My instructor said he hated that because, in real life, patients are in all kinds of different positions when you first get there. So, I was thinking about that and wondered this - When you get to a trauma patient who needs a rapid scan, do you do that in the position they are found or do you try to move them in some way so that you can do the scan better? I am worried about moving anyone in any way until I know what injuries I am dealing with, c-spine considerations, etc. For example, let's say an adult has fallen off a bike and is all crumpled up on the ground. Assume ABCs are ok and now we need to do a rapid scan for injuries. Do I do that the best I can in the position they are found so as not to aggravate a c-spine or other injuries? How can I do a decent head to toe if they are all crumpled up? Sorry this seems like a simple question but I am a newbie.

Thanks all!
 
I usually transfer the patient onto some sort of chair, so that it's closer to how I learned it in class...

Seriously though, it is all very situation-dependent. As is almost everything in EMS, there is not usually just one way to do something.

As a general rule, I'll take a look at the patient as I'm walking up and get a general idea of their injuries. I'll initially run through what is visible (especially if their back is exposed), as long as their airway and breathing is not being effected by their current position. The ideal position I want to get them in for eval, treatment, and transport is supine, though. There are a lot more considerations that will take place, but again, those are all very dependent on the situation.
 
Scan for injuries as you approach the patient. If patient is candidate for c-spine you will be placing him in a collar and backboarding (supine/ideally). If you cant do a proper assessment with the patients current position, you will have to reposition him/her. Remember to just manage life threatening injuries first and then treat secondary injuries such as a broken arm.
 
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Rapid scan is like a general impression, it's something that you just do.

If it's a trauma with c-spine you can lift up the shirt to expose the back when you log roll.
 
At the fire department I work at we usually hold c spine if its indicated, and put them on a backboard. Address obvious life threats and get them to the box. Dont be afraid to cut all clothes off... this comes from experience. I once had a trauma and I cut the front of the shirt but didnt check the guys back. When we got to the er they found the imprint of a baseball bat across his back.
 
When it comes to assessing trauma patients, while I start assessing them as I walk up, I'm pretty much able to check the ABC's without moving them and from there, I just do the assessment. I generally go from head to toe but where I start is more situationally dependent. With traumas, I don't like to be on scene any longer than I have to. It doesn't mean I'm going to scoop & run, but more that I just won't waste time.

Once I'm doing the assessment, I'm usually done within a minute or so. I'm just looking for obvious trauma, life threats, etc. The more detailed exam comes later.

As you get to doing these exams, you'll just eventually do them without having to really think about the mechanics of it and you'll naturally adapt to the situation and your mind will be more free to consider things.
 
Welcome to the fourms! Every situation will be different and you will have adapt to what is going on. Generally the persons position has to do with what is going on. If the guy fell off a roof he will be on the ground and assessed there, if he hurt his arm he may be in a chair when you arrive. As others have said it is important to look everywhere especially the back. Once missed a screwdriver stab under the chin. ER missed it too so I dont feel so bad only found it once he was in surgery. Then again he had a meatcleaver wound to the forehead so you know.
 
I love the term they used in the show combat rescue for what I've always learned as the rapid trauma. They call it the blood sweep. Gets my mind in the right frame to keep this quick.
 
Uclabruin103 said:
I love the term they used in the show combat rescue for what I've always learned as the rapid trauma. They call it the blood sweep. Gets my mind in the right frame to keep this quick.
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It shows their mindset. They're combat operators so they expect that their patients have been wounded somehow. Therefore they'll do a "blood sweep" to look for wounds. It is the right mindset in that they want to do the initial assessment quickly and find any immediate life threats.
 
I don't move them just to facilitate an assessment. Usually you can make appropriate decisions in an entrapment from outside the car but if you are lacking information you would need to make a better decision heir on the side of precaution.
 
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