Seizure at Work

[Aprz]

At my current job (not a working EMT; I work fast food), a customer had a seizure. Was counting my money drawer when I heard people shouting "Call 9-1-1! Call 9-1-1". Leaned over my counter (blocked by a wall) to see what was going on, and there was a crowd in the back. I was partially towards the back to see what was going on, and my friend handed me the phone and told me to just call 9-1-1. I called 'em up, opened the employee side door to get into the lobby where the incident was going on, and I see a female probably in her early thirty's convulsing on the floor while a male had his thumb in her mouth! The dispatcher was was trying to get my attention on the phone "Hello? Hello?!", but I demanded to the guy to get his thumb out of her mouth "Hey! Get your thumb out of her mouth! She might bite you!" He said no. I repeated to him telling him to get his thumb out her mouth or she might bite him, and then tried talking to the dispatcher. She couldn't hear me so I walked through the employee door again to tell her our location plus I didn't know the address exactly so I needed to grab a little paper that said where we were at, but since it was a land line, she figured it out anyhow. Told her that a female was having a seizure. I walked back and told him the paramedics were on their way. He still had his thumb in her mouth, and I warned him again. He said he didn't care if he get hurt just as long as she didn't get hurt so I quickly reversed it and notified him "Hey, I'm an EMT. If you don't get your thumb out of her mouth, she can bite it off, and it could choke her to death. Get it out now." He still refused, but moments later she stopped convulsing. She sat up, but was just staring out the window. She was not responding to anyone when talking. Just staring. I noticed there was blood and I asked "Where is that blood coming from?" Somebody shouted that it was from the guy's hand. He and some other guy was about to lift her up and I shouted "No! If she goes back into a seizure, she could fall and get hurt even worse". By this time they started listening to me, she was sitting up on her own when I said let her lay down, so I asked them to at least support her back in case she goes back into an episode. They asked me what can we do, and I told them "Just make sure she doesn't hurt herself. If she stops breathing, breath for her", and as that happened, she started looking around very confused. The guy who had his thumb in her mouth turned out to be the husband, and he told her she just had a seizure. I asked her name, if she knew where she was, what month it was, and if she was aware what was going on right now. She knew her name, and what month, but didn't know where she was, and thought asked if she fell when I asked her if she knew what was going on. Her kids came running up, stood in front of her while crying, along with her husband (didn't see his hand bleeding at all). She wanted to get up for the kids, and adviced her not to get up, but she tried anyhow, and her husband and some another guy assisting restrained her, and I said "Don't restrain her. Ma'am. I recommend you don't get up for your own safety. Can somebody calm the kids down [was looking at her husband]?" The fire department arrived and immediately took over. Didn't question me at all, and I didn't interrupt them when they were asking her and the husband questions. They did a 12-lead, asked the husband and the patient questions, c-spined her, and transported. Before the paramedics arrived, I was going in and out from answering the dispatchers questions to telling the guys not to do things. Dispatcher hung up when paramedics arrived. Since I was stuck in the room with the patient, medics, husband, and kids, I got to overhear that the blood turned out to be from her neck hitting a chair when she fell. I am unsure if she had a seizure before falling, or after, but the husband insisted to the medics that it had to happen before.

Just thought it was interesting enough to share even though the guys didn't really follow my commands, I never got to touch the patient (and I already know that there isn't much you can do for a seizure anyhow), didn't do a patient assessment (saw she was breathing, saw the blood on the floor, asked A+O questions twice, and that's it), and I didn't get to say a single word to the arriving medics. I think it could've been a lot worse if the guy thumb got bit off so I am thankful for that. This situation makes me question if I wasn't very commanding perhaps by looks (I look like I am fresh from high school), the fact that I was wearing my work uniform for the fast food place I work at, or if it was just the fact that the husband was freaking out and he wouldn't even listen to a paramedic in uniform (or higher up, an RN or physician) if one was there.

 

[akflightmedic]

Overall this experience ended well and gave you a very valuable lesson, one which some people fail to ever learn.

That lesson is how to assume control and maintain it.

A lot of mastering this skill has to do with posture, body language, tone of voice and then of course backing it all up with competence and confidence.

The scene had lots of bystanders, sounded like some employee contributed chaos and of course the patient actively seizing drawing even more attention.

To assume command, first clear the scene. Even though the guy had his thumb in her mouth, you could see she was being tended to (even incorrectly). You assume control by controlling the crowd first. You take command and state clearly, firmly and loud enough to be heard...everyone please clear this area, please step back. I am an EMT and 911 is on the way. Please step back, thank you!

You have now asserted yourself without yelling or panicking, the crowd will obey and they will now view you as the scene commander. This will come in handy if you ever have a need to delegate tasks on scene prior to 911 arrival.

After you have pushed back any unneeded people, the person tending to the victim is isolated. He is going to be aware of what you just did and he is going to give you more serious consideration. You then approach him, kneel down and state calmly, I am an EMT and 911 is on the way. Believe it or not, he is going to be very willing to hand over control as you have now demonstrated the ability to bring order and control to a scary/hectic situation when he is feeling quite helpless as his wife flops about.

After informing him of your position and what has been done, you can then advise that he remove his finger for reasons stated. You can quickly educate him that she will not swallow her tongue. Do not demand, do not yell, do not order. When you calmly yet firmly ask and also throw in a piece of education, it indicates to him your competence and he will follow commands.

You did ok with the remaining instructions and I would not expect much more from you in that regard. Your youthfulness or gender have no bearing on this situation, it was all in how you presented yourself. You need to be aware of what pitch or tone you are using, body postures and language.

I have 5ft 100 lb partners (or in that area) that could bring command to any scene without anyone questioning them. It takes practice and it is a little taught or practiced skill in EMS training.

 

[jjesusfreak01]

First thing is you probably should have handed off the phone. The dispatcher just needs to confirm the address, and you probably weren't the best person to do that. You can't control the scene and talk on the phone at the same time. Not really blaming you though, you got handed the phone, its hectic, and no one else probably wanted to take control, so good job.

 

[Aprz]

Thanks guy. Scene control was what I really thought about this since I couldn't convince the guy for my life to get his thumb out of her mouth. I see how that works though, it's kind like getting the less involved to listen first, and after the more involved sees that you have taken care of the less involved, will take you more seriously versus me being on the phone and telling him to get his thumb out of her mouth while a crowd engulfs us. I agree I probably should've passed the phone back to my phone worker, and told him "Hey, you call 9-1-1, and I'll go check what's going on". When we originally called 9-1-1, all I could see was a crowd so I couldn't tell the dispatcher what was going on until I walked to the patient, walked out of the room so she could hear me (it was really loud), and walked back in with her on the phone still. Good lessons learned: delegation and assume control. Thanks guys for your input. I didn't feel bad about the situation at all since the guy didn't get hurt, and the wife was slightly oriented by the time the medics arrived. Only things I thought about was how I didn't talk to the medics, although I thought about this more and I'd say I didn't do anything significant (although it would have been nice for them to document my story if they did I think in case these people turned around on me for whatever reason) and about how I couldn't get the guy to listen to me until after she stopped seizing. I think the phone thing is a good point to realize that whole addition assistant aspect of scene size up. I've been helping teach CPR, and I always tell them to say to bystands "Hey you, go call 9-1-1, get an AED, and come back", hehe, and I didn't do that (and I mean I should've been "You can 9-1-1, get an ambulance" sorta thing. Since it's was a co-worker, no need to worry about him coming back, haha, or at least I hope.

 

[chadwick]

DON'T LET HER SWALLOW HER TONGUE!

 

[firetender]

Exercising the Dinosaur

I want to try my hand at using this as a lesson. I see some stuff in here that I think some of you could find useful (Not personal, APRZ.)

female probably in her early thirty's convulsing on the floor while a male had his thumb in her mouth! The dispatcher was was trying to get my attention on the phone "Hello? Hello?!", but I demanded to the guy to get his thumb out of her mouth "Hey! Get your thumb out of her mouth! She might bite you!" He said no. I repeated to him telling him to get his thumb out her mouth or she might bite him, and then tried talking to the dispatcher. She couldn't hear me so I walked through the employee door again to tell her our location plus I didn't know the address exactly so I needed to grab a little paper that said where we were at, but since it was a land line, she figured it out anyhow. Told her that a female was having a seizure. I walked back and told him the paramedics were on their way. He still had his thumb in her mouth, and I warned him again. He said he didn't care if he get hurt just as long as she didn't get hurt so I quickly reversed it and notified him "Hey, I'm an EMT. If you don't get your thumb out of her mouth, she can bite it off, and it could choke her to death. Get it out now."

THE SCENE: You're on a land line phone. Tethered to it. You're yelling at a guy in the next room. He's got his thumb in a seizing woman's mouth. You're either calling the call in or running the call. You have no semblance of control of the scene because, really, you're not there; you're on the phone. You're just a bystander having NO idea of what's going on.

POINT: In what textbook does it say that seizures only occur to people who are alone? In fact, those diagnosed with active seizure disorders not controlled by drugs are MORE likely to be accompanied in public. Make sense?

POINT: You're behind the counter, you're responsible to your employer which would logically extend to his/her customers' welfare. You're an E.M.T. But does that give you the right to make flash judgments about the scene, the disease entity, the people at the scene and ESPECIALLY their relationships to each other?

POINT: The reality of the scene is that a woman is having a seizure and SOMEONE is intervening. You really ought to figure out who that person is. Wouldn't that fall into the job description of EMT? Why? Because this was what you could call an "Accompanied Seizure". The guy was her husband and you wrote him off, assuming YOU knew what was right.

He probably had more experience with her in this than you have had applying Band-Aids tm!

POINT: As an E.M.T. you missed the first vital step after the ABC's were accounted for (which they were, visually, by you.). You did not assess the scene adequately. You had no idea what you were in the middle of.

POINT: How many people have you known who have died in the street from seizures and how many after being mishandled by passersby or medics for that matter?

POINT: Most witnessed seizures run their course. The ONLY thing you have to watch is that airway. Please, give me another break and tell me how many seizure patients have bitten the thumb off an intercessor and choked to death on it? (I'll give you $10.00 if you can document me ONE.)

POINT: I'm being hard on you, but for a reason; offering THAT as an excuse shows a true lack of understanding of your field OR the disease.

He still refused, but moments later she stopped convulsing. She sat up, but was just staring out the window. She was not responding to anyone when talking. Just staring. I noticed there was blood and I asked "Where is that blood coming from?" Somebody shouted that it was from the guy's hand. He and some other guy was about to lift her up and I shouted "No! If she goes back into a seizure, she could fall and get hurt even worse". By this time they started listening to me, she was sitting up on her own when I said let her lay down, so I asked them to at least support her back in case she goes back into an episode. They asked me what can we do, and I told them "Just make sure she doesn't hurt herself. If she stops breathing, breath for her", and as that happened, she started looking around very confused. The guy who had his thumb in her mouth turned out to be the husband, and he told her she just had a seizure.

POINT: If I warn someone that the finger they have in someone else's mouth may get bit off and they say, "That's okay." Then, for the moment, That's Okay. Why? Because with seizures, you WATCH and only intervene when absolutely necessary.

INTERPRETATION: From what you said I felt you had a very high investment in being the Boss. That's okay, really, some scenes NEED that but seizures like this? No, with this, the best you can do is ESTABLISH CALM IN THE ROOM, and MAKE ROOM FOR THE PERSON. That is actually where you would begin gaining control of this situation. As you handled it, everything you did was about resistance and authority (though bowing down to the medics when they arrived). Please look at this in terms of how your adrenaline and knowledge can get the better of you.

POINT: You know the guy ain't gonna budge. You need to #1) assure the safety of the patient, and #2) Figure out who that guy is! In this case, I say build a perimeter of safety around her AND him. Then WATCH. I see you doing a lot of pushing instead of letting the RECOVERY unfold on its own terms. Sometimes, like triage, this is difficult, but the resistance you pose to the scene, AKA, her husband, could negatively affect the course of recovery of the patient.

I asked her name, if she knew where she was, what month it was, and if she was aware what was going on right now. She knew her name, and what month, but didn't know where she was, and thought asked if she fell when I asked her if she knew what was going on. Her kids came running up, stood in front of her while crying, along with her husband (didn't see his hand bleeding at all). She wanted to get up for the kids, and adviced her not to get up, but she tried anyhow, and her husband and some another guy assisting restrained her, and I said "Don't restrain her. Ma'am. I recommend you don't get up for your own safety. Can somebody calm the kids down [was looking at her husband]?"

I hope by now you see the vital piece that in your EMT surety you barreled completely over; THE DUDE WAS HER HUSBAND! Oops! Aprz encountered a Higher Authority!

Exit; Stage Right! In the absence of any life-threatening emergencies, HE has just taken over responsibility for his wife.

Personally, I'm surprised you didn't come here moaning about getting cold cocked by a patient's husband! He had the legal right to ask an Officer of the Law to "Get him away from me!" You, by not knowing who he was, made yourself quite vulnerable, can you see that?

The fire department arrived and immediately took over. Didn't question me at all, and I didn't interrupt them when they were asking her and the husband questions.

Can you see how clearly arrogant you come off? How extremely courteous of you not to intervene!

They did a 12-lead, asked the husband and the patient questions, c-spined her, and transported. Before the paramedics arrived, I was going in and out from answering the dispatchers questions to telling the guys not to do things.

Once again, you didn't have control of the scene, you just interposed yourself on it.

Dispatcher hung up when paramedics arrived. Since I was stuck in the room with the patient, medics, husband, and kids, I got to overhear that the blood turned out to be from her neck hitting a chair when she fell. I am unsure if she had a seizure before falling, or after, but the husband insisted to the medics that it had to happen before.

Just thought it was interesting enough to share even though the guys didn't really follow my commands,

OUCH!!!

I never got to touch the patient (and I already know that there isn't much you can do for a seizure anyhow), didn't do a patient assessment (saw she was breathing, saw the blood on the floor, asked A+O questions twice, and that's it), and I didn't get to say a single word to the arriving medics.

That's good, really because as an EMT you were completely unprepared to offer them anything. Something about "didn't do a patient assessment".

I think it could've been a lot worse if the guy thumb got bit off so I am thankful for that. This situation makes me question if I wasn't very commanding perhaps by looks (I look like I am fresh from high school), the fact that I was wearing my work uniform for the fast food place I work at, or if it was just the fact that the husband was freaking out and he wouldn't even listen to a paramedic in uniform (or higher up, an RN or physician) if one was there.

Look...you did SOMETHING, you honestly were looking out for the interests of a person you determined was in danger, you called for help and when it arrived you did nothing to interfere. It worked out fine...

...and there's a lot to learn.

your friendly firetender

 

[Aprz]

Eh, just a slight misunderstanding regarding the land line. Only for the first half minute of the episode, or less, I walked out of the room to talk with the dispatcher, which was originally to say where we were at, but turned out it was just a confirmation, other than that moment I was next to the female and male until the medics arrived. I never yelled at him from another room. I know it sounds bad, but I was yelling at him right next to him because it was so loud.

The thumb bit off part, that's me coming up with a bad way to get across how I imagined it. What I imagined was possible was that she would bite down, he would jerk his thumb out as a reaction, and I thought that part of the meat around his thumb and blood could obstructed her airway. I didn't imagine it as a full out amputation of his thumb.

My choice in not trying to get his thumb physically out was conern that he would get physical with me, I could hurt him or her trying to get the thumb out, and I figured that it would be his own fault if he got hurt if she did happen to bite down. I did my best to just try to convince him to get it out.

I mentioned that I didn't say anything to the medics as part of the story and for legal reasons. My concern was that since I didn't talk to them about my involvement in the episode that could somehow record my story in their PCR like "kid tried to get involved; did nothing; never touched patient" or something along that line, that him and her could turn around on me and just say I did whatever wrong months later, and that could be a legal issue for me since it would just be my word now. I didn't think I had anything valuable to say to the medics other than to record that I did really nothing.

And no offense to you either, if it weren't for you mentioning that you weren't personally attacking me in the beginning of your post, but rather just trying to get some pointers across, I would've thought you were doing that. Your not so friendly sarcasm did not help (e.g. "How extremely courteous of you not to intervene!") and some comments (such as "Personally, I'm surprised you didn't come here moaning about getting cold cocked by a patient's husband!") hit me with that feeling. Tone it down next time? Totally down for learning from this, but don't want that hot head feeling when reading your posts. Your post looks like you were overly excited.

Thanks for the input.

 

[Aprz]

I must quickly admit that I am surprised I learned a lot from this, mainly about how poorly I did scene size-up. I expected mostly a pat on the back, and a "you did what you can" sorta thing from this.

 

[firetender]

Totally down for learning from this, but don't want that hot head feeling when reading your posts.

Gotcha! Thanks for saying. I'm not immune from having periodic outbreaks of self-righteousness.

 

[Aprz]

It's cool. I currently help out with demonstrating skills in the EMT program I attended and a First Responder class I took before EMT, and I'll tell the students about my experience, and share what you guys said to me to show them how important scene size-up is, and how easy it is to screw it up. Everything turned out okay, but I could've executed things more flowingly and appropriately. And now that I look at it, I kind of think it's funny how excited I imagine you were from posting that up, and probably just really like educating like your profile says.

 

[CAOX3]

He probably had more experience with her in this than you have had applying Band-Aids tm!

Im assuming since he has his finger in her mouth he doesnt have much experience dealing with someone having a SZ.

 

[firetender]

Im assuming since he has his finger in her mouth he doesnt have much experience dealing with someone having a SZ.

...AND, the normal course of her seizures may be such that biting down is something she just doesn't do. In his case, it really may not matter. The challenge I'm talking about here is expecting circumstances and behaviors to conform to your expectations. Be open to seeing what is REALLY happening.