No matter what color an ambulance is, it's something of a black box to folks who don't work in EMS. I thought perhaps one of the most helpful things I could do as an EMT would be to simply lay out for you what an EMT does. While there are variations on the way an individual EMT processes these tasks, based on the situation and personal experience, these basic steps are the way every site visit should begin, per national standards. Understanding this recipe will help you understand what an EMT does.
|photo by Coolcaesar|
1) Ensure that the scene is safe. An EMS crew is of no use to a patient if the scene puts the patient or the crew in danger.
2) Confirm the number of patients. Many times a dispatch is vague, e.g., "for a medical problem." There's nothing worse than driving away from a scene with a family left behind wondering, "Well that's great for gramma, but what about Sally?"
3) Determine the basic nature of the illness or mechanism of injury. In other words, what's wrong with the patient or patients and what's the short version of what happened?
4) Based on the patient and the mechanism of injury, Decide if precautions should be taken to immobilize and protect the cervical spine. Because damage to the vertebrae in the neck can be life-threatening, the EMT needs to take care to protect that part of the body before any further treatment is undertaken.
5) Given the patient, the scene, and all the other factors, Evaluate the need for additional help. Will the crew need a lift assist for a heavy patient? Does the patient need to be extracted by the fire department? Should the police be called toe secure the scene? As a basic life support unit, do you need to call for advanced life support?
6) Be protected by appropriate BSI ("body/substance isolation") measures. The crew should always be gloved, and may need to wear gowns, masks, or safety glasses depending on the scene and patient.
Once this "scene size-up" has been completed, the initial assessment of the patient may begin along these lines:
1) General Impression. The EMT needs to have a basic idea of the patient and the situation as the foundation for the rest of the assessment. For instance, "A male, middle-aged patient complaining of chest pain." Nothing more complicated than that.
2) Obvious Life Threats. Is a patient has an obviously life-threatening injury or condition, the EMT doesn't need to and shouldn't fret about the rest of the detail until that life threat has been dealt with.
3) Level of Consciousness. Is the patient alert? Is the patient responsive? Often times, this is taken care of right away by simply saying something like, "Hi, I'm Nevets, and I'm with the ambulance. What can I help you with tonight?" If the patience responds appropriately, you know they are responsive to verbal stimuli, and you can move on. If there are problems with the LOC, then steps should be taken to correct these problems.
The next steps are the ABC's:
4) Airway. Does the patient have a patent, or open airway? Is there a working pathway for air to move from outside the body into the lungs and back out? The EMT needs to be concerned about obstructions, wounds, and other things that compromise this. The good news is that, since the movement of air is required to speak, if the patient answered the question in Step 1, you know there is an open airway. In some cases, airway maintenance is so complicated that the EMT never moves beyond this until the patient is at the hospital. There's a common saying: We never deliver a patient without an airway.
5) Breathing. Okay, so there's an airway. That's great! But how's their breathing? The EMT will get a respiration rate (how quickly the patient is breathing), check for unusual breath sounds, ensure that both sides of the chest are rising and falling about the same, and evaluate the quality of the breaths.
6) Circulation. Only at this point should the EMT worry about things like blood pressure, pulse, bleeding and other signs of circulatory distress. To many people it's surprising that we wait this long, but the truth is if a patient as an altered level of consciousness or is not breathing, it doesn't matter how well their heart is working: they may die with a perfectly good heart. Without oxygen, the heart can do no good. If the brain is damaged, it may not matter if the heart gets it blood.
At this point, the EMT makes a Decision for rapid transport ("priority") or for further assessment on-scene. Look for another post soon about the further assessment process -- but in the meantime I was this was either helpful or interesting. If you have any questions, please let me know!
p.s., If you haven't already, please do go back and read EMS 101 and EMS 201.