This is another guest post from Will Kone (BusyPoorDad), who works as a paramedic and emergency manager. I couldn’t decide whether it was part of the Preparedness Priorities series or not, so I’m running it as a standalone.
I know many people are preparing for the day when the EMTs and the ambulance won’t arrive. But until then, it may help to understand their methods and how best to either assist them or keep from hindering them.
As usual, I expect Will will be on hand to talk further about this in the comment section.
You used your kit.
Ok, now your secretary just got hurt running with scissors. No kit is going to “fix” the problem of impaled scissors. (Or any other major problem.) You need expert help. So until the world as we know it ends, this means a hospital with doctors who have x-ray’s and other expensive gear. So you will call 911.
You called 911, now what?
Most systems have a trained dispatcher. This person will try to gather info about what happened, where it happened, what you have done so far, and give help till EMS arrives. That is a lot of information to get and often collected from people in a panic.
So be ready for the dispatcher to ask you what seems like dumb questions. In the case of the running with scissors example, you might get asked, “Is the person breathing” when they were stabbed in the leg, or “Are they in a car or truck”? There are reasons for this, often because someone was not breathing after being stabbed in the leg. Not breathing makes a big difference than just stabbed in the leg.
You may be told to stay on the phone till EMS arrives, often this is to help get better directions they can relay to the responders, or to report any changes (good or bad) for the patient. When they arrive it is best to have someone outside to direct them to the patient. How long and who arrives will depend on where you are.
A major city will often have a response of five minutes or less for a life threat (like scissors in a leg) or you might get prioritized lower compared to other calls. (A wound that has had its bleeding stopped vs. someone with crushing chest pain, for instance; dispatchers will send EMS to the chest pain first.) These responders will most likely be paid professionals with the local city government or a private company contracted with the local government. They will be your neighbors in the sense that they live in the same city as you work in/live near, but you really are not likely to see them around town.
If you’re in a rural area, response times can be over 30 minutes. The people who show up will most likely be volunteers. They received your call from a paging system at home or where they work, stopped what they were doing, drove their personal car to the station, got the ambulance and then drove to where you are. Greater distances mean longer response. They are normally not paid and get all their training on their own time and in many cases on their own dime. Ninety-eight percent of the time they are unpaid professionals. They will be your neighbors; you will go to church with them, run into them at the library, shopping store, etc.
In the city or systems with paid professional EMS responders, they are likely going on several thousand calls every year. (My section is almost to 35,000 runs for the year as of October and the department expects to reach 200,000.) The advantage is the responder has a lot of experience. With that many calls they are going to run into things more often. The down side is that they will also run into a lot of “B$” calls. Any paramedic that can get through the first two years can become jaded and uncaring. It is a defensive mechanism. Most paramedics will have a health dose of jadedness, but still be very caring. They did not become paramedics to become rich or get respect. (They don’t get either in any quantity.) They want to help others.
In the rural systems, the responding department might have as few as 500 calls in a year. This means the person responding may not have lots of hands-on experience. But don’t assume this means they are not professional or capable. The top three paramedics I would want to work on me are from the rural area. They used their free time to study, practice, and train. Because they don’t get paid, they are really dedicated to the profession. They do this because they love helping others. Also, in rural areas, the number of “B$” calls are a lot lower. (The number of “why didn’t you call sooner” are much higher).
Either way, this means that when they show up to the example scissor incident they will be very pleased that: 1) it is a “real” call. And 2) that you took action to help the person. (Even more pleased that you did the right thing because you took those first aid classes.) They will do some things right from the start that you may or may not note. They want to make sure the scene is safe; rushing in where a scissor-stabbing nut running loose is will not help anyone and just add to the number of people hurt. (Or is that chest pain from a leaking poison gas line and not just a heart problem)
You will see them take “BSI precautions” — Body Substance Isolation. This means gloves mostly, but sometimes a gown or face mask/goggles. The idea is to prevent skin-to-body-fluid contact, because the responder does not know what the patient has, and the patient does not want what the responder might have. (They are around sick people all day long, who know what they have contacted.)
Once they have determined who and how many patients they have, they will focus on the patient(s). They are not ignoring you. The best source of the information they need is the patient, and the answers the patient give tells them a lot about how the person is doing. Your help is appreciated, but may not be recognized right away.
When you see them, as they first come up, give them a very quick review. For example: “Sue was running, tripped and stabbed herself with the scissors, there was slight bleeding, I stabilized the wound with some bulky dressing and wrapped the area with a bandage to hold it in place.”
If they ask you any other questions, answer, but be ready for them to not ask anything after that till they are ready to move the patient.
They will approach the patient, introduce themselves, ask what happened. They will do this even if the person is unconscious and you told them this. Partly, this is to see if the patient’s status has changed from the last time you talked to them, partly because sometimes apparently unconsious people can still hear what is going on and it does not hurt to talk to them.
The responders will assess for “life threats,” — your basic airway, breathing and circulation. If the patient is not breathing well, the responders have tools and equipment to help. It is always nice when the patient is talking; that means the airway is open and they are breathing and their heart is beating. After the initial assessment, the responders will take vitals, the pulse, blood pressure, respiration and oxygenation of the blood (SpO2%).
From that point they will likely make a choice about where to take the patient or if to take them. Yes, if. Many times patients want to take themselves to the hospital because they fear getting the bill or “don’t want to bother the paramedics.” Depending on what is wrong, the responders may agree.
If they chose to transport, expect them to continue with questions, lots of questions. We have many mnemonics for this: SAMPLE, OPQRST, DCAP-BTLS, ACBDE, etc. Many times the patient will be asked the same questions over and over. Each time care is transferred, from the paramedic to the nurse, to the physician’s assistant, to the doctor, to the other doctor, etc. This is not because none of these people talk to each other. It is due to a few factors. First, people don’t always tell the truth to different levels of care providers. What they tell the paramedic is not what they tell the nurse and they tell the doctor something else. Second reason for all the questioning is to see if the patient is having a change in mental status. If you tell the paramedic that you are 44, allergic to sulfa, and got your scissors stuck in your leg while running, but tell the nurse that you think your allergic to “suffer” and your leg hurts really bad but you don’t know why, that tells something about what is going on inside.
The people who respond to calls for help are just like you. They are concerned about their neighbors and want to help them when they are in need. They are professional and highly trained. Both rural and urban paramedics have the same requirements for certification, same continuing education requirements, and operate under the same Medical Control protocols. The only difference is one is paid, the other is not. (and in a lot of cases, the volunteer in the rural area is a paid responder in the city.)
“Who am I? Why am I here?” The immortal words of admiral Stockdale are best answered like this: I’m William V. Kone, a First Sergeant, Paramedic, Emergency Manager, and a “Busy Poor Dad.” I’m 23 years into the Army Reserves, currently the interim Company Commander of an HHC for an Engineer Battalion. I work for an Ambulance Company and have been with EMS since 1997, and with Fire Service since 1996. I have been with rural districts in upstate New York, a Suburban district in Maryland, and currently work the City of Cleveland and Cleveland Metro area. I also work with the Emergency Management Agency in the small city I live in, have a BSc in Emergency Management and Homeland Security, level 1 Continuity Of Operations Planning certification, and am working towards my CEM.