WVAC 911: Lessons from EMS — Forming a general impression
As an EMT, when you get on scene, there can be a lot going on. It’s generally a new environment, such as a house you’ve never been to, and the fire department and/or the police department may be on scene.
Once we have determined the scene is safe, we have to block out all the noise and distractions and focus our attention to the signs that help us form a general impression of the patient. If it is a motor vehicle accident, then the condition of the car will give us indications as to what to look for.
- Were the airbags deployed?
- Did the vehicle roll over?
- Is there a “starburst” on the windshield (an indication that the occupant may have struck the windshield with his or her head)?
- Is there intrusion into the passenger compartment where a patient was sitting?
- Was the vehicle struck from behind, head on, or on the side (all of which will give us clues as to the suspected injuries we might encounter that may not be obvious when looking at the patient who is unable to speak to us)?
When a patient is unable to communicate with us, the patient’s location and position also give a clear indication of the person’s potential condition. In a car accident, is the patient slumped over the steering wheel or lying down outside the car? If we are walking into a residence, we note if the patient is on the floor, sitting on the couch, lying in bed, or in what we call the tripod position (indicating difficulty breathing). Are there any signs of trauma or blood?
All of the above considerations or observations occur in the brief seconds we approach the patient and/or scene. Once we see the patient, we start immediately forming a general impression of the patient’s condition, taking note of whether the patient is agitated or restless, their skin pallor, whether they are working hard to breathe, whether they look at us and respond to us when we speak to them.
Despite the presence of many first responders on a scene (police and fire), the EMT and in some cases a paramedic will take responsibility of patient care when they arrive on scene. On my first call with WVAC, I was so impressed with my crew chief. It was a car accident on a back road, late on a rainy night. When we arrived, police and fire were there controlling the scene and assessing the patient who was leaning up against a fence. The car had significant damage and intrusion into the passenger compartment. My crew chief hopped out of the ambulance and made her way straight for the patient. She was updated on the status of the patient condition from fire personnel on scene and assumed patient care. Once satisfied the patient was stable, she headed back out to inspect the vehicle’s damage. She kept her head, and relied on her training. In a short period of time she had to digest what the patient told her and process what she observed with the condition of the vehicle. Her level of confidence and care of the patient, all while teaching me, was admirable. I knew right then and there that I had joined the right service, with WVAC.
Forming a general impression is one of the more important lessons I’ve taken from EMT training. Becoming an EMT has helped me pause and be aware of the person in front of me. Everyone has stuff going on with them, and if we care about people, we need to try to cut through the noise to get a general impression of how they are doing.
Whether the fire department, police or EMS are the first to arrive on scene for your medical emergency, we are all focused on getting you the care you need.