Sunday, September 25, 2005

It's not my emergency.

Medics and EMTs as a whole are a clever group of people. Because of the nature of the job, the split-second life or death decision making aspect of our existence, we have come up with numerous acronyms to help us remember the right order of the right questions to ask. OPQRST for assessment, DCAPBTLS for trauma, SAMPLE for medical history, AVPU for level of consciousness, APGAR for birthing babies, ABC for initial assessment are just to name a few. Even ALS for Advanced Life Support (paramedic) or BLS for Basic Life Support (EMTs). There is even some that are used more for humor than real treatment, like CATS (Cut all to shit) FUBAR (duh), and DFO (done fell out). All of these are hammered into our brains from the first day of EMT school and they are repeated over and over through out our career. Its so when you get a fucked up patient you can quickly assess the situation and treat your patient. One of the first drilled into our head are the ABCs. Stands for Airway, Breathing, Circulation. These are the first three things that a medic needs to make sure your patient has. An Open Airway so that your patient can Breath so that they do not lose their Circulation (or pulse/ blood pressure) This comes immediately after your scene survey. It is the beginning because if your patient does not have those three things your patient will die.

So fast forward to me, last night, on a scene of an MVA (motor vehicle accident), Roll-over ejection, then run over by an unsuspecting commuter just driving down the freeway. We were called for mutual aid for another EMS system. They were there first. The patient was already on a LSB (long spine board) with a C-Collar around his next. He is unconscious and most moving. His Airway is filled with blood, and his Breathing is irregular and gurgling. The Medic from the other system is standing over him, screaming orders at the FD (fire department) and her EMT partner. I walk up to her and calmly ask "What do you need?" This after I see this man fighting to breath through the blood filled airway. The medic looks at me and barks "I need a cravat!!" (a cravat is a triangle shaped bandage used to splint arms and shoulders and is sometime also used as a make-shift restraint)
Now she needs a cravat like she needs a hole in the head. So just thinking ahead I give her a "what the fuck" look and ask "D you have a BVM (bag valve Mask, u)sed to assist ventilations) and an O2 tank?" She, flustered, gives me "What!?, BVM...uh...Yeah...Its in the bag...But really I NEED A CRAVAT!" and she then runs up to her truck I guess looking for a cravat. Leaving me standing by this barely breathing patient. I look through the bag on the road next to him, which happens to be a trauma bag, not an airway bag. No O2 or BVM to be found. She then returns to the patient with a cravat and ties his hands together with it. Well THANK GOD we got that done, can we NOW manage the Airway? Apparently not. He get swept up, placed on the stretcher and rushed off the the back of their ambulance, still gurgling without O2, without an open airway without suction, but he does finally have a cravat.

Now I am not saying that I am a brilliant Medic, who knows everything, with pristine medicine. I am by no means a ParaGod. I am just a simple medic. And I am not one to question another Medic's treament or medicine. Every one goes it thier own way. But like any job thier is a standard of care. Thats where the acronyms come in. It keeps everything easy and in the right order. But it is in no way carved in stone. Some medics get vitals before the SAMPLE history. Some load the pateint in the truck before doing a secondary survey. But no matter what the ABCs come first, you do this while walking up to the patient. You can assess these things before even laying a hand on the patient. Paramedicine is not hard medicine. Its cookbook. A trained monkey could almost do this job. Its made simple because a medic must be able to think on their feet, make quick decisions that could mean getting a live patient to the ER, not a dead one. Its hard work to keep a cool head in the middle of an emergency. One just has to remember the first LAW of EMS. IT'S NOT YOUR EMERGENCY.

1 comment:

nh said...

There's some other good ones:
DRT - dead right there.
In order of severity:
FU - Fucked up
AFU - All Fucked UP
TFU - Totally Fucked Up
then FUBAR