Tunnel Vision

[tcripp]

Alright, here's one for you where I am looking for suggestions on how to improve my game. You see, when we (I) roll up on an MVA/MVC, I tend to tunnel in to patient care and skip over the whole scene assessment piece. As soon as I hear that there is a patient in need, I skip over the basic of operations and start focusing in on patient care.

I need a trick or something so that I can remember to stop and give a scene size up (verbally over the radio) before making first patient contact. I know to do it...and it's not an adrenaline rush that screws me up...but it's that first patient that I know needs my help.

Okay - let'r rip!

Toni (aka Terri)

[Just Plain Ruff]

Alright, here's one for you where I am looking for suggestions on how to improve my game. You see, when we (I) roll up on an MVA/MVC, I tend to tunnel in to patient care and skip over the whole scene assessment piece. As soon as I hear that there is a patient in need, I skip over the basic of operations and start focusing in on patient care.

I need a trick or something so that I can remember to stop and give a scene size up (verbally over the radio) before making first patient contact. I know to do it...and it's not an adrenaline rush that screws me up...but it's that first patient that I know needs my help.

Okay - let'r rip!

Toni (aka Terri)

Count to 10. Take a deep breath, Then look at the scene. Then get out and look again.

But honestly, this is a skill that's crafted over many calls. The first time you get injured at a scene or you miss something will be the last time that happens if I know you like I think I do.

I found that I was in the same boat as you when I started as a medic. A mentor of mine said "dude, slow the F down and count to 10" I did that consistently over a couple of weeks and it began to be second nature.

Remember the old adage, "it's not your emergency, it's theirs, don't make it your's or you are no help at all" told to me by the same mentor.

I was on a scene as a new medic. We had a suicidal teen who left a note and he was hiding from us. WE split up my partner and I. My partner had a deputy with him. I did not. (stupid tax on this one). I searched the basement and the outside. I found the kid unconscious(so it appeared) in the garage that he had locked. I broke the window of the door, unlocked the door and went inside just after radioing that I found the kid in the unattached garage out back. Deputy and partner coming up behind me I entered the garage and bent down to check the patient and he went crazy, hitting and biting and scratching. I got hit in the face, my eye sustained a corneal abrasion that hurt like hell and I basically got whooped by this kid until the deputy and my partner who was about 350 pounds landed on him. they subdued him and I limped away with much pain.

So I didn't follow my rules and wait for help, I didn't wait for my partner but as a new medic I was 10 feet tall and bullet proof. I found I was only 4 feet tall and definatley not bullet proof that day.

That's when I realized that I had to do the counting exercise even in scenes where theres only one victim lying flat in a garage.

I tell you this because that was the call that was my wake up call to really take my time and looking at all the aspects of the scene, there were knives, hammers, screwdrivers and many other deadly implements/weapons in that garage and luckily for me this kid only used his fists and feet and teeth.

My guardian angel was over me that day.

[Happiness]

Tape a saying "check scene before you look at pt" on your dashboard or your clip board. I always step out of my ambulance and count to 10 that gives me time to at least have a quick look.

[tcripp]

Tape a saying "check scene before you look at pt" on your dashboard or your clip board. I always step out of my ambulance and count to 10 that gives me time to at least have a quick look.

Count to 10. Take a deep breath, Then look at the scene. Then get out and look again.

I was seriously thinking about putting a note in my truck that read - VEST - # of Vehicles - # of Patients - Additional resources - THEN triage!

Last call that caught me...rolled up and stated "Medic on scene, stand by for further info". As I opened the door, FD was standing there telling me "we've got a pregnant pt who can't feel baby/legs". I put HEMS on standby and walked to look at the patient. See how I rolled right by the rest of the size up?

Anyway, quick assessment had me launch the bird. I had established all others would be refusals that I thought we could handle secondary to shortage of EMS resource...but I forgot to radio that back.

I'm liking the note in the truck...or...better yet...I'll add "don't put gloves on until all the above is done".

[hatelilpeepees]

Where you are most likely to get burned is when first responder says oh, that one over there is dead, these two over here are critical. Then you found out after all the helicopters leave that your dead patient isnt quite dead. I think the dash sticker is a good idea, but i always used the same rule I used for itubation, I have to hold my breath until i get to first patient, then breath, have to hold my breath until I get to next patient, and so on down the line. I also like to send my partner to the opposite end, and let us both meet in the middle and add everything up. Getting the proper head count so that you can get enough resources and the right resources on the way is crucial.

[Richard B the EMT]

The first time you get injured at a scene or you miss something will be the last time that happens if I know you like I think I do.

Thank goodness it was only a drill, simulated school bus versus 2 cars and a power/phone pole. Several responders went up to the bus, and were advised by the field judges they'd been electrocuted, because they had NOT done a scene safety check before placing their hand on the bus door. The rope from the pole was simulation of an electrical cable across the bus.

NEVER forget your scene safety check. Job One is going home in more or less the same shape you started the tour, across the board for LEOs, Fire Fighters, and us EMSers.

[paramedicmike]

Thank goodness it was only a drill, simulated school bus versus 2 cars and a power/phone pole. Several responders went up to the bus, and were advised by the field judges they'd been electrocuted, because they had NOT done a scene safety check before placing their hand on the bus door. The rope from the pole was simulation of an electrical cable across the bus.

NEVER forget your scene safety check. Job One is going home in more or less the same shape you started the tour, across the board for LEOs, Fire Fighters, and us EMSers.

I'm sure their scene size up was fine and they judged the rope to be no hazard. This falls back to the scenario planners for failing to create a realistic environment/scene. If they really wanted to create a realistic scene they would've found a length of black cable consistent in appearance to what travels from pole to pole and used that.

[Bernhard]

Practise, practise, practise.

Multi victims drills help a lot, if they're good and if you're really willing to learn something. Another good way is to prepare just mentally: take self experienced situations, drill settings, stories of co-workers, out of EMS magazines/forums and even public news stories, then go through them with a little bit of "what if" imagination.

After such an incident (or drill) critique yourself, maybe by writing a detailed situation report, even if you keep it to yourself you will learn something. There is always at least one point to improve.

And if you're don't anxious enough to keep the report for yourself, post it here.

On the practical side: on scene counting to 10 and taking a deliberate breath is a good advise, already given. Try to improve your detection ability of "things going wrong" (= you getting tunnel vision). Train to get back to the Plan–Do–Check–Act circle, even if you loose it for a second.

Be confident in your abilities and your tools, and always be able to apply basic procedures. That saves time when really having to take care for multiple patients, it gives you time to think more about organization.

Then, you can save the world!

[DwayneEMTP]

Though it's cliche I do believe it is valuable, "this is not my emergency."

My previous partner grabbed my collar once and jerked be backwards onto my ass as I was walking around the side of the ambulance and the extended side view mirror on a pickup doing about 80mph missed my face by an inch, maybe two on the outside. That did it for me!

I've never had to call in a scene report unless I needed additional medical resources, and then just to explain to dispatch briefly what was going on so that they could make intelligent decisions on where to draw the resources from. I also believe that if you are patient focused first that other things are being missed too. If you focus initially on the gasping patient in the front seat do you still remember to ask all involved how many people started out in the vehicle? Do you remember to send fire to look for possible ejections? Did you notice that the passenger side door is open? Who opened it? Did an injured passenger wander off?

Tunnel vision is really good for one patient, its unethical, immoral, and unprofessional for the group. And if you run many calls, you will absolutely miss patients at some point, and I know that that is not something that you would be able to live with very well.

The first thing that MUST be done at the start of every emergency is....Nothing. You have to pause, breath, see what things look like generally, then more specifically. What resources are available? What are they doing and can you trust them to do other things?

A dispatched call is like Valium to me. I get mellow and relaxed. It used to make my partner batshit! He's say, "Give dispatch a call and see what the nature of the call is." I'd say, "It doesn't matter, right? We're supposed to be able to handle anything on 3 minutes notice." He'd say, "Yeah, yeah, whatever, just call." I'd say, "I don't want to know, it's almost never accurate." He's say, "God damn it! I don't care if you want to know or not! Will you PLEASE call the fucking dispatcher and ask for the nature of the call!!!" So I would, and they'd report a 'fall with hip pain" and we'd show up to find an arrest. I just don't like to get stirred up. I don't do good work when I'm stirred up. I'm willing to bet that you're the same.

How do you remember that? You don't need a note girl, you just need to remember why you're there. To take control of the scene and all patients as well as possible patients, and you can't do that with blinders on. You're responsible for every person on scene, even the other responders. On every single call you have to remember to do the entire job...I friggin' hate that part...I mostly just want to do medicine, but that's not the only reason that I was called.

You have some of the smartest posts here..I'm confident that a visual reminder wasn't needed so much as to refocus on your total mission.

All comments meant in the spirit of friendship. I absolutely do not mean to imply that someone like me needs to teach you basic EMS, but when you want so badly to be a really good provider it can be easy to lose focus of the entire scope. Unfortunately being scene focused initially means that some people will suffer longer than they might have needed to while we assure that everyone, the healthy and damaged are accounted for and protected.

Dwayne

[tcripp]

I've never had to call in a scene report unless I needed additional medical resources, and then just to explain to dispatch briefly what was going on so that they could make intelligent decisions on where to draw the resources from. I also believe that if you are patient focused first that other things are being missed too. If you focus initially on the gasping patient in the front seat do you still remember to ask all involved how many people started out in the vehicle? Do you remember to send fire to look for possible ejections? Did you notice that the passenger side door is open? Who opened it? Did an injured passenger wander off?

It's part of our SOP, call in the scene upon arrival. That's what I seem to be forgetting.

Tunnel vision is really good for one patient, its unethical, immoral, and unprofessional for the group. And if you run many calls, you will absolutely miss patients at some point, and I know that that is not something that you would be able to live with very well.

Thanks for the thump on the head. I think I had forgotten about this part...and this is a good reminder.

A dispatched call is like Valium to me. I get mellow and relaxed. It used to make my partner batshit!

LOL - I guess dispatch has the same effect on me. It's not adrenaline or excitement...just when I see that first patient, well, it's like moths to a flame.

All comments meant in the spirit of friendship. I absolutely do not mean to imply that someone like me needs to teach you basic EMS, but when you want so badly to be a really good provider it can be easy to lose focus of the entire scope. Unfortunately being scene focused initially means that some people will suffer longer than they might have needed to while we assure that everyone, the healthy and damaged are accounted for and protected.

Deep sigh. Got it. As one of my captains told me the other day, when it is an MCI...all the rules change. I just need to remember that.

Thanks, all!