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What to do first on calls?


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Working in a new system- just wondering how different people run their calls....

This is my method:

-BSI/Scene safe- I always start surveying as we pull up on scene

-If I have one let's say medical pt- I walk in- (get my general impression)- assess LOC- and begin by introducing myself and I will start speaking to pt while I may take a radial pulse... then move into my assessment..vitals etc....

-reason I ask is that this new system I am in - we had a call the other day for diff breathing, my partner and I get on scene (pt was alert and conscious)... and my partner bent down to speak to patient and just as he was about to introduce himself and begin assessment- the medic storms in and started complaining because the first we should have done before anything else was lung sounds.....

I was always taught to take a few seconds and check pt and speak to them initially- then move into vitals... lung sounds...etc.

When I asked my partner after the call- he said "No- that is how they (medics) want to see it done......

I do not see the logic in not taking a few seconds to speak to your pt.....

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Skinut.....

I think that you and your partner were correct in your pathway that you were taking. You gave me a pretty good general impression (of the MEDIC) by reporting that he STORMED in. Standard procedure in that system? to STORM The EMT's without even questioning where they are in their alorhithm?? HE (or she for that matter) has no idea how long you have been there, what you have completed prior to his/her arrival, etc. I mean simply, you probably would have turned around to the guy had he given you the chance and state "We just got here and STARTED our assessment" indicating that you haven't had time to evaluate the patient and make a care decision before his majesty's arrival.

If you guys were JUST there and had just made intro's/determined level of Consiousness then you hadn't moved onto the next part. I do like my lung sounds done under B of my ABC's just because I haven't ruled it out as an immediate life threat or not. I guess the medic just needed a little more tact in his approach? Tell me this, how would you have felt if the medic came in (on a crital patient) grabbed the lung sounds while you finished your intro. or two, seeing it's a non-critical patient ASK you two for an update? I like either of those approaches when working in an ALS/BLS tiered system. If I have the time to play, ask for a report, if I don't, don't discredit or re-do what the Basic's already have done. Work from the baseline set, and move forward.....as a team.

James

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Did you talk to the medic ?.. I really doubt that the medic wanted you to run in and immediately check lung sounds..without primary assessment, introduction, etc.. I suggest to pull the medic aside and introduce yourself and suggest how you want to improve and make things better. Now, for no point should you immediately "check lung sounds" on the initial arrival (unless trauma). You did not describe if your an Intermediate etc.. or if you can administer meds.. if you can't, it does not matter if you listen or not... he needs to re-assess, before tx.

Again, talk to the medic himself, apparently your partner does not have a clue.. if the medic wants you to listen, tell them you will try, but of course you need a set of v.s., and oxygen of course. (Like we are supposed to, since you will have re-assess them anyway...

I realize you are new, but stand your ground; otherwise, you will be like your partner...........

Good luck,

R/R 911

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I do not see the logic in not taking a few seconds to speak to your pt.....

That's because there is none.

Take the three seconds to say "Hi. I'm skinut2234." Then, depending on how they present, ask their name or ask what's wrong. It gets you off to a better start with the patient. It also provides you with a function of your assessment. If they can talk back that tells you a lot. If they just give you that 1000 yard stare and keep forcing themselves to breathe that tells you a lot, too. The only time when this might prove to be a waste of time is if they're unconsious or dead in front of you.

I would rather arrive on scene and have you tell me "This is Mr. Jones. He's been having trouble breathing for an hour. We just got here and that's all I have." than arrive and have you provide me with a rushed set of vitals but not be able to tell me the patient's name or what's wrong.

I'm with Rid. Talk to this medic. Be professional. Stand your ground and don't back down. By posting this and asking, you know what's right. Maintain this position. Don't become like your partner. That does no one any good at all.

Good luck.

-be safe.

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Skinut, in my opinion the way you were going at the assesment is the correct way. I have to say that if you were on scene for a few seconds that you were just starting the assesment and the Medic(s) probably do it the same way.

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Not to be redundant, but you did good. When you enter a scene and speak to the pt you are doing several things simultaneously that are essential to assessmant and thus, good pt care.

1) you are establishing a rapport with the pt. If you came into my house and just started touching me all over right off the bat, I might question your professionalism, your knowledge of what you are doing, and I might even be combative.

2)You are checking "A", the most efficient and easiest way to check airway: can they speak?

3) you are checking "B", how is thier breathing? are they able to speak in full sentences?

4) You are assessing their level of consciousness. Are they responding appropiately? do they look at you when you speak? do they respond verbally?

Now, coupled with the "look test"you've just completed a primary survey in under five seconds.

Then you can auscultate for breath sounds.

Talk to the medic. They were probably just having a bad day. And even if they are always an ass :bootyshake: , at least you can justify your actions so you have nothing to worry about.

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I think it was unprofessional of the medic to criticize you in front of the patient. If he felt that it was critical listen to breath sounds he should have listened himself. Once the patient was safely in hospital he could have spoken :boxing: about your approach.

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You did everything right. I also like to add when I introduce myself, I always follow up with the question "Are you having difficulty breathing?" This requires them to giving you a verbal answer if they can, or at least a nod.

Or you could just be observant and take note of how many words thay say before needing to stop and take a breath, or even better notice if they present obviously with clinical signs i.e.: tripoding, nasal flaring, sternal retractions, etc.....

Out here,

ACE844

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