—Brent Q. Hafen, Ph.D., and Keith J. Karren, Ph.D.,
                            Prehospital Emergency Care and Crisis
                            Intervention, 1989

                (Few people are initially prepared for the sights, smells, and
                sounds of intense human suffering.)


FIRST THINGS FIRST

Introduce yourself to the patient.
If you have time and are in doubt,
Simply ask, “What
Would you like me to call you?”

Cut clothing away quickly
To see a bleeding site clearly.
Put on a pair of latex
Or surgical gloves to protect yourself…

Many religious people
Attach great significance
To religious symbols.
Unless it is necessary for treatment,
Do not remove crosses or amulets.

Observe circumstances, collect
Suicide notes, and compile
The relevant materials. Is the patient
Restless, irritable, or combative?


BYSTANDERS

It is best to wait rather
Than try to remove weapons
Or potential weapons from unstable
Victims, relatives, bystanders.

Ask someone, “Will you please
Turn off the TV?” Or do it yourself.

Say. “Please sit
On the ground on her left side,
Ma’am, and hold her hand.
Talk to her. Don’t move
Her arm, and don’t let her move
Her head. I’m going
To be checking her hips and legs.”

Comment positively on the aid
Already given (for example
“You’ve done a good job
Of immobilizing the head.”)


TOUCH

Take a hand, pat
A shoulder. Remember that
You have to be comfortable doing it,
And not just trying it as a gimmick.

Squeezing a foot or patting
An ankle, if you are working
Near the foot is not
Usually considered intimate.
Patting above the knee is.

Sometimes a man receiving
Help from a woman EMT
Or a woman patient being treated
By a male EMT will automatically
Respond to comforting physical
Gestures with flirtatious behavior.
Do not respond by flirting back.


ASK

Ask questions about an area
Or organ before you examine it.

Ask: What’s your name?
         What’s happening to you?
         Where are you going, or where
         Are you? Can you tell me the date
         (Day of the week, year)?
Document the patient’s condition
Precisely—“disoriented to time.”

Depending on the urgency of the situation,
Either ask yes-or-no questions
         (Have you eaten today? “Does it hurt
         When you move your arm?)
         Or open-ended questions
         (“When does the pain come on?”
         Tell me more about your last meal”).

How intense is the pain?
         Dull? Throbbing? Sharp?
         Crushing? Stabbing? Does
         The pain change in intensity
         Or remain constant? What
         Started it? How long ago?


RESPONSIVENESS

What can the patient feel?
Can he identify the stimulus?
How does he respond to pain?
With unconscious or sleeping patients,
Determine how easily
They can be aroused.
If they cannot be aroused
By verbal stimuli, can
They be aroused by a pain
Stimulus like a pinch?

If the patient does not respond
To voice, try pain.

Your patient is RESPONSIVE
If he seems to be unconscious but will:
        * Open his eyes if you speak to him.
        * Respond to a light touch on the hand.
        * Try to avoid pain.

The answer you receive from the patient
When you ask, “Can you tell me where
You are hurt?” is the CHIEF COMPLAINT
In many instances, this
Will be obvious, such as the patient
Who lies bleeding in the street
After being struck by an automobile.

Even in this circumstance, however,
It is useful to determine
What is bothering the patient most.


CHECK

Check the Facial Features.
Feel the Head and Neck.
Check the Clavicles and Arms.
Check the Chest. In injury
           Patients, feel for air
           Crackling beneath the skin
Check the Abdominal Region.
           Sudden pokes will make
           The muscles tense.
Check the Pelvic Region
            For Tenderness. Damage here
            Can cause great pain,
            So be gentle.
Check the Back.
Check the Feet, Ankles, and Legs.

Describe pulse amplitude by using the following scale:
        4 + Bounding
        3 + Normal
        2 + Difficult to palpate
        1 + Weak and rapid, thready
        0    Absent


HELPFUL TIPS

Avoid traffic accidents
While going to the scene of an accident
Or to the hospital. Use a seat belt…
Park safely and carefully.

Check all equipment.
Keep the interior clean.
Are all your bandage wraps cleaned up?

If there is any question
About the patient’s condition, assume
The worst and work from there.

If a patient requests
That you pray with him, do so.


LEGAL SITUATIONS

What Happens if a Patient
Files Suit? [How to document:]
            Draw a thin line
            Through an error.
            Never erase an error.

Another legal situation
Is death. If a person is obviously
Dead (crushed, decapitated,
Rigor mortis setting in),
You may be required
To leave the body at the site.


ANSWER

If death is imminent either
On the scene or in the ambulance,
Be supportive and reassuring
To the patient, but do not lie.

If a patient asks, “I’m dying.
Aren’t I?” respond
With something like, “You
Have some very serious injuries,
But I’m not giving up on you.”


AND BEAR IN MIND

The heart is a hollow, muscular
Organ the size of the fist.

Once the patient remains 
In clinical death for a certain time
(Typically four to six minutes),
Brain cells begin to die.

Along the edges of the eyelids
Are openings of many small oil glands
Which help prevent the tears
From evaporating too rapidly.