Motivation to review the basics!

[Brian McVickers]

Last Friday night we were camped at Stovepipe Wells in Death Valley. We had arrived in late afternoon and all of the nearby designated remote campsites were taken and we did not have time to find a spot in the back country. So we pulled into the RV/campground area and grabbed a spot, cooked dinner and snuggled into the tent.

With both kids in the tent I never really fall completely asleep, sort of a one eye open protective instinct I guess. It must have been about 2am when I had a dream. The LOUD squawking sound distinctive only to tires skidding sideways on pavement followed by a series of rumbling thumps and crashes accented with some broken glass and then complete silence.

Not a dream after all! I sat straight up in the tent looked over at my wife Amy, who had been startled awake by my movement and said "there's been an accident, it sounded like a rollover!"

I put on my boots, unfortunately forgetting my pants but had boxers on, while Amy found and handed me the flashlight. I grabbed the medical bag from the truck and headed towards the yellow glow of a flashing turn signal about 200 yards away.

The vehicle, a small SUV, had skidded and rolled coming to rest about 30 feet off the road on its passenger side with the roof towards the paved road. The passenger had climbed out of the vehicle and was laying on the ground, the driver was out walking round the vehicle and collecting their posessions. The campground security had called the on-duty EMT and there were two other people on site to help.

I received my WFR certification a couple of months ago and since the class I have not had much exposure to using it. Needless to say this situation was a bit surreal. The EMT was said to be about 10 minutes out so I jumped in. I asked the other two people to help, one to hold the light and the other to stabilize the head of the passenger who was laying on the ground. I checked ABC and did a blood sweep while asking the passenger lots of questions to measure his LOR.

By the time I had located his pulse the EMT arrived. I told the EMT what I had gathered up to this point, he asked my level of training, I asked if he could use my help, he said yes.... wow, this is exactly what my WFR instructors said would happen. We grabbed a few bags out of the EMT truck and went back to the passenger. The EMT said we needed to put a collar on him, told me where to find the trauma sheers and asked me to make room for the collar. So there I was, no questions, cutting off this guys nice jacket and vest. I was impressed how trauma shears will go through anything with little effort.

With the collar on and another EMT and ambulance now on scene we strapped the passenger onto a backboard, loaded him into the ambulance and the two professionals continued to do their fine work. They drove off about a mile into the desert and thirty minutes later a helicopter arrived to take the passenger to a hospital in Las Vegas. I can only imagine if this rollover had happened anywhere else in Death Valley, these guys lucked out and had people there to help within minutes.

I learned a few things:
- Stop and take the time to put your pants on.
- I give a pretty lame verbal SOAP report.
- Keep a watch or timer in your medical kit, along with a headlamp.
- EMTs are cool.
- It is well worth the time to re-read your training materials on a regular basis, I jumped right back into my books when we got home.

Brian

[kcowyo]

Kudos Brian for your efforts and quick thinking.

But how did they have a rollover in Stovepipe Wells? On the road coming down the hill? I don't get it, unless they swerved to avoid a coyote. Was alcohol involved at 2am or did the driver just nod off?

That's a great bonus story to your trip that will never happen to most people. Good job!

:beer:
.

[Hltoppr]

LOL...after a while you'll be calm enough to stop and figure out which pair of pants would be least likely to stain if they get blood on 'em...then walk to the scene, whilst putting on your gloves.

SOAP reports are kinda tough without practice. I try to go over 'em in my head with made-up scenarios.

EMS sin pantalones....

Way to go McVickers!

-H-

[Rallyroo]

But how did they have a rollover in Stovepipe Wells? On the road coming down the hill? I don't get it, unless they swerved to avoid a coyote. Was alcohol involved at 2am or did the driver just nod off?

I was wondering the same thing.

[BKCowGod]

I'm just giggling about what it might have looked like for the crash victim to suddenly see a half-naked man running towards him...

[Brian McVickers]

Kudos Brian for your efforts and quick thinking.

But how did they have a rollover in Stovepipe Wells? On the road coming down the hill? I don't get it, unless they swerved to avoid a coyote. Was alcohol involved at 2am or did the driver just nod off?



That baffled me a bit too.
Looking at the road the next morning there are no corners or curves and only a slight decent in that area, nothing out of control. I think the driver fell asleep, accelerated, the vehicle began to drift, he woke up startled and jerked the wheel hard enough to induce the rollover. I saw no alcohol containers and when asked the driver said no...

I was impressed that the vehicle was gone by daylight.

Brian

[jeepmedic46]

Kudos to you. Well done with staying calm. I work as a paramedic and I can't tell you how many times I go to a scene and I can't get a report from anyone who is calm. A job very well done on your part.:victory:

[Brian McVickers]

I'm just giggling about what it might have looked like for the crash victim to suddenly see a half-naked man running towards him...

It's my technique for measuring LOR while approaching and doing my scene size up, much more efficient!

[FourByLand]

Great job, Brian!

Makes me want to grab my books and start refreshing!

[jcbrandon]

Nicely done, Brian.

[1leglance]

Having dealt with field emergecies and tons of hospital codes I can tell you that review & mental "what if's" are the only way to stay sharp.

SOAP's are tough if you don't do them regularly...if nothing else just make sure you can tell a short & sweet story.
Always start with # of injuried and levels of injury...that tells the rest of the folks how busy they are about to be.

Please put on your pants :) And gloves (I always double glove since there will be gunk & my hands get sweaty which make putting on fresh gloves tough), and a headlamp and whatever else I can think of.

I would recommend that everyone put a sharpie marker in their first aid kit if they ever plan to render aid to others, you can mark red areas, write pt info on their body before they passout and more.

Great job and anytime we are hanging out we can mock "what if's" to stay sharp.

[OneTime]

About a little over a year ago me and wiffy were coming back from Mt biking Black Canyon Trail. Just south of Cave Creek on the 17, I witness a single veh roll over.

I start working on the pt and this guy comes up very calm and asks if I could help. I give him a few intructions and he replies "are you and EMT?" I respond yes. Still very calm he states "Oh good Im a trauma doc at John C Lincoln." (The local truama center) He really just stayed out of the way till I said "tell you what, how about I assist you instead of the other way around." Way cool guy!

[Rexsname]

I hate to continually display my ignorance but... here goes! What are SOAPS?

REX

[BKCowGod]

http://www.chrisdolan.net/yapcna2006/images/soap_opera.jpg

Or, for a more real answer, http://en.wikipedia.org/wiki/SOAP_note

[Rexsname]

ROTFLMAO! I knew I had opened myself up with that one! I also knew that the right answer would come along with it. Thank you!

REX

[Brian McVickers]

SOAPs are referring to SOAP reports or SOAP notes.
It is a record of all the information you have gathered on a patient.

They are used in several ways, my wife uses one form for her PT work, for wilderness medical situations it includes the current condition of the patient, the history of what led up to their current condition, your diagnosis and treatment plan including your plan to evacuate or manage along with any anticipated problems and requests for equipment and assistance.

(From the Book) - just for fun and a good review!

S = Subjective/Summary/Story
"I have a (age, sex) whose chief complaint is (description of symptom including Onset, Provokes/Palliates, Quality, Radiation/Region/Referred, Severity and Time). Patient stated Method of Injury or History of Present Illness.

O = Objective/Observations/Findings
"Patient found (describe position). Patient exam reveals (describe injuries). Vital signs at (time), SAMPLE"

Vital Signs include:Time, Level Of Responsiveness, Hearth Rate, Resperitory Rate, Skin Color Temperature Moisture, Blood Pressure, Pupils, Temperature.

SAMPLE includes: Symptoms, Allergies, Medications, Pertinent medical history, Last intake/output, Events leading to the incident/illness.

A = Assessment (problem list)

P = Plan (Plan for each problem on the assessment list)


There are essentially three varieties:
Written - the most detailed.

Verbal Complete - a verbal version of the written, to be used to debrief or update people new to the scene or to be used with solid and reliable methods of communication such as a telephone land line.

Verbal Headlines - a down and dirty overview to be used when time is an issue when updating new people or when using unpredictable forms of verbal communication such as mobile phones or radios.


Brian

[Brian McVickers]

What do you meant a “blood sweep” Also, What do you mean by “LOR”

Do you mean you simply did a quick scan to see if the pt was bleeding? About the LOR, do you mean LOC as in level of consciousness?



Yes on both accounts:
LOR is Level of Responsiveness = same as = LOC Level of Consciousness. It is measured and conveyed in A+Ox 1,2,3or4.
So "PT's LOR is A+Ox4. If the LOR is A+Ox0 or 1 you also indicate what stimulus was effective for generating a response, voice, loud voice, or pain as in a pinch or rubbing their sternum.

Blood sweep is checking to see if and where the PT is bleeding, done by visually inspecting what you can see and then sliding your gloved hands all the way under and around the PT where you can not see and then checking your gloves for blood after each time you slide your hands under the PT.

I really like the idea of doing ride alongs to learn more.

So far I only know what I have been trained. I took training for Wilderness First Responder through NOLS and the Wilderness Medical Institute. There are some things that the WMI admittedly does different than the norm because of the likely abnormal situations and environments WFRs would be operating in. They trained us to make the SOAPs incredibly dry, impersonal, quick and factual. The idea being that you may only have one shot to get a communication out from the back country and it could even be interrupted or fail to be received.

My biggest frustration from this past first experience was my own response to communicating a soap to the arriving EMT. Granted, it was 2am but I felt a bit tongue tied and may as well have pointed to the PT and said "ugg that man hurt, ugg ugg, he fall down go boom, ugg"

Brian:coffee:

[muddyluxury]

I understand the stress of the real deal. Right now being deployed I call up a 9 line medevac, give MIST report battle drills like its cool.

and we never do them in a classroom. 9lines done at the range over the platoon FM freq, Mist reports done will crew serves are going off, and lots of people yelling,

And the only way to do it all is with the 9 line written down, we greese penned it to the truck winshield, everybody has one with the casuality feeder card, and in the Indv First Aid Kit. The Mist report is more like Doc, i know you just saw what happened, but anyways here it is, then he takes it from there.

sometimes when they are feeling spunky... the gunner get's stuck with an IV durring movement while going over battle drills before they leave the wire. point being practice, practice practice

[kellymoe]

Great job keeping a cool head.

I have been a firefighter paramedic over 23 years and that was the first time I have heard of SOAP. I Lean something new every day.

[jh504]

Good job handling that situation. Its nice to have that training to fall back on when something does happen isnt it?! We use SOAP format in all of our classes over here and I never use it in the real world. The blood sweep thing sounds like a derivative from PHTLS (just finished it). Thats a great part of an assessment because a lot of folks will get tunnel vision and miss the gaping wound on the pts backside.:)
I understand having trouble recessing information in that kind of a situation. One thing I try to do is always grab a pen or pencil as I am heading that way. After you have stabilized any life threats write down everything the arriving medics will need. Age, vitals, meds etc. Then you can just read off to them or hand them the piece of paper. Good first responders in our county will always hand us a sheet with all our baseline info covered. Its a great help! Good job again with jumping right in and taking control!

[Fish]

The most important question:
Does the fly in your boxers have a button to keep it closed?

Seriously, great job. I've been an EMT for 20+ years now and was a paramedic for 10+ years of that time. It's amazing how few of the general public can actually help out in an emergency.

[Brian McVickers]

Thanks!

It is great to get all the solid feedback, I had no idea there were so many similar versions of similar practices.

That WFR training paid off again about three weeks ago. Sitting at a restaurant with my 2.5 yr old son and 3 soon to be 4 yr old daughter I had the absolute-never-want-to-do-it-again-experience of performing the Heimlich on my daughter.

I had looked over to see her gaping mouth and this wide-eyed horrified panic look on her face. I'm not even sure it was the Hemlich, I picked her off her seat, knelt down behind her, put my entire left forearm across her front just below her ribs and my right hand on the small of her back with her shoulders against my chest and compressed with my left arm. One compression and the guy at the next table said "its out!" A nice marshmallow sized hunk of cheese and tortilla! She never even cried, she went back to eating! So now we are on a big push for small bites, chew and swallow before the next bite.

Brian

[Brian McVickers]

The most important question:
Does the fly in your boxers have a button to keep it closed?

.

No button but I was fully covered, however it was a bit drafty. Worst part of not having your pants on is not really being able to sit anywhere!

[Brian McVickers]

I understand the stress of the real deal. Right now being deployed I call up a 9 line medevac, give MIST report battle drills like its cool.

and we never do them in a classroom. 9lines done at the range over the platoon FM freq, Mist reports done will crew serves are going off, and lots of people yelling,

And the only way to do it all is with the 9 line written down, we greese penned it to the truck winshield, everybody has one with the casuality feeder card, and in the Indv First Aid Kit. The Mist report is more like Doc, i know you just saw what happened, but anyways here it is, then he takes it from there.

sometimes when they are feeling spunky... the gunner get's stuck with an IV durring movement while going over battle drills before they leave the wire. point being practice, practice practice

This sounds interesting, can you share an example or description of the 9 Line or the MIST?

Thanks
Brian

[jh504]

No button but I was fully covered, however it was a bit drafty. Worst part of not having your pants on is not really being able to sit anywhere!

Haha. kind of reminds me of this story that came out a few weeks ago. http://www.star-telegram.com/229/story/1375079.html?storylink=omni_popular
You know a guys hardcore when he is taking on the Taliban in pink boxers!