The first thing that all emergency responders learn is that scene safety is the utmost priority: Arrive alive and maintain situational awareness, no matter the incident. Clues are factors that help to guide EMS providers through an intricate procedure or a maze of difficulties—precisely, pieces of evidence that lead one toward the solution of a problem. Some of these clues, while helping to diagnosis a patient, also might save your life. Although good medical diagnosis leads to proper treatment modality, maintaining situational awareness will help to keep you safe.
Having taught emergency medical providers for many years, I always try to help them to understand that there is a significant difference between a good practitioner and a great one. The better ones are providers who can evaluate and determine the severity of any patient before they even touch or speak to the individual. Taking time to achieve this skill is essential and can be accomplished through constant education and patient field experience.
Maintain calm
As I mentioned in previous columns, as humans, first responders can get caught up in what is called the tunnel vision trap. When fire and EMS respond to critically ill or injured patients, first responders almost always see and feel the overwhelming emotions from family and friends. A hectic incident or grossly traumatized patient can make providers get caught up, which prevents them from being able to correctly see modest signs/symptoms that they usually wouldn’t miss. As a result, one can go down an incorrect protocol path, and the patient might have an untoward outcome.
A consequence of tunnel vision—other than the possibility of improper patient care or treatment—is personnel safety. For example, emergency responders who get caught up in the scene emotionally or become distracted might endanger themselves.
Never get too involved doing patient care to forget about scene safety. Good advice for a two-person ambulance crew is that one provider concentrates on patient care and the other constantly watches the scene for any changes that might put the team in harm’s way. For some incidents, this can be a difficult task.
Family members’ and friends’ emotions, people under the influence and several medical/trauma situations quickly can turn a typical calm incident into a physical outburst.
Five senses plus
Sometimes, we can forget to use all five of our sensory skills. Emergency responders must use their sight, hearing, touch, smell and even taste. For example, smell, while so simple, might be forgotten.
Some chemicals have a familiar odor to them. For instance, remember, the chemical compound hexane and the gas phosgene are associated with the smell of freshly mown grass. Butanol smells of leaf litter or forest floors. Look for the appropriate clues before going further.
On the flip side, hydrogen sulfide gas, used in chemical suicides, is an olfactory nerve paralyzer. It rapidly deadens the sense of smell, even when present in low concentrations.
All that said, perhaps your most important “sense” is your sixth sense. If something doesn’t feel right, you must evaluate to determine whether you need an exit plan. Never allow any person or object to get between your crew and an exit. No matter where I respond, one of my priorities is to figure out several ways for a speedy escape. This concept applies on the job as well as in your personal life.
Safety and patient care
Also vital to clues during patient care is performing BLS (such as hemorrhage control and most airway issues) before ALS. Sometimes while performing an ALS task, a provider can miss basic patient survival skills. Starting an IV on a significant trauma patient is a prime example. Such a patient needs good airway and bleeding control, along with rapid transport to a trauma center. IVs don’t save trauma patients. BLS skills can.
Constantly look around the patient and scene for the not-so-obvious clues. Take off the horse blinders and maintain 360-degree awareness.
Finally, I will leave you with one hint that I teach every emergency medical provider: If your patient is sweating, then maybe you should, too.
Use all clues to maintain safety and provide better patient care and outcomes.
Subtle but vital
Incidents are fluid and can drastically change in an instant. Sometimes a subtle clue can make a difference in patient assessment and treatment, but more importantly, it can save your life and the life of the members of your crews.
Richard Bossert
Richard Bossert is a retired operations chief for the Philadelphia Fire Department. He started in the fire/rescue services in 1970, volunteering for the Warminster, PA, Fire Department. He worked for three career fire departments: Chester, Bensalem and Philadelphia. Bossert became a certified EMT in 1973, then paramedic in 1980. He received a bachelor’s degree in pre-med from Pennsylvania State University in 1977 and a master’s degree in public safety administration from St. Joseph’s University in 2003.
