Mastering The Head-To-Toe Assessment

You probably practiced your head-to-toe assessment a bunch in your EMT class. Maybe more than any other skill in the EMT curriculum. If your class was or is anything like mine (as a student or a teacher) you performed the head-to-toe assessment again and again.

As much as we practice this skill in EMT class, I often wonder why so many EMT’s have such bad head-to-toe skills out on the street. It seems that, once we get out on the street, the systematic, thorough head-to-toe assessment falls out of favor and quickly gets replaced with the faster, more direct focused assessment.

That works just fine most of the time. If it didn’t, I figure it probably wouldn’t be such a universal phenomenon. (For the record, have you ever worked somewhere where this wasn’t the case? Neither have I.) The downside is that when the patient arrives who really needs a, honest-to-goodness, rapid, complete head-to-toe, we’re not up to the task.

I happen to believe that patient assessment skills are one of the defining qualities of a talented EMT. Here are seven tips to keep your head-to-toe in top form.

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The Art of Using Trauma Shears

I got a request recently from a maker of trauma shears to give their product a test drive and see what I think. I’m more than happy to give their shears a few turns around the block and kick the tires a bit. Who knows, maybe they’ll be really good. Maybe they’ll be my new favorite set.

All the shears I’ve ever owned have come and gone. I don’t have a particular set that I’m really attached to right now. I’ve had some great sets of shears over the years. I think my longest running favorite pair lasted around five years. I don’t remember the brand now, but they were good. Black handle with a bit of cloth tape for grip. (I know it isn’t a bio-friendly practice.) Nice tight feel to the action.

Like all shears I eventually lost them. Some scene was moving along and I handed them off to someone in the rush of delegation to strip a patient down and they never returned. Equipment comes and goes. It’s the way of things.

The truth of the matter is, it doesn’t much matter how good or bad the shears work. The guy (or gal) wielding the shears is the deciding factor in how fast a patient gets stripped. I can strip a human in seconds with a wobbly pair of $2.00 knock-offs. The shears just don’t make that much of a difference. It really comes down to technique. Here’s the skinny on how to take a patient from their winter-best to fully naked in seconds.

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The Non-Conformists’ Guide is Here!

I’ve gone live with the book and newsletter sign up and it appears that everything is running smoothly. I’ve already had a half dozen sign-ups and the link has only been posted for a few minutes.

Thanks for your patience. This writing project took me nearly six months to finish. I had an idea of what I wanted this book to be and I wasn’t willing to stop until I’d succeeded.

The result is The Non-Conformists’ Guide to EMS Success. This is no pamphlet or power point slide show. This is 48 pages, almost 16,000 words, and chapter after chapter of compelling ideas designed to challenge the way you think about your job, your leadership, your life, and your role in EMS. And it’s all free.

If you’re ready to stop listening to me talking about it and get the book for yourself, just click the newsletter sign-up at left. The EMT Spot practices a strict, double opt-in, anti-spam policy. We’ll never reveal your e-mail to anyone, ever.

You’ll receive an e-mail confirming that you really did sign up for Splatter and the e-book. Once you click the confirmation link you’ll received your welcome edition of Splatter and the .pdf version of the e-book will be attached. It’s as simple as that.

The newsletter will also have an opt-out link at the bottom if you’d rather not be on the newsletter mailing list. (But I hope you’ll decide to stay)

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The E-Book is Coming!

OK, I can’t keep this to myself any longer. It’s time for the big announcement. With the final draft still in the mail from my editorial team and the final design still lacking a few details, it would probably be best to just keep this under wraps for a few more weeks, but I can’t wait.

My first E-book is scheduled for release on January 21st, one week from today. The e-book will be free and it will be available right here at The Spot.

The Book is called The Non-Conformists Guide to EMS Success. This book is the culmination of two decades of EMS experiences, mistakes, failures, trials, and errors that lead to my ultimate success. My goal was to write something that would be useful to EMTs at any stage in their career. And I didn’t hold anything back. This is my road map to finding true success and fulfilment in EMS work.

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CPR Right Now

I helped teach CPR to our latest EMT class this past week. This class is always a good reminder of how fast emergency medicine changes.

Here in their first week, the new students are beginning to hear our warnings.

“You are going to hear about many different ways to perform this skill. Some are older methods than the ones we are teaching you today. Some are newer. Some things you are learning will quickly go away. New methods, new machines and new research are all in progress. That doesn’t mean what you are learning right now is wrong. It is an imperfect method. Prepare for change.”

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The Art of The Pulse Check

   Fast or Slow, Strong or Weak, Regular or Irregular

I’d like to teach you how to take a pulse in three seconds or less. Yes it’s possible.

I am, quite possibly, about to contradict everything you learned about taking a patients pulse in your EMT class. Hear me out on this one.

In general, I think we overemphasize the importance of coming up with a set of numbers that represent the patients vital signs and we underemphasized the importance of placing the patients vitals in context for their condition. The pulse is a prime example of this dynamic at work.

The patients pulse holds a wealth of clinically significant information. The exact heart rate isn’t one of them. Sometimes, we get this misconception lodged in our brain that the purpose of feeling the patients pulse is to determine how many times their heart is beating each minute. We will dutifully devote 15 seconds, 30 seconds … yes some even advocate taking a full minute to make sure this number is perfectly accurate.

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The Art of The Nasopharyngeal Airway

I would surely rank the nasopharyngeal airway (NPA) as one of the most under-rated / under-utilized pieces of equipment in the EMT bag of tricks. They’re useful, simple and versatile. As a group, we tend to do a pretty good job oxygenating our patients, but I think we drop the ball on BLS airway adjuncts.

Most of our unresponsive or semi-responsive patients should be arriving at the ER with an NPA in place. If you’re bagging a patient they should have one … maybe two NPAs in place.

They’re fast, they’re friendly, they work much better on the semi-conscious and they don’t stimulate the gag reflex quite like their cousin the oropharyngeal airway. They also stay in place better, leaving the mouth open for examination and advanced airway techniques.

I’ve often had EMTs explain that they didn’t drop a basic airway adjunct because they knew I was right around the corner and I’d be intubating. That’s a poor excuse. When I arrive on scene I’d like to see that the EMT at the head has managed the BLS airway aggressively.

So let’s bone up on our NPA skills. Once you’re comfortable with these little beauties, they only take a few seconds to drop. You don’t need to make it a big production. Grab the right size, squirt a clump of KY on the end and go.

So let’s break it down and make you an NPA, quick draw, master.

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Test For Unconsciousness: The Sternal Rub

Ahhh the embattled sternal rub. Revered, reviled … the sternal rub is the Ann Coulter of medical interventions. Abrasive, annoying, loved by many, hated by many more. The subject of the usefulness of the sternal rub is bound to cause controversy in any EMS forum.

In other words … it’s a great subject for The Spot.

Like many controversial assessments and treatments, the sternal rub (sometimes referred to as the sternum rub) got its bad-boy reputation more from its misuse than from its own shortcomings. Never-the-less, the technique does have its shortcomings.

Like so many other tools, it has its place when used appropriately and it has its potential for misuse. So let’s make sure you understand its uses and limitations.

If you’ve never encountered this technique, the sternal rub is a test for unconsciousness. It’s a popular form of painful or noxious stimuli designed to illicit a response from a conscious or semi-conscious person. Establishing an unresponsive patients ability to respond and remove noxious stimuli is perfectly medically appropriate.

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The S.O.A.P. Reporting Break Through

SOAP is another one of those EMS acronyms that has endured through the years. I was taught the SOAP format in my EMT class 20 years ago and I’m still teaching it to my EMT students today.

SOAP reporting has a bunch of things going for it. It’s simple, it’s universal, it easily adapts to a multitude of situations and its feels familiar, because it’s the order your brain naturally recalls a memory of something that happened.

If there is one major limiting factor to SOAP it has nothing to do with its design and everything to do with its use. When you were in EMT school we drilled you on the importance of accurate and complete documentation. We frightened you with ideas about the legality, confidentiality and permanence of your medical reports. We worked hard to impress upon you the importance of your reporting and, like most, you probably took these lessons to heart. All of these scare tactics might have given you the idea that your medical report is a serious and formal necessity. Serious yes. Formal … no, not always. In fact, in the case of verbal hand-off reports and even standard report narratives (to a lesser degree), I’d argue that rigid formality works against you.

If you want your reports to shine, especially your SOAP format reports, you need to drop the rigid, robot-like formality. What I want you to get from this unconventional review of how to use SOAP is this: you can adapt the format. You can mix it up. You can play with it. SOAP is our tool. We can use it or disregard it in the ways that we see fit.

From now on, I want you to think of soap as your way of answering these four questions:

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Seven Flawless Physical Restraint Tips

Physical restraint techniques and procedures are a subject of debate and controversy in EMS. Few agencies have taken the time and energy to research and develop a comprehensive restraint guideline for field providers to follow.

When violent or aggressive patients show up (and they always do) EMT’s are left to fend for themselves. In these situations we take on a great deal of risk, both personal and legal, to bring the patient safely to the hospital.

I’ve had my share of both good and bad take-downs. When things go well the call transitions smoothly from the street to the hospital. The patient stays protected, the prehospital personnel stay safe and everyone goes back in service happy.

When things go badly people get hurt, patient care gets compromised and everyone ends up writing a lot of paperwork. In the worst cases you may end up sitting across from your patient in a courtroom explaining why you made the decisions that you made.

Here are some tips to help make your next patient restraint scenario go smoothly. Follow these guidelines and you’ll reduce the possibility of ever having to explain your actions. If you do end up needing to justify your decisions, you can take comfort in the fact that these gudeliness give you a rock solid foundation of compassionate, patient centered care. 

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