True Story…
The dispatch information was updated before we had even rolled our rig out onto the pad. Eye injury, no serious symptoms. Jodie shut down the lights and I informed dispatch that we’d be responding non-emergent.
Up stairs and inside the small two bedroom apartment, Samantha, our patient, was waiting on the couch, holding a hot compress to her swollen right eyelid. Mom worked calmly in the kitchen finishing diner for her other two children. Alan, Samantha’s father sat on the edge of his seat next to his daughter in a state of barely containable anxiety.
He had recently arrived home from work and his wife had informed him of the apparent infection in Samantha’s right eye. One look and he was on the phone to us. Now he breathed rapidly as he fumbled through a list of questions. What caused it? Could it damage her vision? Could she lose her eye? Could she go blind?
I cleared the engine to go back in service and sat down next to him. Over the next ten minutes we both explained what pink-eye was and how to take care of it. We talked about hot-compresses and how contagious the bacteria was going to be. We reviewed the typical course for such and infection. How to prevent it in the other kids. How likely it was that one of them already had it. And we discussed his plan for morning. (It involved asking a neighbor to drive them to a near-by clinic.)
Alan called 911 for pink-eye. And…(This part is bound to be controversial, depending on what kind of system you work in.) I never offered to take him to the emergency room. And he never asked.
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Part one of a two part series on scene presence. Part two is here.
A regular reader of The EMT Spot asked a great question recently. (Thanks Timothy.) “How do I keep my cool and not loose my head in stressful situations?” I want to give you a tip that has 
worked well for me in the past. It’s a phrase I learned as an EMT and it’s helped me on countless occasions.
“It’s not my emergency.”
I know. I know what you’re thinking. On the surface, “It’s not my emergency.” sounds like a very callous and uncaring thing to say. But give me a chance to explain.
I was taught the phrase, “It’s not my emergency.” by a talented young paramedic who was a mentor in my early years in EMS. Since I first learned it, I’ve heard it used in a much more callous and uncaring form. More often than not, when I hear people say this catch-phrase it’s said in a dismissive manner. “It’s not my emergency” has become, “It’s not my problem.” or worse, “I don’t care about your emergency.” It never meant that to me. That’s not how I learned it.
For me, “It’s not my emergency.” is a mantra that helps us remember our role in the trial and tragedies that befall our patients. It reminds me of my place in the human drama of EMS. My role is that of the caregiver, not the patient. And, until the day that I pick up a phone and dial 911, that’s how it shall remain.
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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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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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What we cannot calculate or measure is the number of lives Jim affected.
-Gary Ludwig
Five years ago tomorrow, James O. Page went for a swim outside his home in Carlsbad California and the
world of EMS lost a great man. If you don’t know who Jim Page was, it’s hard to articulate. Perhaps Gary Ludwig said it best (above). Or maybe the nickname, “The Father of EMS” comes closest to summing it up.
Jim was the technical advisor for the TV show emergency. For over thirty years Jim was a big, loud, relentless advocate for EMS systems across the nation and around the world.
He served as the EMS Chief for the state of North Carolina, The Director of The Advanced Coronary Treatment Foundation and was one of the founders of JEMS Magazine. Through his six books, 400 articles and over 800 public lectures Jim was a tireless advocate for improved standards of EMS care.
He simply lived the value of wanting EMS providers to be better, every single day. And that’s why he’s one of my heroes.
Regret is a horrible thing to carry around. The opportunities that haunt us most are the ones that we don’t take. In 2002 I received a generous invitation from a good friend, Thom Dick.
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Now here’s a novel idea. I wish I was being sarcastic but I’m not. Personally I think someone should have tried this a long time ago. In Minnesota, the local dispatch center ha decided to tell people to just call 911 any time they think they need a police man, a fireman or an ambulance. They’ve dropped the whole idea of asking people to only call for emergencies and to find a non-emergent number somewhere if they have a non-emergent need.
Apparently they started routing all the calls into the same center some time ago and now they’ve just decided to screen the calls themselves. I suspect they were doing that already. If a caller called on the non-emergent line with chest pain I suspect they got routed over to the emergent side. If a called needed non-emergent service, I suspect they received them even if they called the emergency line.
So now, instead of investing countless dollars in ineffective public education programs and getting upset when people still call on the wrong line, this center is going to stop swimming upstream and just tell folks, “hey, call us and well figure it out.” You might even say they’re going to let the patient define the emergency. Revolutionary.
This runs counter to everything we’ve been trying to do with 911 dispatch for over 20 years and I commend Minnesota for being bold enough to try it. Way to think for yourselves guys.
Steve
