Category Archives: Patient Care

I’ve seen it all, we’re done here

I thought I had seen it all until today.

Every manner of injury, illness, presentation and patient seen, noted and documented.

Oh universe, I love it when you mess with my mind.

 

THE EMERGENCY

A bicyclist has been hit by a car

 

THE ACTION

Well, not exactly “hit” and not exactly “by a car” but at least there’s a bicycle involved.  Units are approaching from all directions downtown and traffic is thick as it is almost 330 on a Friday afternoon.  The bicycle messenger rider is standing, rather clamly, on the sidewalk near a stretch of street with cars inching forward, but none of them stopped.  At least not stopped as much as you’d expect for someone who just hit a bicyclist.

As we approach he’s holding his right arm with what appears to be a napkin, likely from the Chinese take out place behind him.

The assessment begins and we’re hard pressed to find any injuries consistant with a vehicle versus pedestrian.  We are allowed to get so deep into the assessment before discovering what happened because, as always, our question of “what happened?” is met with a 25 minute slide presentation about how he was following all laws, riding this direction from this place as he always does, blah, blah blah.  I used my patented “skip to the part where it’s an emergency” more than once and finally he explained the napkin on the arm.

He got bit.

By a dog.

While on his bike.

I did a quick double take.  On the bike, even crouched over his shoulder is a good 5 feet off the ground.  How did a dog-

And that’s when the delivery truck in the far left lane, the one right in front of us hit a pothole, tilted and gently scraped a no parking sign.  Judging by the sign and the scratches on the truck, not to mention the truck not stopping, happens all the time.

The dog was in a car.

It was hard not to stifle the giggles and my partner is a pro at getting the giggles out, so my next question was tough.

“Did you get a look at the dog?”

He suddenly had somewhere to be and rode away before we got his signature on the form, but I imagined him on his hipster bike, riding along in traffic and some dog out for a joyride just sniffing the air decided to see what the City tasted like.

 

That was a first.  And it reminded me that as soon as you think you’ve seen it all-BAM-sumpin’ new.

 

acheter

Sideways

I am a big skeptic of putting the 2 people with the least ability to assess a situation in charge of the system’s response to a reported emergency, but until we change things they can only code what they are told, right?  And the caller is never, ever, EVER, wrong.  Especially when describing technical rescue.

 

THE EMERGENCY

A caller is reporting he has fallen over 50 feet and is unable to walk.

 

THE ACTION

I had to read it twice too.  First party caller has fallen 50 feet, unable to walk.  Should be unable to do most things after that fall, especially when he would have hit the ground at a decent pace, then suddenly stopped.  Stranger things have happened, right?

The dispatch rounds out, after us in the engine, the truck, medic, Battalion Chief and Captain, with the Rescue Squad.  Further questioning suggests the patient is trapped.  Never before have I wanted the TV version of EMS to be true so they could patch me directly through to the caller and figure this all out.

 

Arriving on scene my firefighter and driver are grabbing some hand tools and a long spine board when we all look around the address for a second, an old habit of sizing up burining buildings.  None of the surrounding structures, trees, even light poles are more than 20 feet off the ground.

Something doesn’t smell right.

The balance of the assignment arrives as we head inside, ready to treat trauma.

We found drama.

A middle aged man is sitting on a chair still on the cell phone with the call taker, no apparent injuries.  He is inside a single story building and the folks standing around him seem confused as to why so many firemen have arrived.  The rest of the units are cancelled as we begin to learn the tale of the “long fall.”

This gentleman tripped on the sidewalk and would like to know who he can complain to after we take him to the hospital.

“Why would you goto the hospital?” I asked, already knowing it was a mistake.

“For my injuries, of course.  I must be hurt if the ambulance took me in.  I’m on disability already and can’t be expected to get around on my own all the time.” Was his response as his cell phone rang.

The caller on the other end wants to speak to “whoever is in charge over there” and I LOVE these calls so as the EMT confirmed the appearance of non-injury I spoke to the patient’s wife who also heard what our call taker heard.

“He says he fell 50 feet!  He needs to be taken to a hospital or something, he could die!”

“Sir?” I was embarased it took me this long to put 2 and 2 together, “Where did you trip on the sidewalk?”

“50 feet up the block!  I couldn’t walk!  Go look at that crack!”

He kept giving the distance TO the fall, not OF the fall, hence all the confusion. GIGO.

After refusing to listen to our reassurances that an ambulance ride was not only unnecessary but would end up costing HIM money, he was taken to the local ED “to get checked out.”

While loading up the gear the engine boss decided to go have a look at the crack in the sidewalk that could end up being a killer.  About 25 feet up the sidewalk we saw a slightly raised seam that someone could indeed trip over.

So we taped it off.

Tragedy averted.

 

Of Blankets and Discipline

A very eye catching story has been circulating for a few days involving everyone’s favorite EMS system to hate, Detroit and a Paramedic who claims to have been reprimanded for giving a blanket to a person who was cold after a fire.

I was waiting to comment until the Detroit EMS Administration commented.  Let’s just say I’m glad I wasn’t holding my breath.

As a Quality Manager I see this differently than most line medics might.  On the surface a medic was doing the right thing giving a blanket to a cold person.  It’s what we do most: Make bad days better.  We all know most of the attaboy letters don’t involve medicine but instead note demeanor and comfort measures.

Seems like a non starter.

However, it seems there were some policies in place, whether you agree with them or not, regarding dispensing agency property.

Take a deep breath…I’m getting to my point.

Most Vice Principles have a list of trouble makers who are just under the disciplinary surface and are watching them like a hawk waiting for a reason, any reason, to bust them on a black and white policy violation.

I don’t know enough of the facts to pass a decision regarding the blanket, but I can tell you that if this was brought to my desk I’d ask how we solved all the other problems to be able to spend time on this.  If there had been a decision to reprimand based on the Rules and Regulations, in my experience, there is more going on than meets the eye.

I wander the halls looking for my borderline crews to screw up on something so I can have a chat with them, sure, but more often I’m wandering looking for any chance to talk with them about how things are going.

This could have been a policy enforcement or the straw that broke the camel’s back.

Let’s just hope the camel doesn’t need a blanket.

You Make the Call – Handcuffed

Man it sure has been awhile since we fired up the ol’ You Make the Call Machine here at HMHQ, but I thought it’s finally time to get back on the posting circuit.

 

For you new people, I post a situation, you answer it based on your local policies.

 

Dispatched in the first response vehicle of choice for your agency, the local PD has detained a man who assaulted another person.  The other person is receiving care from your partner and is stable, bleeding controlled and has agreed to transport.  PD presents you to the window of the patrol car where you can see a superficial laceration to the forearm just distal to the left elbow.  There was a small drip of blood that appears to be dry, no other injuries are obvious through the window.

After repeated pleas the officer agrees to open the door and remove the patient but warns that he became violent when they took him into custody.  He stands and allows a brief primary and secondary exam and you note no other deformity or injury.  He is refusing vital signs, treatment and transport in colorful language, but denies alcohol or drug use.  When asked if he understands the risks of refusing assessment and treatment he replies in the affirmative and states his reason for assaulting the man and the police is his business, not yours.

 

Is he able to refuse service?  If so, who signs the form when PD tells you there’s no chance of him removing the cuffs to allow for a signature?

 

You Make the Call.

When a complaint is a cry for help

I absolutely LOVE answering the complaint line here at HQ.  Not HMHQ, my real HQ gig.  The complaint line at HMHQ never rings.  :P

 

Many may not want to hear the public rattle on about how we stole tens of thousands of dollars from their wheelchair or lifted a priceless piece of art the last time we were called code 3 for a spoon stuck in the disposal, but I LOVE it.

My pencil jots notes as I listen to the complaint in it’s entirety never once asking for clarification.  I get the entire story out and make sure they say everything they want to say.  90% of their complaint is usually because they want to be heard, not because they have a legitimate complaint.  They want to hear that it’s not cool that they don’t have as much stuff as I do or that spoons fall into my disposal all the time.  The venting is the powerful process here, I should know, right?

 

However, every now and then I get a call from someone unclear on the concept.

 

THE EMERGENCY

Not sure that heading still fits, but we’re almost 4 years into this thing, why change now?  A woman has called me requesting the ambulance crew who transported her 2 days ago be fired.

 

THE ACTION

OK…

Her story goes a little something like this:

The ambulance crew was late, rude and refused to help her.  They didn’t carry her into the ER and refused to give her to a nurse.  The ambulance crew then pointed at her and make remarks that I won’t repeat here.  Her language was colorful and hurried while I made notes and pulled up the chart from that day.

When she was finally finished I assured her I would look into her claims and explained the process.  While I was doing so I returned no records of a her being transported that day.

“Could this have been yesterday?” I ask seeing her name pop up on another day, then another.  In fact the software we use turns grey days blue if a patient is contacted on that day.

 

There are more blue days than grey.

 

I also notice that today is blue so I pull up the chart.

While I’m doing so she continues on that after the rude evil paramedics left she collapsed and had to spend 2 days in ICU.  She then described the pile of bills she is already receiving.

I noted her concerns for the file and asked the only question I needed to ask:

“Were you transported to St Closest today at 10 AM?”

“What? How do you know that? That’s a violation of my privacy!  How dare you access my medical record without my permission!” a brief pause… “Well?”

“Ma’am, if you’ll permit me..” and I restated her clinical concerns and her destination concern, and the claim that she was not delivered to a nurse, all of which is directly connected to her medical record.  And although I had no way of confirming her identity, no PHI was exchanged and clearly she knows most of the fleet and they know her.  As I scan a few of the charts looking for patterns of behavior I find what I’m looking for.

Most of the crews are using her statements in quotes and they match almost to the word:

“Patient states she will file a complaint if not transported to Saint Farthest, Saint Farthest is on divert, patient ambulated away angrily with steady gait.”

 

When I asked if she had been transported to her facility of choice and if the Paramedics had actually been rude to her, she began the back track.  She didn’t really want them fired, maybe just talked to, or even just mention that she was not pleased with the level of service she received.  Then we talked for a good 20 minutes about her medical conditions and her use of 911.  I offered a few contact numbers for local resources and even threw in a few breathing exercises for relaxing after a long day as an urban outdoorswoman.  She thanked me and in the end apologized for taking my time.

“That’s why I’m here, Ma’am.  If my Paramedics ever do anything you don’t like you call me right back, OK?”

 

That was in January.

Today I noticed her name on a chart where she was transported for a chronic condition, but the colorful language was gone.  I had to go back and check the name to be sure.

Her blue squares have decreased significantly since and I’d like to think I had something to do with that.  It wasn’t a rapid response car, or an advanced skill set, it was taking the time to listen and offering support.

 

Try it.

Just because it’s right…

…doesn’t mean you can do it.

We’ve had some confusion around the yard as to just what we’re supposed to be doing when it comes to assessing the car rather than the patient.
We all know to assess the patient, not the car, the patient, not the monitor etc etc.

At a recent training evidence was presented that contradicts our current protocols as set forth by our regulators.
It seems a number of folks took that training to heart and are trying to apply it to the patients they encounter in the field.

Problem is, the treatment, or omission of treatment in this case, is causing trouble for me in the CQI office since I now have to talk to folks about doing the right thing and breaking the rules.

First a note on one of our favorite terms: mechanism.

Motor vehicles today are designed to crumple, absorb energy and disperse it around the passenger compartment. This design allows for a great deal of damage to be incurred prior to the passenger, if properly restrained, is injured. This is the reason that recent CDC wording of field trauma triage criteria specifically mentions intrusion into the passenger compartment. Your protocols and policies likely have a similar clause.
The problem is when the protocols and policies start making assumptions about the possible damage to the car and how it relates to possible damage on the patient, then prescribes treatment based on the car, not the patient.

Rollovers used to be a big deal. If everyone is belted chances are they’re self extricating before you get there and strap their curved spine to a flat board. You know…just in case.

Even more frustrating is when you finally convince the patient that the hospital will take careful care of them in case they have a back and neck injury only to arrive to a triage nurse removing the collar, performing the same assessment you did, then removing the board if your treatment was based only on mechanism.

Even worse is when you convince them to be seen at the trauma center based on damage to their car, only to see them moved to the hallway prior to your chart being completed…no board, no collar.

I asked a few of my crews to think of the worst Paramedic they had ever seen and if they would want that person “clearing” C-spine injury in the field on them. The point set in that most of us can barely get our noses out of the cookbook long enough to do a complete assessment now. Those folks have no future in EMS if I have anything to say about it.

So what to do?

Attend the meetings of the groups that make the rules. Get on the agenda and speak. Bring research, evidence, examples from other systems already doing what you want to do.
You get a lot more attention when you bring in a multiple page presentation on Community Paramedics rather than complaining in the yard that we need more training to be able to do more.

Follow the policies. If they aren’t what your patient needs, lobby to change them. Don’t ignore them in the field or your next patient may suffer when you’re on suspension and that medic you despise has to treat them.

Which is worse?

9 Letters away from a solution – An EMS 2.0 update from San Francisco

I’ve been going about it all wrong.

 

Here I was scouring the laws, policies, regulations and statutes looking for a way to get alternate transport vehicles, like vans, SUVs and cars classified as ambulances.

Turns out all levels of regulation are quite clear on what an ambulance (the 9 letters, in case you’re wondering) is.

It starts at the State level defining an ambulance (I’m paraphrasing these) as a vehicle modified to accommodate a stretcher and staffed by 2 people, at least one of them an EMT-1 and that meets all local standards for an ambulance.  So that kicks the details to the local EMS agencies.  I’m OK with that, let the communities decide what specifics they need.  Oh, but there is the 2 person standard and the stretcher part I need to change.

The California Highway Patrol has standards for a vehicle to be LABELED ambulance and allowed to violate certain aspects of the vehicle code by using red lights, siren and blocking the right of way etc.  It requires a forward facing red light, distinctive paint, a cot and 2 people.

Dang it.

Then the County Health Code breaks down an ambulance and a routine medical transport vehicle, both requiring cots and 2 people.  This is looking bad.  So far I have to change a state law, a vehicle code and a County Health Code.

The local EMS Agency is specific on the staffing requirements of a BLS and ALS ambulance, equipment for first response vehicles (do all ALS first response vehicles really need a long spine board?) and are also charged with certifying that all ambulances in the system comply to the standards.

I have a huge uphill battle if I want to start transporting people in something other than a 2 person ambulance.

Or do I?

What is surprisingly lacking in all the statutes I’m reading are 2 things:  The definition of a patient, and a definition of what a patient uses to get to the hospital.

It appears the automatic default is that a patient will go via an ambulance and vehicles carrying those 9 letters are well regulated, and for good reason.  But what about when we let folks refuse transport, then they climb in a car and go to a hospital anyways?  Is that drier violating the state law, vehicle code, County Health Code and local ambulance ordinance? Of course not, silly, it’s not an ambulance.

It’s not an ambulance.

I’ve been going about this all wrong.  A complete 180 is in order.  Instead of trying to wiggle my solution into a decades old understanding of 9 letters, we could simply exist without them.

This theory applies only to my pilot project of course, the 9 lettered certified ambulances are still meeting all local, state and applicable laws, but now imagine being able to call the company taxi and send the person who meets criteria in something not labeled ambulance and they get the care they need.

Won’t someone think about the billers?!

Oh, I forgot to mention 1 little law that does go against my idea: Medicare part B.

Medicare part B is the legislation that looks retroactively and decides if the ambulance was really necessary and reimburses accordingly.  This is the main reason so many systems tell their practitioners not to walk patients to the ambulance like I do.  They’re likely not going to pay you for that trip.

So why are we still making the trip in the most expensive, regulated manner possible?

Because of 9 little letters.

Medicare has strict definitions as to what makes a BLS and ALS ambulance and gives subscribers guidelines as to what is and is not covered for reimbursement, even being as specific as to where you are when we declare you dead.  Another reason some agencies transport all cardiac arrest patients.

Turns out the folks who would meet criteria for a retriage to alternate transport wouldn’t be eligible to have Medicare cover the bill anyways.  So why not arrange for alternate transportation at far less cost?  It’s a cost more likely to be recovered and freeing up the ALS ambulance to find another paying customer patient in need.

 

I was always told there was a big law somewhere telling us we had to do things a certain way.  And there is, if you want to keep doing things the same way.

There’s still a lot of research required and permissions to get, but the biggest blockade to my desire to introduce alternate transport options is gone.

Just leave out those 9 magic letters.

The Complaint Box

…is my email inbox at work.  Or my voicemail…whichever…

I knew our CQI position handled citizen complaints, but I had no idea how many there were.

“It’s a thankless job” they told me when I took it.  Like being a Paramedic in the City was a thankful job?

Almost like clock work most mornings I get a call from a person I’ll call “Bob.”

Bob doesn’t like the Fire Department, or my mother, or my race, or the fact that I am his employee since he pays taxes.  Bob was taken to an ER for a complaint and was shocked and appalled we were directed to place him in the triage waiting area after a nurse assessed him.  In other words Bob is 99% of our business.

Bob and I have a 30-45 second conversation about his most recent abduction by the Paramedics and how they assaulted him, robbed him and left him to die…at the hospital.  When I pull up Bob’s run history the computer returns “Seriously?”

Some may say Bob’s calls are a hindrance or a distraction, but Bob keeps me on my toes.  Bob is my window into the mind of someone who does not know our lingo, our policies or our commitment to his overall health and safety.  Others may say I should report Bob, but that’s what he wants, a reaction, and all I do is listen, explain and then he hangs up.  then I get a coffee.  It’s a routine we have.

 

Other  complaints vary from legitimate clinical concerns from local hospitals, to regulators who question charting, to folks who simply want to vent.

But my favorite calls of all are the ones I can tell in an instant are without merit.  Bob helps he spot them easier.  How do I know?  They don’t know our lingo.

 

For example, if you tell me the ambulance people told you they would “throw you out of the truck” you’re lying.  How do I know?  Because a “truck” to us is a giant 5 man device with a 100 foot ladder on the back and is big and red.  We do not call it a truck…only you people do.  And by you people I mean the ungrateful masses who demand our services in 4 minutes or less only to complain that we took you to the wrong ER, since they “kicked me out” earlier today.

Kicked you out did they?  How do I know you’re lying?  Because they don’t kick people out.

When people get bored waiting 4 hours for a refill of Plavix (which they were never going to do in the first place, we told you that) they leave or are told to go to the pharmacy, but they are not kicked out.

We stole your wallet you say?  (Keep in mind folks, I am required to investigate these complaints no matter what they are)

Doubtful since I recognize your name from my days on the ambulance and we keep track of these things.  2 years ago you claimed we stole $500 from your wallet, then 8 months ago another $700 and today the total is up to $900 and we somehow walked off with your brother’s bass guitar.  I’ll investigate this but I should warn you, the No Merit letter is on my desktop I use it so often. (The Further Investigation by Investigative Services Bureau Recommended is there too FYI).

But just for once think about what you are about to say to me in your complaint.  If the crew kicked you out of the truck how again did you get to the hospital for the nurse to sign our form that they accepted you?

If we stole your grandmother’s $2000 necklace, why can you not describe it to me?

I’ll take your call, I’ll treat it as true until I complete my queries, but put some effort into it first folks.  If you’re unhappy and make something up you’re just wasting my time and yours.  If you have a legitimate concern I want to know about it.

 

Think twice about questioning the professionalism of the folks who took care of you when you didn’t need it, only wanted it, and how they did everything you needed up to and including taking you to an ER you did not need for a reason you could have handled yourself.

But if they weren’t professional, if they didn’t do what you needed, I’ll be the first one to tell you so.

 

Talk to you again on Monday Bob.

We Never Looked at the Son of a Bitch

Josh Kennedy Photography

“Oh Happy! How could you use such foul language on your blog?”

How could you use such foul language in your run report?

Two of the most misunderstood yet widely used abbreviations in EMS today are WNL and SOB.

They drove me nuts as a basic, troubled me as an intermediate, frustrated me as a medic and now that I’m in charge of reading all these charts, I’m simply disappointed.  And it’s not just my guys and gals either.

How many of you out there are noting ‘WNL” for a vital sign or in a narrative describing a patient’s range of motion, bruising, etc?  Yes you have, don’t deny it.

WNL – What does it mean?  It has multiple entries in the medical lexicon, including We Need Lawyer, We Never Looked and, down at the bottom, Within Normal Limits.  But even then WNL needs a qualifier to be accepted.  For example “WNL 79″ for a blood glucose level.  WNLX is an accepted medical abbreviation but only when the value (X) being measured is mentioned.  Simply writing WNL in the abdominal section does not count.

What gives me the most frustration, however, is that many folks apply THEIR OWN normal limits in this assessment, not those of the patient.  If the blood pressure is 210/100 and they state that is their normal, can we mention “WNL 210/100 per patient”?  Absolutely!  Please do, because that will guide me as to why you didn’t treat for acute hypertension.  A simple WNL for BP is shoddy documentation and makes me wonder if you even assessed the value and applied it to the entire patient presentation.

So, WNL can be used, but only if qualified.  Got it?  Good.

SOB- Commonly referred to in EMS circles as Shortness of Breath, but that’s about it.  outside of EMS, most notably in legal circles, it can mean something else entirely.  Officially SOB refers to See Order Blank unless, wait for it, it is given a qualifier.  For example, SOBOE is official for Shortness of Breath on Exertion, but a simple SOB is not enough to describe the patient’s condition.  When looking at the Chief Complaint drop down you may find a fancy word dyspnea.  Dyspnea is defined as the perception of respiratory discomfort, so someone can’t technically be complaining of a perception of difficulty breathing, can they?  Sure we could apply this term to a number of our asthma related complaints that have no idea what true breathing difficulty looks like and seem to have no trouble lighting up a cigarette during our assessment, but does it apply to our large population of unknown respiratory difficulty patients?

How do we describe shortness of breath without using SOB? Describe the signs and symptoms of course.

“Pt c/c SOB” tells me nothing. “Pt c/c difficulty breathing on inspiration” now there we go, and it didn’t take all that much longer to type.

It is also a good idea every now and again to define your abbreviations long hand in the chart. “Patient presents SOBOE (Short of Breath on Exertion)…” to allow for review and as a defense in case your abbreviations are ever called into question.  Your QI or a lawyer will pull your charts and see you are consistent in your use of the terms and abbreviations.

Now I hope your O2 sat reading doesn’t say WNL…

 

A Comment from The Most Important Chart she’ll ever write

Reader BG Miller left the following comment on my post about how a seemingly NBD (No Bog Deal) chart could be the most important one we write:

Okay, question from one of the non-EMS readers…
One of the injuries being listed for Zimmerman is having his head bounced off the concrete one or more times.  So you have a patient with a possible head injury who is experiencing great emotional stress and possibly shock, (unless he is a complete psycho, but that’s another argument) is he capable of signing a refusal?

Of course he is.

“Having his head bounced off the concrete” is not an injury, but a…wait for it…mechanism of injury, meaning he experienced an event that could have led to an injury.  Similar to saying “He got stabbed.”  Well, where, how deep, with what?  All those questions have to be asked to establish the extent of a possible injury.  So if I was told that at the scene we would transition, in my opinion based on little else, that this would shift from a refusal to an AMA consult with online medical control.  He’d also get a full work up in my office, not in the squad car.  Depending on the discoloration, shape, sound and feel of his injury (yes, I said sound) refusal may be out of the question.  Certain injuries can indicate that a significant amount of force caused it and remembering that the brain inside the skull can be injured just as badly, if not worse in some cases, can lead us to determine appropriateness for transport.

In my system, if a person exhibits trauma above the clavicles, they are candidates for full C-spine precautions.

Being capable of signing the refusal is an easy determination to make, it is when he should be evaluated and refuses is when it gets sticky.  This kind of scenario is when the lie of kidnapping gets added and we all panic and say we won’t kidnap the person who needs further assessment and just walk away.

 

Under ordinary circumstances getting his head smacked might leave him a bit dizzy but aware enough to decide on his own treatment.  Under ordinary circumstances a fight/shooting might put him under emotional stress but able to understand the medics treating him.  But what about when those two are combined?  Does that change your interaction with him as a patient?

As I mentioned above, if you as a witness tell me those things happened I need to better assess for an injury.  That is when we move to the ambulance, doors closed, lights turned up, so we can see everything the cops and their flashlights missed.  Funny thing  about cops, they are trained to look for weapons, drugs, offensive motions etc, but few of them have any clue how to assess for an injury. “He ain’t bleedin’ ” tells my nothing Serpico.  Bleeding is the least of my concerns.  From the cot inside the rig we can assess and if indicated initiate transport after convincing the patient it is warranted. “Look, you’re already in here, we could be there in 10 minutes and it’s done.” “You don’t need it? Well, you might be right, but let’s make sure, wadda ya say?”  If he needs to go, we can convince him it was his idea in the first place if we do it right.

Emotional stress accounts for most of my calls.  I often joke that we spot you 20 points on your blood pressure because of all the sirens.  If I had just shot someone I would be…well…I don’t know.  I would have to assume I’m jittery from the adrenaline of nearly being killed, killing someone, and now being assessed for an injury.  However, the down from that high could also be intense.  we all handle stress differently and can’t draw any conclusions from a person’s demeanor or level of calmness at the scene.

 

Also, having read a few cop’s take on self-defense shootings, it seems common that the problem the police face isn’t getting the shooter to talk to them but getting the shooter to shut up long enough to be mirandized.  Like someone that’s been through anything traumatic they tend to babble a bit.  So as a medic do you note what they are saying in your report?  “Came out of nowhere,” being mumbled will have a different spin in court than, “I shot him.”

I too have seen a tendency of purposeful shooters to not stop talking, mostly of the walk by and drive by variety, boasting of their accuracy or the severity of the wounds of their target.  When it comes to documenting their responses or comments, I stick to what is medically pertinent.  In this case, since the patient was involved in a violent action I will have PD in the ambulance with me and searched prior to being placed in the ambulance.  If he mumbles something it is the officer that needs that information, not me.  I could not care less why he did what he did, I care about his injuries.  If he mentions “Dude had a baseball bat and then everything went dark…” I note the bat because it directly impacts my impression of the injury.  Other details we’re better off pretending we didn’t hear and let the police handle it.

 

Thanks for a great question.  What about you fellow EMSers?