Transcript

0:13

Go. As always, it is so great to be here presenting for Action Med. Today, I am going to be presenting on handing it over to EMS, being able to give report to them on the patient situation when they arrive. So let's dive in. So disclosures, I have none.

0:33

But as always, make sure that you are abiding by your own standing protocol, what you and your your overseeing physician have agreed upon. This is purely for educational purposes. You know, work it work it out with your own protocols. But definitely, I hope you can take what I talk on today, into consideration when doing those protocols. Learning objectives.

0:59

I want you to be able to identify important information that dispatch and EMS need to know when you activate 911. I want you to be able to recognize when and how to trend patient vital signs and how those are important bits of data to give to EMS. And I want you to be able to give a good, clear verbal report to EMS once they arrive on scene and you transfer patient care to them. So we as ATs, we have emergency action plans that include when and how to activate EMS, and many of us have had to do so. I know I have.

1:40

So I just wanna touch on some typical athletic related emergencies that we might need EMS for. And that would be, you know, if if an athlete's not breathing, if you suspect cardiac arrest, if you suspect a a back or a neck injury, if there's bleeding that can't be stopped, if there's a broken bone or joint dislocation with CMS is compromised or the bone is sticking through the skin. Those are all things where we know we need the extra hands. We know we need EMS to come help. But some other emerging considerations I wanna touch on, You know, we we may not see these as often as athletic trainers, but we still need to be prepared and know how to recognize a situation where we have inadequate resources.

2:35

And some of those, the big one that I've encountered is spectator involvement. So our scope of practice obviously differs from state to state, but typically, our scope covers first aid only to spectators. Our our primary scope revolves around athletes and athletic injuries. Most of the time now keep in mind, I'm speaking from a secondary school point of view. So I'm with athletics.

3:02

But anything beyond first aid for a spectator or, you know, your patient population outside of your scope, we're gonna need to activate EMS. Any penetrating trauma, unfortunately, you know, shootings are a thing. I wish they weren't, but that's not the reality that we live in. So we need to be able to, you know, call 911 for for gunshot wounds or you know, in athletics, we could even see javelin impalements, broken bats, or, like, field sticks. Anything like that could could, be a penetrating trauma.

3:44

Another big one is, multi casualty incident. And that's where, just to review, an MCI is where the amount of patients overwhelms the amount of available resources. So, typically, I know myself, I am the only athletic trainer at my school. And if anything were to happen where I even have 2 patients, I I have outdone the resources available to me. I need to activate EMS.

4:12

So anytime that you need additional help, you need to activate. And patient deterioration. Anytime your patient's condition is worsening, you need additional help and care, especially with head injuries or, you know, if if they have asthma or anaphylaxis or diabetes and your interventions that you've attempted are not, they are not helping, then you need to activate. And, of course, there are so many other incidents where we would need EMS. So this is just some examples, some common examples, some of the bigger ones.

4:51

It is not an all inclusive list. So use your best judgment. If you think you need to activate EMS, you probably do. We athletic trainers have good strong gut feelings, and we need to trust that that sense of intuition. So once we call EMS, what do we say?

5:10

I'd like one ambulance with 2 EMTs and a sigh of lights and sirens, please. No. No. No. No.

5:15

If only it was as easy as a fast food order. I'm sure most of us have called 911 at some point in our careers, and each one of us who has will have a completely different story about what info we gave and how the interaction went. I know I have had smooth a plus calls to dispatch, and I've had one that I still cringe when I think about it. So what does dispatch need to know? So they need to know your location and be specific.

5:46

Use directional terms, not just labels. The for the desired parking lot, as well as its letter label to confirm that EMS crew has the right parking lot and then the number door they need to enter in. So you wanna go broad and then narrow down to the specifics. So in my example, it's the southeast parking lot. It's labeled lot d, and use door number 12.

6:20

If your town is small and everyone on the crew knows where they need to go like like my crew does, then you may not need to give the turn by turn directions, but make sure you know what they are and can provide them to dispatch if needed, especially if it involves any sort of hidden entrance or unmarked entrance. You need to be able to direct dispatch and EMS to where they need to go in order to reach your position. Patient's demographic. They need to know what the patient's age, sex, gender is if possible. This helps the EMS crew be able to prepare in advance with age appropriate equipment needed while they are en route to you, and it helps them identify the patient easier once they're on scene.

7:06

They need to know the type of emergency. What do you believe is going on? A severe asthma attack, sickle cell crisis, anaphylaxis, heat stroke. You don't have to get into the nitty gritty of the specifics here, but you do need to be able to give a general impression to dispatch so that they can relay the situation to the EMS crew. This helps exponentially as then in the back of the truck, EMS can grab any relevant medications or other equipment that they might anticipate needing for quick interventions once on scene.

7:39

You need to be able to share patient stability. Are they rapidly deteriorating, or do they seem stable? Taking their vitals is gonna tell you a lot about which which data points to relay, and I'll get into that in in just a minute. You need to also be able to give them any relevant information. If they're suffering anaphylaxis, if you know they're allergic to bee stings and got stung, tell them that.

8:05

Tell them, you know, if an EpiPen was administered and how long ago. If they have asthma, do they have a history of attacks? Is there inhaler? Was it administered? Is it helping?

8:18

A big one is if CPR is in progress. If you have a cardiac arrest and CPR is in progress, make sure to relay that to dispatch. If you if you know that there's a history of cardiac issues and you suspect your situation is cardiac in nature, tell them that. You don't need to relay to dispatch that the patient has a history of SVT or whatever it may be. You certainly can.

8:46

Don't get me wrong. With dispatch and EMS, the more info, the better. But you will have a chance to deliver the in-depth specifics to EMS when they arrive on scene. As, you know, as with any 911 call, answer any questions dispatch asks in order to provide the best possible information. Do not rush your words.

9:09

Speak clearly. Don't hang up before EMS or before dispatch does. Those are kind of the the big pieces of when we call dispatch. What do they need to know so they can share it with the responders. So in the meantime, response times can vary widely depending on the size of your city or town, the location of the the hall relative to your location, the availability of the EMS crew at any given point.

9:41

So what do you do while you wait? There's plenty to do. There is crowd control. There's directing runners to stage at key entry points for EMS. There's contacting parents.

9:51

But one of the most important jobs that you can do as the athletic trainer is train your patient's vital signs. Obviously, if EMS is coming, we have a reason for activating them. And vital signs can tell us so much about our patient's condition and their level of stability, but they tell us even more when we have multiple sets to compare to. If your patient is stable, you can take vital signs every 15 minutes or so. But as ATs, again, if we're activating EMS, I say take them every 5.

10:23

Treat the patient as though they're unstable and do the vitals more frequently. The more data points you have to plot against themselves, the more clear picture you have of the patient's overall condition. Odds are, if we're calling EMS, our patient is not as stable as we would like, or we probably wouldn't be calling EMS to begin with. Obviously, situationally dependent. But I know that I would rather have more vital sets to trend so I know I'm not missing something, especially if we're dealing something where shock can come into play.

10:59

While monitoring them closely, you'll be better prepared to initiate potential life saving measures if the need arises. So I have two examples here of a tool you can use. The left chart is one I made up to include the vitals I feel are the ones I'm most likely going to obtain while I wait for EMS. And, of course, again, this is all situationally dependent. You might not get every one of these vital signs every time.

11:26

This is only for trending vitals. It's it doesn't have any spots to take patient history or tie or, you know, other relevant information. It is just for tracking vital signs. The one on the right is what our air med team, with Sanford Health uses and has distributed to our ambulance service. This one includes more info such as patients' allergies, meds, their chart number, but not some of the vital signs that may be helpful like I've listed on the left chart.

11:57

That's not to say you can't write them down in the margin, but I find in an emergency, the less I have to adlib, the better. I like things laid out. I like both of these because you can fill it out, tear it off, and hand it directly to EMS. There are plenty of versions of both of these tools available online for reference and for sale all over the Internet. Find something you like, grab it, use it.

12:24

It is so helpful on scene. So when EMS gets there, you need to be able to quickly, clearly, and concisely give report to them. So remember, they already have some of the basic background information based on what information you gave to dispatch. So this is where you can get into the more specific details. Tell them your patient's name, age, and date of birth if you know it.

12:52

Tell them briefly what happened. Describe the mechanism of injury or the nature of illness. Give any patient relevant medical history based on your current situation, what signs and symptoms are present, how long it's been going on, what happened. Use the s in your sample history, your OPQRST. All of that is gonna be here.

13:17

So to review that signs and symptoms, onset, provocation, quality, radiation, severity, and time. Try to include the other sample elements such as allergies, medications, past pertinent history, last oral intake, events leading up to the situation. Try to include all of that. If you don't get all of it, make sure you get the most relevant pieces. Tell them what you've done to try to help your patient and what was the outcome, whether it's an inhaler, an EpiPen, a glucagon injection, Narcan.

13:53

If there's a reduction of symptoms, if if it didn't seem to have any effect, it didn't help at all, or if their symptoms have worsened, those are key information pieces that EMS needs to know. What's the patient's level of consciousness? Or if you if you have the Glasgow Coma Scale memorized, I know I don't, but if you do, go ahead and and relay to them the patient's score. What is it now, and what is it when you first got to your patient? How has it changed since initiating care?

14:21

If they have altered consciousness, are they responsive to verbal stimuli, painful? Are they unresponsive? Are they alert to person, place, time, and event? Are they able to speak coherently, or do they make unintelligible sounds? Do they recoil from painful stimulation?

14:36

If you know the GCS scale, go ahead and give it. Some EMS protocols are determined by GCS score. If you don't know it, it's okay. As long as you are able to relay the general patient condition, that will be good. EMS can calculate the GCS, on their own.

14:57

And then the vital trends, give them a verbal overview of what the patient's vitals have done since starting care and what their most current vitals are. This is where you can hand them the trends that you wrote down from the previous slide while they were en route, but make sure to verbalize any significant changes, including changes in rates and quality. Answer any other questions EMS asks you. Any clarifying questions, try to give as clear information as possible. If your patient is unable to answer the questions due to their condition, but you know the answer, go ahead and and offer that answer for the patient.

15:33

I know we like to let the patient answer themselves when they can, but in an emergency situation, that might not be the case. So your goal with the verbal report is to give EMS a clear picture of the situation in a very short amount of time before transferring patient care to them. So I have put together an example to show how it can flow. So here, you are let's see. You are called to your high school's track complex for a report of someone being stung by a bee.

16:11

On arrival, you see the athlete who was stung, and you know she has a history of severe allergy to bee venom. Her ankle is red and swollen around the site of the sting. As you talk to her, she begins to develop hives and facial swelling and reports she's starting to have difficulty breathing, and you can hear an auditory wheeze. She has her bag, and you are able to administer her first EpiPen to her thigh. You activate EMS and direct a coach to call parents and position runners, to guide the ambulance to the location to the location of the patient.

16:40

So what information do you give dispatch? You say, I'm the athletic trainer at JCC High School. I am out at the track, and we have a 15 year old female who was stung by a bee and is experiencing anaphylaxis. We've already given her one epipendose. We are located on the north end of the track.

16:57

Have the ambulance use the north entrance to the complex off of Springfield Parkway into the gravel lot. At the south end of the lot is a chain link gate that will be per that will provide direct access to the track and will be open. So then you're trending your vitals, and EMS gets there. So what verbal report do you give EMS? This is Jane Doe.

17:19

She's 15. Birth date is August 10, 2008. She was in the grass infield when she was stung by a bee on her left ankle at at approximately 3:0:8 PM. She has a history of anaphylaxis to bee stings and started to develop signs of anaphylactic shock shortly after being stung. We administered her first EpiPen at 314 and have her second dose here in her bag.

17:41

She has not lost consciousness and has been alert and oriented the whole time. Her breathing was rapid, shallow, and labored with significant wheezing, and she was tachycardic with low blood pressure, but these have all improved since EpiPen administration. Her current vitals are pulse is 118, respirations, 20, blood pressure 105 over 70, and oxygen is 97%. She has no other known allergies and is not on any medications. Her parents have been notified, and we'll meet her at the hospital.

18:13

I will accompany her until they get there. So how can you help EMS help you when you need them? Don't be a stranger. Go to your local department and introduce yourself. Not all EMS members or departments, especially in large cities, I've found, are aware of who athletic trainers are and what we do.

18:35

I have had better luck with this in the smaller towns, than in the bigger cities where you don't know which crew you'll get on any given day. So make sure that you are establishing that connection. Share your emergency action plan with your responding department. The more information, the better. Make sure you include any maps you have of your campus that will help EMS navigate to an incident location easier, especially if you have, like, an aerial view of a track complex or whatnot where you can indicate entrances.

19:09

Those are super helpful. Keep your EAPs short, sweet, and to the point on location. They should be clear and concise where anyone reading it can call EMS and can follow the steps to achieve the same desired outcome. Venue EAP should be 1 page posted in areas of high visibility. So don't put it inside a cabinet door.

19:29

Put it on the outside and make it easy to follow. Bold the most important bits. We know that in crisis, people will not focus on small print. They're gonna look for things that stand out. So make the important parts stand out if you're not the one calling.

19:46

Dispatch will still get the basic information they need in order to send the appropriate help. If you can, familiarize yourself with your local EMS protocols. A lot of departments will share these if you ask. So this goes back to having that good interprofessional relationship. Develop that report.

20:07

Get those get those protocols. Something I've been able to do, being both an athletic trainer and an EMT on my local department, is change our EMS protocol to match what I do as an athletic trainer, specifically regarding cold water immersion in cases of heat stroke. Medical direction has improved the change as it pertains to the school, But the original protocol is what we will still follow for patients of the general public. But information is power, and you never know what positive changes you can bring about if you don't know what all the stakeholders are working with. So try to get your hands on those protocols if you can and know what e how EMS operates in different situations.

20:49

A big one, I'm a huge believer in this, train with your local EMS on things specific to you and your setting as an athletic trainer. For me, being at a high school where football is king, I train my EMS crewmates annually on football equipment removal. I may be the one using the tools 99% of the time. But if they know what the process is and what their role is, they can more effectively and efficiently assist me if I need to call upon them. Once the equipment is off and the patient has been placed on the scoop stretcher, I can then transfer care to EMS, and they take it from there.

21:25

There's no question on roles from the time they show up to the time care is transferred. You and your patients will benefit exponentially if you have a good working relationship and understanding with your local EMS counterparts. Giving verbal report, my example may seem a bit scripted because it does follow a very basic script. It's the same flow I use as an EMT when I give report both on the phone and in person to the receiving emergency room when I'm transferring or transporting a patient. The more you practice, the more the flow of information will become second nature.

22:00

It won't seem clunky. You'll be able to provide that necessary information very easily. So I know that this is something that's been talked about in various presentations in the past, but it's something that I feel we can never be exposed too much to. The more we hear something, the more we soak it in and can utilize it and practice it, the more it will help our patients to our fullest potential. If you have any questions, please feel free to contact me through email or even on Twitter.

22:32

I'm pretty flexible, and I love questions. That is all I have. Thank you so much for tuning in.