Transcript
We're I'm excited again to have doctor Mark Hoffman on, our, was one of the panelists today and as we've had before in the past.
And just real brief, doctor Hoffman is currently professor of athletic training and kinesiology at Oregon State University.
He's been on faculty since 2000 and 2 thou yes.
And teaching, within the athletic training program.
He is a he has extensive experience in emergency medicine also, where he currently is an, intermediate, athletic trainer, intermediate EMT.
He's, Warrior's first employed by the US Forest Service in that capacity.
Additionally, he is a lieutenant and EMS coordinator of ADARE Rural and Rescue in Oregon.
So he has with that, he has he brings a lot of experience both from both sides into this very timely topic is on patient reevaluation.
That's something that we see a lot.
I know in our instruction, we're doing training courses and in real time.
It's been I think for any, athletic trainer not doing the hand off day to day, that becomes it's a it's a core skill that is, often overlooked but really important.
So with that, doctor Hoffman, I am excited to have you here today, and I'm a turn it over to you.
Alright.
Perfect.
Well, thanks, Ray.
Thanks for, helping me, or allowing me, to talk with you guys.
This is a topic that that I think is a skill that a lot of athlete trainers just don't get a chance to practice as much, so we'll we'll give some tips and tricks for that.
I have no conflicts of interest.
Our learning objectives here today, really to understand the key components and the importance of reeval and, and the hand off, to master that art, and I like that word of art, because it is sometimes intimidating, and it really should be much more of a conversation.
We're gonna identify an overview, identify and, some things that potentially are barriers between the, the athletic trainer and EMS to facilitate better patient care.
So how my perspective really has changed over the years, many years as an athletic trainer, background in EMS, but more recently, now working, part time as a firefighter EMT.
I get find myself on a lot of EMS calls and interact with other providers that are giving handoffs.
So I get that opportunity both to give handoffs and receive handoffs.
So, there there are factors that influence all of these things, and and I think as athletic trainers, particularly for things that we don't do a lot of, we'd like to just have a a simple recipe, which sometimes works, but I I'd like to maybe talk more about some general concepts and kind of how how to think about doing these.
So the length of your EMS response is gonna matter.
Right?
Because you may or may not have a whole lot of information once they show up, and that's fine.
They know that if they have a quick response that by the time they show up, you may not have a whole lot of information for them.
If you're in more of a rule setting and you have 10, 15 minutes before EMS shows up, then they probably expect a little bit more, info, a little bit more patient packaging, and and in-depth information as they take over patient care.
It really does depend on how sick your patient is.
Right?
So if you have somebody with then I'll refer to kind of a a simple shoulder dislocation for whatever reason that needs to be transported.
That patient really isn't that sick.
The intensity of the scene is gonna be pretty low, and and, conversations can be, it can be a little bit more conversational and and less emergent.
But, if you have a really sick patient, then, things need to get moving quickly.
You need to have, your information organized for them.
So we'll talk about some stuff for that.
And so that's the next point is how much have you been able to do.
Right?
So have you gotten a full set of vital signs?
Have you gotten partial vital signs, if you've gotten blood sugars.
So some of that really figure it really figures in how far close your EMS responders are.
And then the other thing that will be a common theme here is how well you know them and how well they know you.
So I think we've kind of pushed that idea in this connection between EMS and athletic trainers for a long time, but it is absolutely vital.
So understanding patient reevaluation, you can see some common themes here, right?
So what needs to be reevaluated?
If it's your trauma patient, if it's a head injured patient, they're gonna need to be reevaluated, more quickly.
If it's a medical patient, somebody that's having an asthma problem, they need to probably be evaluated more quickly, but not the same things on your asthma patients need to be reevaluated on your as your trauma patients.
You may not need to get blood pressures as often on your asthma patients as you need to monitor their respiratory rate and their, saturation.
So kind of understanding what's going on in your patients, it will drive a little bit of what your reevaluation is.
But at the at the very beginning for any sick patient, particularly, and even trauma patients, you obviously need to get blood pressure pulse respirations in o two sat.
Ideally, a blood sugar is nice on most of those cases, but more important on some than others.
And then just reevaluation, we go back to this idea of a simple dislocation that needs to be transported, that reevaluation may not happen, right?
You may not need to really reevaluate them once you have done your CMS.
If you have enough time, maybe you've splinted that patient, you reassessed your CMS, and now they're ready for for transport.
Right?
But if they show up during the splinting process, then that reevaluation changes a little bit.
So trying to be a little bit intentionally vague here because it's so situational.
And this is where, spending more time thinking about in this situation, what would I do?
What would I give them initially?
What would I evaluate?
What would they like to have on the on the back end that is going to be more important than just, a hand off.
Sometimes, and me included, I used to teach students, like, hey, you need to get that sample history, and you need to give those medics when they come in everything in sample.
Well, it may not be all that important, in the moment that they know exactly when the last time they ate.
So you kinda gotta pick and choose as and and you'll get better as you practice these, what information, you should provide and what information they're gonna be looking for for your reevaluation.
And that does, dovetail directly into your hand off.
Right?
So so what's a hand off?
A hand off really is just this opportunity to share with incoming providers or the receiving provider.
Excuse me, and what information you have about the patient that's going to be important for them in their immediate care and then as they hand off as well.
Because remember, this is a chain.
Right?
So you are handing off to EMS, and then in their transport, they're also gonna be providing the hospital with information, as an incoming medic unit.
So so they are also going to be collecting information and providing a hand off on the on the back end of their care.
I like to say that initially, it really is just kind of brief.
So if we look at a situation where you have a patient and you have 2 medics that are arriving, they're initially going to want to know kind of what happened, what your findings are, and what you have done.
Right?
So maybe a little a little less about history and mechanism right there.
So it might be like, hey.
We have a, a 16 year old male football player here struck in the head on the field and unconscious.
And, this is what we've done at this point.
Right?
So we've been able to assess neurological.
We haven't been able to assess neurological.
What your assessments are, as opposed to at that point, they they need to know what they need to start providing care.
So in those more serious patients, it's just that information, so they can provide start providing care, and then you can fill in information as the, as the scene kind of plays out.
They are going to want to know, name of the patient and date of birth.
Everybody is pretty much doing electronic, charting these days.
So even to open that chart, they're gonna wanna know, first name, last name, date of birth.
Right?
Gets them into their system, and then they're gonna start collecting that information as you're providing that.
Typically, one person is gonna be charting and one person is going to be, starting patient care.
Right?
They're probably gonna come in, get their own set of vitals, while you are continuing to provide them with some information.
And that that varies a little bit.
We had a case where I, where I respond the other day where, they responded to the high school and a long jumper had a clearly fractured femur.
Upon their arrival, the athletic trainer had, evaluated, splinted, packaged the patient.
So they showed up, and received a hand off from the athlete trainers.
Like, hey.
This is, this is Jane.
She fractured her femur.
Loud pop, obvious fracture.
This is what we've done.
CMS was intact before.
CMS was intact after.
Here's her name, date of birth.
That's really all they need to know to get started.
Right?
And then they will continue to gather other information, as the case goes along.
So it really kinda depends on each situation.
The other thing I'll say here is that who gets the hand off?
Right?
And and so if you're at a place, where you have several athletic trainers working on a patient, the ideally, the person that is directing the scene, right, is not necessarily the lead provider.
So you may have, an athletic trainer that is providing care, and then you may have another athletic trainer that is back running the scene.
So that person that's running the scene is usually gonna be off to the side talking to all the medics and saying, hey.
This is what's going on, while the other medic comes in and is starting to ride, patient care.
But if you're at a high school and you're the only person, right, you're trying to do both.
So trying to really figure out who is going to be the person that gives that information to the medics.
And we try not to have it be everybody kind of chiming in.
If you have a multi person care team, every person chiming in, providing additional information.
So a lot of times, that hand off is from whoever is running the scene and the medic that is doing the charting, as they start through things.
And the only way to get good at these is is to practice them.
Bringing the gap, and and I I'm really big on this.
Right?
This is a key interaction, for not only your current call, but all your future calls.
Like, how well you interact with this incoming crew, is going to form opinions in their mind as for your competency and your ability to provide, value to that scene.
So the more calm you can be, the more concise and and helpful, the more likely they are going to involve you in the patient care and and it just builds that relationship going forward.
So that gets to that point of, you know, displaying confidence is important here, and the only way to get better is to practice.
And some people think this kinda sounds silly, but, as a as a firefighter, a lot of times when we show up to scenes, we have to give a size up.
Right?
And so that's on the radio.
And the only way we practice those is a lot of times just driving down the road and pretending that house is on fire and say, this is a 2 story single, single family dwelling fire showing from the right, the right window on the front of the residence.
However that works.
And so so I encourage you to, you know, the next time you're driving on the long drive, maybe in the car by yourself, maybe with some family members, just to practice these.
So envision a patient that you have had in the past and practice what you'd say.
You know, it's like, hey, your MS crew shows up and say, hey, you know, this is what I have.
Right?
This is such and such.
This is what happened.
This is what I've done so far, and this is what I know about their history.
But getting that to kind of flow and understand how you're going to share that information really is beneficial if you can practice several of those.
And then if you get a chance, right, work with your local EMS, provider or your fire department and say, hey.
You know, I really kind of been wondering, like, what you guys want when you show up and how I can, be more most concise in providing this information.
Can we run for you through a few of your deals?
Right?
So give me a scenario, and then I would kind of provide them what the the hand off would be.
And the other thing is, I think it's here on my conclusion slide.
Right?
So you wanna be confident in your evaluation and evaluation skills.
So that's that is number 1.
If you're not confident in the vital signs that you are collecting, you're not going to be confident in giving that to the providers.
And if you're not confident in those baseline vitals, you're not gonna be confident in your reevaluation skills.
So really having those skills dialed in and confidence in those is important.
And this next thing this is what I tell everybody is, like, you want to do that reevaluation and get that information as often as you feel like you need it.
Right?
So sometimes you're with that patient and you're like, wow.
They just don't they they don't look good, and and they're starting to look worse.
I'm gonna it's not like you have to look at your watch and say, oh, well, it's not time for reassessment yet.
Okay.
Let's go ahead and get another pressure and see what's happening with this.
Right?
So you'll have that intuition as far as, hey.
I wanna get this information again.
Right?
That simple dislocation, you probably don't get that itch to say, oh, wow.
I wonder if their blood pressure is changing.
Right?
And if you do, you you go assess it.
So general guidelines on our critical patients, they get re reassessed every every 5 to 10, Your stable patients, every 15.
But I want to emphasize that that you, as a provider, you should gather that information every every time you feel like you need some new information.
The initial hand off can be really kinda brief.
Right?
So this is what we have.
This is what we're working with.
This is what I've done.
Right?
So you don't necessarily need to give them all their meds and and all that, their allergies and everything on that initial, download of information that can kinda flow as the the cases, coming out.
And then, most, EMS fire personnel are are normal people, just like you.
So really try to make it a conversation.
Right?
And, just be confident in what you're saying and, just have a conversation with them.
I will tell you that not all EMS and fire personnel are particularly friendly.
Right?
So even now, I will get situations where I'm on a scene and another higher level provider will come in and just walk straight past me and go straight to the patient.
Just know that's not that's gonna happen.
That's on them.
That's not on you.
So if, if they're really doing their job, they're coming in, interacting with you, getting a download on the scene, before they just jump right in.
But I can also tell you that if they've been on the scene once or twice with you, and they have this opinion of what this scene is going to look like when they show up, it's going to make it more difficult.
So those interaction each of those interactions is important for you to be confident and competent, in your act interaction with them.
And then practice.
You just gotta practice these.
So that's kinda all I have.
I know, Ray, you said you may have a few questions for me, or we have some others that are gonna have questions.
Yeah.
It's a fantastic review, doctor Hoffman.
Anyone, or everyone, just if you have a question, feel free to, write your question in, and, doctor Hoffman will answer that.
Also, you can always raise your hand, and we'll turn the mic on as, you can have a have that conversation with us as well.
I guess, while we're waiting, hopefully, for a couple of questions, you know, I think the first thing that that kinda stands out, I think or 2 things really is one is, you know, you hear that, different ways of simplifying that, and you hear of MIST as acronym or or, like, the demystify and or d m I s t as you're simply giving the demographics.
You know, 33 year old female, you get into mechanism of injury or complaint with abdominal pain, the what the injury or what suspected injury or illness is, and tell what the vital signs, if they're stable, and you tell them that, and what treatments you've done.
And under 30 seconds, I remember the, when I was riding, with, my first ride along, earliest when I was brought on with, ambulance service, they actually, they said, okay.
And I'm just you know, I'm on the my first ride or so after being hired on.
They're like, okay.
You need to make the call to the hospital.
And if you do it in more than a minute, they're gonna hang up on you.
And I'm like, you haven't even shown me how to do that yet.
So, so it was, you know, you learn pretty fast, but really simple.
I think the other one is getting if they goes to what you said, doctor Hoffman.
If they know who you are, then it's just that they're I know that when I've you do this as well, you have a level of suspicion just when you're walking in because you're surveying everything.
It's not, you're moving right in.
So it's not personal.
It's professional and, just giving that request.
So, I've got, Will Keller is on here.
I'm gonna I'm gonna drop it over to Will.
So good morning, Will.
Hello, Will?
The community is there, Will, if you're trying to ask the question.
Yep.
You can un I meant to unmute yourself.
Let's see here.
No.
Hello, Will?
Maybe we answered his question.
Let's see here.
Hope it'll jump on here or not.
But, Will, if you can, just, let us know.
You can unmute yourself, and we will, add you on here.
Let me see if I can do this.
This might be the way to do this.
We'll move forward, Glenn, as well.
But, anyway, yeah, I I think that's you know, some of the main things there is that reevaluation, knowing what when to do that, when not to do that.
What's the what would be the one thing you've you've really picked up on or been more efficient at, over the last couple of years that has helped you in terms of how you manage that, that hand off?
Because you're having to do that, you know, on a unit, you're going to the to a hospital, etcetera.
Does that does that change at all, or you have to give more information from an EMS perspective into the hospital?
Yeah.
So so I think it's helpful and although difficult, right, to kind of put yourself on the receiving side of this.
So you just have to think if I was receiving this patient, what would I really want to know?
So if you're that EMS provider coming in and the athletic trainer is gonna tell you some stuff, You just kinda go back to those, you know, they already have dispatch information, so they've been called.
They have a good idea of why they're there.
Right?
So so just kind of really briefly running through that.
And then you're, like you indicated, this is a and and if it's a high school football player, maybe you need to say their age, maybe you don't.
Right?
So, they pretty much can see the patient.
They know that it's a football player.
They know that it's likely a male.
Right?
So you just kinda have to figure out so try not to make it so robotic.
Right?
So you can say, hey.
Johnny here was a plain linebacker, had head head in collision with another player.
When we came out, he was initially unresponsive.
Now he's responsive.
We have him in full c spine precautions.
Neurologically, he was intact, and, vitals are within normal limits.
So that's the other thing You can if you're comfortable with that saying vitals are all within normal limits, if they are.
Right?
If they're not, you can say, hey, vitals are all within normal limits except his pulse, which is, he's about a 110 at this point.
So really just kind of figure out how that verbiage is going to roll off of your tongue.
Right?
So, I usually say, his pressure is this, his heart rate's this.
He's breathing at this, and his saturation is this.
And that was that's a pretty quick download.
But if you if you're not practiced at kinda giving that, then it then it just feels more cumbersome.
So even even at that, if you can just practice when you have a little alone time to yourself.
Right?
Just how you would present vital signs in a in a concise, efficient manner to another provider, is really helpful.
Yeah.
I think the one thing I've seen is is we we try to try to get technical jargon, just speaking plain speak.
I mean, that's the one thing that's been I really enjoyed about being on an ambulance is that they're like, okay.
You're not having any only time only thing you need to know is your unit number and your you know, and look at some other one or two specifics, but you're just giving basic information, or it's just normal, talk.
I think the other one you you meant you talk you didn't allude you alluded to this.
There's only reevaluation side is the utilization of think about that pit crew, mentality of having you have a lead, you have an assist, and the lead does doesn't necessarily have to be the provider.
The lead is is managing the scene that when each person makes a decision based on what the what the, criticality of the situation is and who you have with you.
Yeah.
I mean, if if we're if you're in a situation where you have the benefit of having multiple providers, right, just, try to stand back, and we talked about it being a little more, operation oriented rather than task oriented.
And so you can say, hey.
You know?
Can we go ahead and get another set of vital signs?
Where are we on our neurological check?
What's happening here?
And then I think most people realize that when medics show up, they just don't come rushing in.
A lot of times, they just kinda come walking in and say, hey.
You know, what do you got?
Right?
And and a lot of times, they're just assessing the situation, looking at what's going on, looking at what you've done, looking at the patient, and then they just come on a 30 second download of, like, hey.
This is what's going on.
Unless that patient is there in obvious distress, they're likely going to just kind of, roll in at a at a nice calm pace and wanna know what information you have for them, and then they'll go go from there.
Right?
Yeah.
Only 6 pages.
Yeah.
And and that's, that period of time is also going to they're also evaluating what they're hearing from you.
Right?
So it's like, oh, well, they, you know, don't really have this or they haven't gotten this or they sometimes might say, hey, you know, thanks very much.
We'll take it from here or, like, they'll say, hey.
That's awesome.
Why don't you you mind helping us package this patient or, grab another set of vinyls for us, or this is what we're going to do.
So, really just try to make it make it as low key as possible, and and conversational rather than really, as robotic as as sometimes.
And sometimes that's just the way it works because we're not real familiar with it.
But the more you practice that at the more, the more easily it's going to come out.
Yep.
It does.
It it's, it is incredible to practice.
I mean, we saw this Ronnie and I did a training session about 2 weeks ago, and we saw within a matter of a within a couple of sessions, one is watching it.
They were watching it several times as part of these scenarios, but also they're doing it.
And their their I would say that Ronnie Woodridge, their their confidence level and their and their efficiency probably improved about 50% in a matter of about a hour or so.
So it's really it's easy to ask to make that really, simple approach there with it.
So, Mark, have you found it, first of all, have do you find yourself practicing at least early in your career?
You know they're coming.
You hear lights and sirens.
You see them walking up.
Have you already practiced in your head your speech, or do you just let it come out as it comes out?
Do you already sort of
Yeah.
That's a great question.
And and, I'll tell you, it really has changed over time.
15 years ago, I I would tell you that I was would have been rehearsing my sample in my head.
Right?
So the signs and and just and and now it's very much more conversational.
Right?
Because, they roll up.
They see things.
So, you know, hey.
We have a, you know, a 12 year old, Johnny here who fell off the, fell off the bleachers while they they were sitting there in a team meeting, and, he's complaining of this.
Right?
I as often as I can, if it is, there's any question about the stability of the ABCs, I will give that, right up front.
Right?
So, but they can also see the patient.
So so if there's any questions, like, oh, wow.
Looks if if they're looking at that patient, like, well, it doesn't look like they're breathing very well.
You're gonna wanna give them some information about the most obvious things that are there.
Yeah.
And then
This is what I like about kinda have that conversation.
Yeah.
This is what I like about paramedics and EMTs.
They wear patches, and their patches is their credentials.
So, and a lot of them will have their name tag.
And so you get to, like, figure out who is who and at what level, and you don't have to ask.
For athletic trainers, we're usually in polos and khakis.
We don't have name tags.
We look like anybody else.
Right?
We look like and so how important is it for you to announce, number 1, you're an ability trainer, but if you are dual credential, how important is that you get that out early in the process?
Yeah.
That that I I, I probably should have included a little so a little of introduction of yourself.
Right?
Especially, and this is the situation if they don't know you.
Right?
So, if they don't know you and they and they show up, and they see you're doing things.
Right?
So you just say, hey.
You know?
My name is Mark.
I'm the athlete trainer here.
This is what we've got.
So or my name is Mark.
I'm an athlete trainer in EMT.
This is this is what I've got.
So so that does provide them with a little bit of context.
So they don't necessarily know if you're just a coach, and I just say just.
Right?
So a an untrained person there, or if you have some, background in it that's that's also very helpful.
But that they'll also gonna pick up on that pretty quick, but once you start talking to them, they're gonna they're gonna know if you know the game or, or not.
So Yeah.
If you can practice these and be, conversational, get the information out nice and calm, Your your scene's gonna go a lot better and, building that relationship because, they're gonna talk.
Right?
So, hey.
How'd that go?
You know, when they'll say leave you and they clear the hospital with the patient, they're gonna have a little down low.
Like, hey.
You know, that person was really dialed in.
I really appreciated this.
Like, cool.
There there was there was a little bit of a struggle bus once we got there.
So so they they will form those opinions and, have an idea what's going on.
Great.
That was this is fantastic, doctor Hoffman.
I know we've gotta move on, but as well, we could keep probably talking for an hour and a half on this one topic just to and and on things we've seen and how we've improved and how we continue to collaborate.
And the key to that is just getting to, you know, work under I think you you said it best is, you know, see for you know, you understand what they're doing even knowing that when they come on scene, they're still gonna do a vital sign set.
But they're they're using the information, critical.
So, the critical everything you've collected already, give it to them very in one nice package, and it helps them to move along because I know that, you're probably no different than any other.
You where you are with the end of the system.
You have a tie they they have a timer when you arrive on scene, and they want you to get off scene.
And that's for the for a good reason, regardless if it's critical or, or a noncritical patient.
So
Yeah.
So, yeah, they are yeah.
Same times are are definitely being monitored.
So, and just we can't emphasize enough.
Just practice them.
Yep.
Practice makes permanent, so practice right.
So That's right.
Yeah.
Well, good deal.
Thank you, doctor Hoffman.
I appreciate you coming on again, and look forward to having you on again in a future, session.
Okay.
Thanks, guys.
Great.
Tomorrow.
Thank you very much.
Patient Re-evaluation and Efficient Handoff Reporting to EMS
General Course Information
Learning Material
Presentation (Video)
Updated Apr 6, 2024
1955 Cherokee Street
Baton Rouge, LA 70806
United States
Baton Rouge, LA 70806
United States
Copyright © 2024 Action Medicine Consultants, LLC
___MESSAGE___
___MESSAGE___