What do you say?

[guitardemon]

I am an EMT and a volunteer fire fighter. A few weeks ago i was on a multiple injury car accident and i was stuck holding c spine on a women for quite a while. There were two other patients who were injured much worse than my patient so most of the attention on the scene was directed towards them. So for a good 10 min i was hold c spine on this women. I asked her what happened, and i tried to reassure her and tell her that we had another ambulance on the way for her, but after that i wasn't really sure what to talk about. So my question is when you are stuck in situations like this, what do you say/ talk about with the patient?

[Scaramedic]

I am an EMT and a volunteer fire fighter. A few weeks ago i was on a multiple injury car accident and i was stuck holding c spine on a women for quite a while. There were two other patients who were injured much worse than my patient so most of the attention on the scene was directed towards them. So for a good 10 min i was hold c spine on this women. I asked her what happened, and i tried to reassure her and tell her that we had another ambulance on the way for her, but after that i wasn't really sure what to talk about. So my question is when you are stuck in situations like this, what do you say/ talk about with the patient?

Do you come here often?

What's your sign?

That neck brace matches your eyes.

Seriously, I would reassure and explain to her what's going on. Usually patients are concerned about others in the MVA, so keep them updated on the other victims. Also don't forget the most important line in medicine, reserved for patients who are dead or dying "we're doing all we can."

[dahlio]

Exactly what scaramedic said, reassure. I know with pediatric patients, I can talk to them about things like video games, and TV, but it seems adults are a lot harder to reassure.

[Doczilla]

Provide reassurance. Tell them what they can exect when they get around to treating her. Tell her about what to expect in the ambulance and upon arrival at the ER. Much of the anxiety that they feel is not knowing what to expect, and by demystifying this for her, you are alleviating a lot of that. Tell her how lucky she it that it appears she is not badly hurt. Then, talk about whatever. You can only talk medical stuff with them for so long before you start repeating yourself, boring them, or scaring them. Most patients appreciate you talking to them like a human being. If nothing occurs to you, then talk about everyday things. Ask if she has any children, brothers or sisters, etc. Ask where she grew up, what she does for a living. Ask her how she likes living in the area, etc. This will help to keep her mind off the medical, which is probably weighing heavily on her. It sounds like you did a fine job with helping to keep her calm and reassured.

'zilla

[speedygodzilla]

Try to avoid yes or no questions, as the patients tend to shake their head.

[Kaisu]

i was stuck holding c spine on a women for quite a while.

You weren't stuck - you were entrusted with caring for what may have been the most significant injury of this woman's life.

[brentoli]

Did you talk to her about your agency's plans on implementing protocols to allow you to decide if C-Spine is needed on all car accident patients?

[Dustdevil]

Try to avoid yes or no questions, as the patients tend to shake their head.

Plus 5 for an excellent point! You really have to watch the conversation because of that.

And plus 5 for an excellent question too!

Reassurance and keeping them informed are indeed the major keys. But there is more to reassurance than simply repeating that "everything's okay" and "we're doing all we can." Many patients will take much more from your voice than from your actual words. Keep your emotions and excitement under control and try and maintain a very casual, conversational tone. If you can do that, you can be honest about some pretty horrible facts, yet keep the patient calm and reassured.

And, of course, Brentoli's point shouldn't be overlooked. Did this patient actually have any signs that truly indicated spinal immobilisation, or was it just a matter of reflex formality? Had she been evaluated for the need for immobilisation, or did you just jump on it without an SSI evaluation? If you could have ruled it out in fifteen seconds, that would have freed you to address other, more pressing priorities, which it certainly sounds like you may have had.

[Richard B the EMT]

Me, I try to explain that all this stuff immobilizing the head is for reason, usually not ultimately needed, but no chances being taken if they actually are, followed by telling the patient that any questions asked are to verbally be answered. Then I ask if they understand. I brace to stop any motion before I ask, of course. If they verbalize the answer, it also is an indicator how well they are processing information.

[Kaisu]

If you could have ruled it out in fifteen seconds, that would have freed you to address other, more pressing priorities, which it certainly sounds like you may have had.

There's darn little that an EMT can rule in or out either through lack of education or protocols. My guess is that they were instructed to take C-Spine and they did... and appear to have done a fine job of it as well as they didn't let go.