First Impressions

[HERBIE1]

Had a call the other day for a guy with the typical nondescript dispatch information- "Sick", with "ETOH on board" as a further comment, and it was about 2300hrs. Turns out the guy stumbled onto a bus at the station, and the driver called. Found a 30 year old black male, wild hair, hip/hop looking, disheveled appearance. Had drool coming from his mouth, and was squirming around in his seat. Nobody on the bus knew him, so bystanders were no help.

He had the wild eyes, was agitated, dilated pupils, nonverbal, and mildly uncooperative. Immediately noticed no smell of alcohol, so we began thinking drugs of some type- PCP, etc. As we were removing his jacket to start our exam and treatment, we noticed a glucometer fall out of his pocket- along with a packet of Skittles candy. Bingo.

Long story short, his glucose was below 20. ALS care, Dextrose and he soon became A/Ox's3. Turns out the guy is an IT worker at a local university, had worked a double shift to make extra money for the holiday season, and had simply forgotten to eat anything since lunch. His last memory was getting on the bus to go home- around 3 hours ago- and about 10 miles from where we found him. Nice guy, embarrassed, very appreciative. I told him he was lucky, since the neighborhoods he passed while disoriented were rough- and he was lucky to still have his wallet, his IPOD, his clothes, and even all his body parts intact. He says he recalled being a bit fuzzy when he got on the bus and assumed his sugar was dropping, which is why he bought the candy, but never got a chance to eat it.

We dropped him off at the ER, where he would get a meal, some fresh clothes- (he was incontinent), and presumably he would soon be sent home.

So- our thought process went from- oh great- dragging another drunk off a bus- to uh oh- we may be fighting some guy wacked out on drugs, to wow- poor guy, trying to do the right thing and had some bad luck.

Never assume anything, folks- even when you are given information supposedly meant to help you.

[zippyRN]

DEFG

that is all

[Lone Star]

Herbie,

This is an excellent post that once again confirms the statement "Nothing in medicine is black and white.".

It's only human nature to take the scenario you described at face value. While reading it, I was thinking pretty much the same thing you were as you rolled up on scene.

As I read further, I had that ever popular "Oh, DUH!" moment.

We have to form a 'general impression' when we get on scene, but this story points out very clearly that we cannot write that first impression in stone, to the point that we miss the subtle hints that will be revealed as we progress to patient assessment.

There are more than a few in this industry that have a bad habit of developing 'tunnel vision'. They get as far as the first impression, and thats as far as they want to go. We have to treat our patients based on the evidence we uncover, not just off of our first impression. Not all calls will have such a great difference between your first impression and what you find when you start assessing your patient.

Good job!

[HERBIE1]

DEFG

that is all

Huh?

[DwayneEMTP]

Yeah, other than the dispatched time and the address I completely disregard the type of incident given.

Now, having said that, part of my clinicals in medic school was to spend 24 hours at two different dispatch centers and I was shocked that they hate the stuff they have to dispatch nearly as much as everyone else. At least at the centers that I sat at they were required to dispatch the call as it was received, no matter what information they are later able to obtain, unless it was going to upgrade the severity of the call.

But anyway, it's always felt to me that preparing for the dispatched call was sort of like letting PD or a citizen give me my initial impresssion. Weird I know, but there you have it. Get the address, crank up the tunes (within reason of course) and chill until you're actually able to see what's going on with your own eyes...

Good post Herbie, good to see you back. I hope that you're healthy in mind and spirit.

Dwayne

[zippyRN]

Huh?

the moral of the tale was DEFG

don't ever forget glucose

[PCP]

I am learning very fast that my first impression of a pt is usually not what I am thinking at all is wrong with them. Hopefully that will change as I get more experience.

[Aussieaid]

I use the dispatch info to prepare me for whether it is a trauma or a medical call and even then it can be something completely different. We were dispatched for a "cut to the hand" once and made me wonder why they needed a helicopter. I was already looking for a bandaid and thinking along the lines of getting the local hospital to accept them. The patient had a rather large "cut" to the hand and it was still inside the lawnmower while we flew the pt with barely controllable hemorrhaging!

We NEVER take our interfacility calls at face value. We were once dispatched for a pt with 14 IV drips when it turned out she had a 14g IV in!!!!

It's really easy to take things at face value and most of the time we do no harm but there is that occasional call that we get "tunnel vision" on and find out later we weren't even in the same country. We are the ones who have to live with ourselves when we do do harm because we accepted what we were told at face value without doing a thorough assessment of our own. Sometimes we just need reminding to not get complacent and it is good practice to think of as many possible differential diagnoses as we can to keep us on our toes.

Cheers and Happy Turkey Day!

[HERBIE1]

Yeah, other than the dispatched time and the address I completely disregard the type of incident given.

Now, having said that, part of my clinicals in medic school was to spend 24 hours at two different dispatch centers and I was shocked that they hate the stuff they have to dispatch nearly as much as everyone else. At least at the centers that I sat at they were required to dispatch the call as it was received, no matter what information they are later able to obtain, unless it was going to upgrade the severity of the call.

But anyway, it's always felt to me that preparing for the dispatched call was sort of like letting PD or a citizen give me my initial impresssion. Weird I know, but there you have it. Get the address, crank up the tunes (within reason of course) and chill until you're actually able to see what's going on with your own eyes...

Good post Herbie, good to see you back. I hope that you're healthy in mind and spirit.

Dwayne

Generally we never get any details like "possible ETOH on board"- only a couple dispatchers attempt to give us that. I appreciate their efforts, but like you say, very rarely does the information correlate with the actual problem. We'll get a call for a diabetic, when in fact it's someone who has a cut on their hand, and they happen to also be a diabetic. Part of the problem is that we have a 2 tiered system, and many of the dispatchers try to make every call ALS if possible so they do not get caught underdispatching something. Even if they follow the protocols, they are afraid they will be caught in the trick bag if they send the wrong type of unit.

Hanging in there, bud. It's gonna be a rough holiday season for us. Hope all is well with you and yours, my friend.

I am learning very fast that my first impression of a pt is usually not what I am thinking at all is wrong with them. Hopefully that will change as I get more experience.

Nothing at all wrong with coming up with a first impression- you have to start somewhere. You need to have a jumping off point, but you also cannot have tunnel vision and possibly disregard clues/information that may take you in a completely different direction. Most of the time things are pretty straightforward and uncomplicated, but not always. It's important to keep your options open.

Example- A patient who is in severe respiratory distress may initially present as an asthmatic with diminished lung sounds and wheezing. You begin treating the person with albuterol, and when their distress lessens and their lungs open up a bit, you realize they are also in pulmonary edema and have rales, so you now must shift gears. Could be you are dealing with cardiac wheezing, or a person with a cardiac condition AND asthma.

Constantly reassess vitals, condition, and ensure something else is not happening with your patient. Many of our patients- especially the elderly- have multiple medical problems, and alleviating one issue may simply aggravate or expose another.

[brentoli]

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I've never been to a "bigger system" but don't forget.... often times the dispatcher can only give you the information relayed to them by the caller.

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