Guidelines for laymen for requesting a medical response.

[DwayneEMTP]

So, as many of you know I work in PNG, out in the jungle. I work at a mine that has about 1,500 people onsite at any given time. I am responsible for emergency response camp wide, as well as in the local villages, and also for seeing the more significantly ill patients in the clinic.

The issue here is that I'm usually really, really late on emergencies. Any time someone calls in an emergency they send Security to see if there is really an emergency. They have no medical training. Only twice they've called in for an emergency. Once was a stabbing with a machete. The other a bus rollover with 7 passengers. They should have called me 30 or 40 other times, but didn't.

I've complained to my direct management who, as always, says, "That's just the way it is. Leave it alone." The problem is that we've had some significantly ill patients that could have benefited from prompt, professional care, but I wasn't called. I either saw them being dragged into the clinic, or discovered them there later.

So, being the moron that I am I skipped my supers and went to the security guys and asked why they never called. It turns out that they really only have two levels of notification. "Not an emergency" and "Emergency." And Emergency starts a lot of important people moving, gets them into the loop, and if it's not really an emergency by the accounting of these important people then security gets their assess handed to them.

So I asked, "What if we develop a protocol for, 'Not sure. We need medical to evaluate?" And they loved the idea because it gets the heat off of their backs.

But now I'm not sure exactly how to develop the guidelines for non medical people to use. You need to understand that if I had my way that I'd go on every call for a sick person. But, though it's not supposed to be said out loud, the local national management will never approve that because they're terrified that I'll be busy with a local when an expat needs my care. Bullshit, yeah, but we either work within that understanding or create nothing positive at all.

How to explain to the uninitiated where to draw the lines between "make them walk or have someone help them walk" and "call for an assessment" and "It's an emergency"?

[JPINFV]

How about start with "Would this be something you would call an ambulance for?" and start moving the marker from there?

[DFIB]

Well, this should be easy and quick. Not. Here are some ideas that come to mind and this will be no means be complete but a start.

AVPU Responsive to pain and unresponsive get a to see you.

AMS Teach them the questions to ask and decide if you want than to call at AOX3 or AOx4

PEARL. Teach normal pupil movements.

Respiration Teach normal quality and rate and rhythm.

Pulse: Normal values and when they should call

Temperature,

Skin color and condition

Pain scale and at what level you want to see them

Chest pain. All chest pain should be evaluated by you.

Mechanism of Injury and index of suspicion. For example a patient that falls from a tree more than 10 ft high should me evaluated by you.

I don't know what degree of bleeding the locals consider serious but you could establish a threshold.

Cincinnati coma scale along with cephalea

JVD. You see all patients with JVD

I am sure that everyone else will have more to add but this much should keep you busy for a while.

I envy you brother! This is the king of work and community participation that really gets my blood pumping!

[rock_shoes]

What if you had the ability to essentially "self dispatch"? Ie. the security staff call you any time they're even remotely concerned and you decide whether or not you should attend based on their answers to your questions. The biggest downfall would of course relate to potential language barriers. Do you think the guards understand enough English for "self dispatch" to work?

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[Richard B the EMT]

What about whoever mans the switchboard having a guidebook? Either Dr. Clawson's EMD book or an equivalent might be a good idea for questioning the caller, and making some kind of determination.If that doesn't work, create one of your own using concepts from the book(s).

[DwayneEMTP]

Sorry all, I should have been much more clear.

Those are all really, really good ideas, but this has to be something that can be written, that a local national can understand (Think of s/s that you would give to a younger child as a guide. Not because they're stupid, as they're certainly not, but thinking about medicine in any none gross context isn't something that they have experience with.), but also, to a lesser degree hold them accountable for the decisions that they make.

I'm out of this location in two weeks. They've replaced our positions with Aussie medics, so even the limited ability for training that I might have had is undoable now. It's just something I want to try and leave in place before I go.

I was thinking along the lines of...

Are they awake?

Can they speak clearly?

Can they walk unaided?

Something like that, which seems very simple until I try and turn it into a decision tree, and then it can get complicated quickly, so I need to find a solution that allows a very clear distinction between

"This person has a cold, it's ok to take them or allow them to walk to the clinic."

"I don't know what's going on so I should have a medical person evaluate before making a decision."

"Holy shit, I need an ambulance now! (on the more none obvious examples)

Their fear is that, and it's valid as the Papuans fake severe illness commonly, is that they will activate an emergency only to find that there was nothing significantly wrong with the person, therefor getting in trouble for an unnecessary activation. They have dragged fully unresponsive patients into the clinic to avoid this.

I know it's not an easy problem...I'm grateful for your help!!

[DFIB]

I know that training indigenous locals can be a real challenge but if you give them a check off list of things to look for, you will probably have to ride their butts to get them to comply, they can begin to follow it. They will start with the one that they can relate to. If one has a family member with a stroke he will be interested in the Cincinatti, or once they figure out how pupils contract and that thy should be equal they will be proud of their new knowledge and begin to use it. They will screw up a lot and default to the "I don't want to be bothered with calling" attitude. You can slowly begin to introduce some change to them.

Something as simple as them recognizing that a patient can't remember their name could make a huge difference.

Let us know how it goes for you. I wish you success.

[Bieber]

-Chest Pain - Give 4 baby aspirin if available and get an ambulance.

-Difficulty Breathing - Help with inhaler if person has one and get an ambulance.

-Severe Stomach Pain/Vomiting Blood/Black Stool - Give nothing by mouth and get an ambulance.

-Acting Strange/Not Themself - Get an ambulance.

-Not Awake - Roll person onto their left side and get an ambulance.

-Paralyzed on one side of their body - Get an ambulance.

-Severe Bleeding - Stop the bleeding with pressure over the wound.

-Broken Bone - Help the person get comfortable, get an ambulance.

-Not Breathing - Start chest compressions, get an ambulance.

Something like that, maybe, Dwayne?

Edited July 28, 2012 by Bieber

[tcripp]

Sounds like you are looking at a simplified START? That may be the best that you can do in such a short time and I feel for you.

I do like the one suggestion of, can they simply call you (or the medic on duty) to clarify. That way, someone can make an informed decision.

[rock_shoes]

Sounds like you are looking at a simplified START? That may be the best that you can do in such a short time and I feel for you.

I do like the one suggestion of, can they simply call you (or the medic on duty) to clarify. That way, someone can make an informed decision.

I would imagine you have someone able to translate available in the clinic. Does that make the suggestion more viable?

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