STS: Scenario Basics & Run Reports September 14, 2016

How We Run Scenarios Lead EMT Introduces self and partner to patient Does talking portion (SAMPLE, OPQRST) Can assist with treatment after finishing talking portion Treatment EMT Treats patient Holds C-Spine Vitals (BELLSRPP) Does rapid trauma assessment

Additional Questions USC ID/Driver’s License Did you fall or hit your head? Head/neck/back pain?

Neatness and clarity Legal document 4

Incident Information Record time using military time Explain AMA/refusal of treatment to pt and make sure they understand the potential consequences Must write in the narrative exactly what you advised the patient Refusal of treatment/AMA – tell EMTs to inform patient of what they would do/should do even though they are refusing treatment Example – Patient has laceration, EMSC recommends that you keep the wound clean and see a doctor to prevent infection or further damage to the area Patient was advised that refusing further care can result in their condition becoming worse and may result in further injury, illness or death. Patient was advised to seek medical attention and may contact a staff member at anytime while on campus to summon help. 5

ALWAYS OBTAIN AS MUCH INFO AS POSSIBLE Patient Information Always get pt ID (either USC ID or driver’s license) If pt does not have ID, ask for basic information If pt is altered, ask their friend or ask DPS ALWAYS OBTAIN AS MUCH INFO AS POSSIBLE 6

Comments Include all details and important pt/witness statements [age] Y/O M/F found [position] @ [location], A&Ox[n]. C/C [description/location] [+/-] head/neck/back pain. Hx: [contraindications/special considerations] Rx: [care provided, advice given] [vitals stable/reassessed?] Tx: by [company] to [destination] Include all details and important pt/witness statements Did patient fall or hit head? Head, neck, back pain? If pt has normal vitals: “vitals stable, except for _____” “vitals WNL, except for _____” 7

Vitals and Patient History Know your vitals and the normal ranges (BELLSRPP) Record the time every time you take a set of vitals Reassess vitals every 5 minutes Under notes: record O2 saturation; there is a space for everything else on the run sheet 8

Complaints (Medical & Trauma) Get familiar with where each of the conditions are located Most common: altered LOC, chest pain, nausea/vomiting, nosebleed, syncope, minor lac Check “No med. complaint” or “No apparent injuries” or cross out the box if not applicable

Physical & Refusal of Treatment Fill out the GCS for every pt Note the “ETOH Suspected” box in the right corner category If they refuse treatment, they MUST sign the run report

Trauma

Patient Transfer Remember to write the transport vehicle and unit # Double check transport decisions with Fire captains Since Fire is there, transport decision will likely be made for you but as EMSC takes on more responsibility, we’ll be making these calls so it’s imperative that you know the criteria for transport decisions 12

Run Report Cheat Sheet AVPU (circle one) O: Position found: P: ID: Q: A&O: Head/Neck/Back Pain: (+/-) C/C: S: A: M: P: L: E: O: P: Q: R: S: T: Transport Decision: Treatment: Misc: Supplies used: - Should be written on 4 separate pieces of paper BEFORE the shift even starts - Really important → makes EMTs less awkward in field since they have a script to follow - Helpful to list supplies used to ensure we keep the bags adequately stocked 13

Practice Scenario Dispatch: 21 y/o female, reported trip and fall at football tailgate in front of Tommy Trojan on Trousdale. Typical ETOH case: Dispatch: 21 y/o female, reported trip and fall at football tailgate in front of Tommy Trojan on Trousdale. - Pt lying on floor, dazed, and confused - Pt responds to verbal stimuli C/C: dizziness and nausea, right shoulder pain A&O 2 - Neg for HNB pain - Pt fell, but not sure if she hit her head (friend/witness says pt did NOT hit her head) A: latex & sulfa drugs M: none P: none L: no food, 4 beers + 3 shots in last 2 hours E: trying to climb up on tommy trojan for a picture when pt tripped and fell over the steps - Pt vomits in middle of scenario B: 114/72 E: PERRL L: clear S: flushed, warm, diaphoretic R: 14 breaths/min P: 96 beats/min, strong P: 98 Tx: C-spine precautions, left lateral, rapid trauma (tenderness/swelling in right shoulder), sling, ALS 14

Sample Narrative 21 y/o F found supine on Trousdale. A&Ox2. C/C: dizziness, nausea, and R shoulder pain. Pt tripped and fell; pt’s friend reported pt did not hit her head. - HNB pain. Originally took c-spine precautions. Hx: allergies to sulfa drugs and latex, no other pertinent history. Pt reports drinking 4 beers + 3 shots in last 2 hours, but hasn’t eaten. Pt vomited once during assessment; pt placed left lateral and applied suction. Rapid trauma showed tenderness/swelling in R shoulder. Rx: R arm sling, CMS checked before/after. All vitals WNL except skin flushed, warm, diaphoretic. Tx: by LAFD to hospital. AxO? First Fell but hit head” sooner