Don’t Get Distracted
When working on a scene, especially one with a larger patient count, one must be conscious of developing tunnel vision. Its very easy to get centered in on one patient for one reason or another. In my experience, there seem to be a few reasons for this:
1. The patient is another provider – When one of our own gets hurt, we tend to want to do everything we can for them, right then and there. Most Incident Command structures account for this: Get them off the scene. When they are out of the picture, it’s easier to move on and work on whomever else is injured.
2. Kids – Everyone’s pulse goes a little faster when there are children involved. Bystanders will bring them to you, and lesser trained individuals will not be able to leave their side. We need to work with those around us to make sure the lesser injured children are taken care of while we care for and triage those who could be more seriously injured.
3. Cardiac Arrest – When someone is pulseless, there is a desire to do whatever we can for them. One of the hardest things you’ll ever be faced with in your career will be to look at a patient at the scene of a major incident and say “no, stop. There are other people here who need us.” Keep a cool head, stay calm, and remember, you need to do the best you can for everyone at the scene.
4. Distracting Injuries – Finally, the one we are going to talk about more in depth this week is those patients who have Distracting Injuries. You know what I am talking about; those angulated fractures, those more grotesque injuries that make you stop in your tracks and stare. Just because it doesn’t look pretty though doesn’t mean it needs to be off the scene immediately.
As we move through a scene and triage patients, tag or not, think about what you need to look at. Think, for example, about the scene of a 2 car MVA with three or more patients. Sitting on one side of the scene is a patient with a compound fracture of their radius and ulna. It doesn’t look pretty. Bleeding is controlled. Its being splinted, but because of its appearance, it is going to attract attention.
Sitting next to them is the pale, shivering, diaphoretic patient clutching their belly. It’s Summertime, and there is no reason why they should act like they are this cold. What would you do? Would you concern yourself with that open fracture? Or would you stop in your tracks, recognize the signs and symptoms of shock in this less vocal, lower profile patient, and take the time to assess their abdomen?
When triaging patients or running a scene as EMS Command, we need to remember that not all of the decisions we make will be the most popular ones. Those around us might not like the order in which we transport patients off the scene, and might not think everyone is getting the care that they should. Just remember your training, know that you’re doing the right thing, and ultimately provide the best care possible for your patients.
Follow those simple rules and everything will go as smooth as possible.