EMS World

OCT 2015

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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PATIENT COMMUNICATION not just with our ears but with our eyes, too. Every expression, every gesture, every move- ment can be part of the information we're looking for. This isn't the time to be thinking about our next call or our next meal. Is the patient sick, scared or in pain? Are they hiding something? The answer to all of those questions is probably yes, but watch for the ways questions are answered. A sub- ject's words plus tone plus body language equals a whole lot of feedback. Some crews double- or even triple-team patient interviews. That just makes it harder for interviewers to progress in an orderly way from the general to the specific and ramps up the intimidation factor for the subject. The most challenging of all interviewing skills is absorbing verbal and nonverbal cues while formulating new questions—open- ended, whenever possible—based on pre- vious answers. It's easy to let experience or fatigue overwhelm high-frequency listening and make us resort to a mental script of practiced questions, but it's the ability to vector toward unanticipated, possibly valu- able information that earns an interviewer exceptional results. Now that we've covered all-purpose patient interviewing techniques, it's time to discuss the differences between emergent and nonemergent patients. The Emergent Patient Setting aside scene safety for the moment, if recognizing how urgently a patient needs care is the first step of a "doorway assess- ment," the second step would arguably be deciding how effectively we can deal with serious illness outside of a hospital. Except for when we encounter a clear case of treat right now, such as cardiac arrest or profound hypoglycemia, we need to concede that we have neither the tools nor the train - ing to consistently diagnose and treat ill- nesses correctly, and that hospitals are good places to get help. Once we buy into that, our efforts on scene should be focused on initiating transport, which means the clock is ticking as soon as we start our patient interview. When I was in EMT class I learned to use the mnemonic SAMPLE as a guide for that interview. That isn't always the best approach. Not only are A (allergies), M (meds), L (last meal) and E (precipitating events) often not as important as other questions during our first 60 seconds with a patient but, as EMS educator Dan Limmer points out, SAMPLE is too much of a rote process that doesn't encourage vectoring toward a chief complaint's likely cause. With experience, many field providers employ a two-step emergent patient inter- 30 OCTOBER 2015 | EMSWORLD.com For More Information Circle 25 on Reader Service Card DON'T HESITATE TO CLARIFY ANSWERS TO YOUR QUESTIONS.

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