I was reviewing a set of case studies for a high-fidelity patient simulation program. The EMT scenarios were well-prepared and factual, and the signs and symptoms logically changed if the treatment progression was accurate.
Like many patient assessment drills or simulations, these were scenarios for infrequently encountered traumatic injuries. Tension pneumothorax, femur fracture and abdominal evisceration will probably be only a tiny fraction of the calls EMTs or paramedics run in their careers.
A large percentage of patients don’t easily conform to a National Registry skill sheet or instructor throwaway lines like “load and go” or “stay and play.” Consider adding these often-encountered patients to your class’s patient assessment drills or high-fidelity patient simulation to prepare your students for what they are more likely to encounter on the streets:
1. Elderly patient fell
Spouse is unable to lift the patient from the garage floor, and assistance is needed. The patient denies injury and refuses treatment. The spouse would like the patient transported. Practice the lift assist and injury assessment.
Teaching points: Discuss the conversation to encourage transport, but respect the wishes of the patient and the spouse, and document that transport was declined against medical advice.
2. Middle-aged patient reported as “intoxicated for days”
The patient is incontinent of urine, has not eaten for several days and is only aware of person and place. The Patient requests transport to the most distant receiving facility for alcohol abuse treatment. Practice assessment of incoherent and poor historians and identifying other possible causes of altered mental status.
Teaching points: Discuss the risks of transporting to the closest receiving facility versus the patient’s preferred hospital.
3. 911 misuse
An elderly patient frequently calls 911 because she is weak and “shaky.” Her vital signs are within normal limits, and she has no obvious injuries. During the history portion of the assessment, she begins to quietly cry and confides that she is “terribly lonely.”
Teaching points: Discuss alternative community and social services for this patient. Also, discuss soft-skills approaches to treating this patient’s emotional emergency and well-being.
4. EMS care for feeding tubes, in-dwelling catheters and tracheostomies
A caregiver reports that a feeding tube “has fallen out” of a patient who was paralyzed from a motorcycle accident. The patient needs transport to the physician’s office for tube replacement.
Teaching points: Discuss different types of permanent and semi-permanent tubes and catheters patients may have. Talk about the assessment of the patient as well as the tube placement location. Practice patient transfers from bed to cot or wheelchair to the cot to avoid displacing tubes and catheters.
How do you make your EMT and paramedic patient assessment scenarios and simulations real and reflective of actual calls students are likely to encounter?
This article, originally published September 20, 2012, has been updated
