May 23, 2013

Kids and needle-sticks

Working in a children’s hospital has certainly given me a new perspective on many aspects of pediatric care, both in the emergency and non-urgent settings. One of the biggest changes to my approach with kids is pain management, but not quite in the way that you might be thinking.

A good majority of the patients that walk through our doors are going to get some form of needle-stick, and no matter what, they aren’t going to like it. This can be one of the biggest challenges for us being that kids typically don’t tolerate pain as well as adults. Throw bad parenting into the mix and the problem only multiplies.

For the longest time, my solution to “sticking” pediatric patients was some form of restraint. Sometimes “burrito rolling” the kids in a blanket worked, other times the swat-team probably wouldn’t have been sufficient to keep them still long enough to start an IV. This all changed when I started my training in the ER.

There are 3 steps that we take to perform needle-sticks without our kids putting up a fight:

  1. Explanation.
  2. Distraction.
  3. Pain Management.

Explanation

Before we do anything, we talk to the kids and tell them exactly what we are going to be doing in terms that can understand. The big key here is talking to them and the parents using the same words. If you talk to the kids using “kid-friendly” words, and then turn to the parents and re-explain what you just said using medical terms, the kids will view that as “code-talk” and you will lose their trust.

The other big trick is avoid words like “needle” or “poke”. Using less-threatening words will keep the anxiety level down and will help you get through the procedure without having to fight with them.

Here are some ideas for words that you can use to explain what you are about to do without scaring your patient:

  • Straw = IV (Show them the catheter – minus the needle – and explain that it goes in their vein so you can give medicine to make them feel better.)
  • Rubber band = Tourniquet (Tell you need to put a rubber band on their arm to see how big their muscles are.)
  • Soap = Alcohol Swab (Explain that you need to use some soap to clean their skin “real good”)

Unless you have a form of pain management for invasive procedures like cold-spray or buffered-Lidocaine, you will have to explain that it’s going to hurt. The element of surprise isn’t going to do you any good in this situation. They will pull their arm away and immediately start to fight if you surprise them with a needle-stick. Try asking them if they have ever had anyone pinch them before, and explain that what you are going to do might “pinch for a little bit”. This may sound crazy, but I have personally found that making them promise that they will “let you know if it hurts”, has worked wonders.

A big part of this is also making sure you don’t attempt a needle-stick unless you are certain that you have an acceptable vein. You want to be done with the procedure as fast as you possibly can.

Distraction

This is one of those things that works great, but nobody really thinks to do. Kids have the ability to build up high amounts of anxiety and stress, but they are also easily distracted. Carrying a few tools in your bag to grab their attention can pay off when it comes time to gain IV access on a sick kid.

This can be something like a game on your phone, a book, a toy, or some kind of activity for them to do while you do the dirty work. Obviously, having a second set of hands present will help with this step, but it’s not impossible to do by yourself.

One of my favorites is the i-spy books. They are big, which makes blocking the view of what you are doing easy. They require all of their attention as they have to find small objects on a big piece of paper, and best of all, they are cheap. If you have a second person available, have them hold the book up and search for the objects with them. If not, try propping it up or have them hold it with their “good arm”. You can always tell them to look for a specific object before you start the procedure.

If you are a high-tech, geeky, kinda medic like I am, then you can always get out your tablet, smart-phone, etc and let them play a game or watch a video. Of course, do this at your own risk. All of my devices have protective cases to help prevent damage from dropping.

Pain Management

This is one of those things that you may or may not have available at your service or hospital. I was recently introduced to the wonder of buffered-Lidocaine, and I’m not sure how I ever got by without it before.

I kid you not, using buffered-lidocaine through a J-Tip injector will eliminate any pain that would they would normally experience with a needle-stick. The J-Tip is a neat little device that forces the medication inside the syringe (in our case, Lidocaine) into the subcutaneous tissue around the vein by using a c02 cartridge. I have had it done to me, and I can honestly say that I didn’t feel a thing. The Lidocaine numbs the area good enough that the patients don’t even feel the needle-stick. I usually tell the kids that I’m going to give them “magic medicine” so they wont hurt.

The video below demonstrates the J-Tip injector. It’s pretty dry and boring, but if you fast-forward towards the end, you can actually see it being used on someone’s hand.


Download | YouTube MP3 Converter

Chances are, you probably don’t have this available, but there are other options out there like cold-spray or topical anesthetics. If you don’t have access to any of these options, just remember to follow the first 2 steps. You will find that your pediatric patients will be much more cooperative and will be much easier to manage during your course of treatment.

If you have any methods to needle-sticks in pediatrics, please feel free to share below.

Conclusion: 23-year-old with chest pain

I received some really good responses both on this blog and on Twitter / Facebook. This call wasn’t as simple as treating any other cardiac arrhythmia as it was being caused by a mechanical failure of an implanted device that we had no control over. As it turned out, one of the leads had come loose and was rubbing against the heart. This was causing large amounts of artifact that was being interpreted by the defibrillator as v-fib.

As mentioned in the scenario, the patient had no device to disable her defibrillator, but she did have a card with a phone number to the manufacture. After making base contact, the manufacturer was contacted and they sent a field representative to the hospital to disable the device.

Treatment for this patient was tricky as the defibrillator was the root of the problem. After the defibrillator shocked the patient for the 3rd time, the patient’s rhythm converted to v-tac. The defibrillator recognized this and shocked her again and converted her back to sinus rhythm. Shortly after that, it shocked her again while she was in a sinus rhythm. That once again converted her back to v-tach only to be shocked again by the defibrillator. This cycle continued during a 12 minute transport and shocked the patient for a total of 9 times.

Luckily the patient never went into cardiac arrest. Lidocaine was administered to this patient while en route to the ER to help suppress the multiple episodes of v-tach. After the medication was administered, no further episodes of v-tach occurred, however the patient was shocked 1 more time by her internal defibrillator. The representative from the manufacturer arrived at the ER and was able to disable the defibrillator remotely from a computer. An ECG log was pulled up and revealed the artifact that caused the device to shock the patient.

The patient had congenital heart defects since birth and had the pacemaker / defibrillator in place for several years prior to this incident. This was truly one of those times where the best thing you could do was just get to the hospital.

If anyone else has any similar stories, I would love to hear them!

Case Review: 23-year-old with chest pain

Here’s an interesting case to wrap your head around:

EMS is dispatched to a residence code-3 for chest pain. On arrival, the crew finds a distraught young man waving them inside the residence. He stated that he and his 23-year-old girlfriend were arguing when she suddenly started to complain of severe chest pain. The girlfriend is in the fetal position on the ground crying and grabbing her chest. It is difficult to obtain any information out of her as she is hysterical and won’t answer any questions. The paramedic on the ambulance kneels down to try and calm the patient and get her to talk, while the EMT partner questions the boyfriend.

The patient starts to calm down and tells the paramedic that her chest hurts and is interrupted by the EMT who yells from across the room that the patient has an internal defibrillator. The paramedic turns to his partner who explains that the boyfriend just said that the patient was grabbing her chest saying that her defibrillator shocked her. The patient tells the paramedic that her defibrillator shocked her “a bunch of times”. He instructs his partner to place her on oxygen while he places her on the ECG monitor. Before he can get all of the leads on her, she screams in pain and says “it shocked me again”.

The ECG monitor is applied and shows sinus tachycardia a rate of 112. The crew places her on the gurney and obtains a quick set of vitals. NIBP = 142/72, Sp02 = 99%, HR = 112. Just as the crew prepares to leave the house, her internal defibrillator shocks her again while the paramedic was watching the monitor. The paramedic now suspects that the defibrillator is malfunctioning as she still had a narrow complex rhythm when it shocked her. He asks her if she has a magnetic device to disable the defibrillator. She states that she lost it a long time ago.

The crew loads the patient into the ambulance and begins towards the nearest cardiac facility code-3. While en route, the defibrillator shocks the patient again, only now the patient’s rhythm converts to ventricular tachycardia.

Have you ever run into a scenario like this? What would you do for this patient?

Stay tuned for a follow up post.

Passing the NREMT CBT Exam

I recently had to take the NREMT CBT Exam as it was part of the reciprocity process for Texas. Unfortunately, I let my national registry go a couple years back as my schedule and budget didn’t really make going to a week-long, out-of-town refresher course practical. Of course I regret that decision, but life goes on.

As you might have guessed by now, I haven’t posted much on the blog because I have been spending most of my free time studying. As it turns out, that studying paid off, because I passed the test without much difficulty. It was actually a nice experience as I really had nothing at stake going into the test. I already have my paramedic license, so I was able to sit down and take the test with little-to-no stress. 83 questions and a day later and my results were already on the website. Overall, I thought the process of actually getting registered and taking the test was rather painless, which was a nice change from when I took my initial registry exam.

I used a couple tools to aid in my studying, which I believe made the preparation much easier and I figured I would share my experiences with everyone in case there is anyone out there getting ready to do the same thing.

The first thing I did was buy the Barron’s Paramedic Exam (Third Edition) NREMT study guide and start going over test questions when I had free time. The book consists of tests from 6 different categories, (Airway / Breathing, Cardiology, Medical Emergencies, OB Gyn / Peds, Trauma and Operations) plus 3 120-question practice tests (1 in the book, 2 on the CD). As I was taking the tests, I would write down any topics I came across that I needed to study. I would also write down any questions that I got wrong, so I could further study the subject. I chose this method because it worked well for me when I was studying for my initial certification exam.

Once I finished the chapters, I started using my resources to study the subjects that I needed to refresh on. I waited to take the 3 practice exams until after reviewing all of the material. My paramedic book was fairly outdated, but it was still handy for the anatomy and physiology related topics. The 2 resources I used the most were Wikipedia and Medscape. This was really handy as I could just carry around my notepad and my Android phone anywhere I went and knock out some studying when I had some free time.

Once I felt that I had studied the topics I had written down, I went back and started taking the practice tests. I scored an average of 93% between the 3 of them, so I felt that I was ready to take the NREMT exam. The test itself closely resembled the practice exams that I had taken, so it seemed that my purchase was well worth the money. The CBT exam was definitely different from the written version, but in a good way. I noticed that it started out with really easy questions and it quickly became more difficult. After reading up on the CBT tests later, I learned that one the test establishes that you are competent in a certain area, it quits asking you those questions and moves on to other areas. While I don’t believe the CBT version is “easier”, it is definitely a better way to determine whether or not someone has the core knowledge necessary to work as a paramedic.

I’m certainly happy that I didn’t have to re-take the exam and fork out another $100. And if I play my cards right, I’ll never have to take that test again.

A Guide to Radio Reports

Radio reports or “call ins” can be a bit of an art. Finding that happy-medium between too much and too little information can be difficult. People starting out in EMS often have trouble adapting to formal lines of communication like radio systems as getting the most information out with the least amount of words is an acquired skill. If you have never worked in a setting that utilizes formal radio traffic then naturally, you want to speak just like you would in any other conversation. But in the name of formality and time savings, you have to learn to kick proper English to the curb. In this article, I will go over some tricks that I have learned over my years in EMS and hopefully break the barrier that many of us have when it comes to giving reports over the air.

Time

Different systems may require different amounts of information, but the expectation that your report will be short and thorough typically remains the same. A good rule of thumb for a desired length is less than 30 seconds. If done correctly, that should be ample time to deliver a good report.

Minimizing the amount of time your report takes helps to ensure that you aren’t tying up the base-station radio for other crews that may need orders or have a critical patient to call in. It also frees up time for patient care and you don’t lose the attention of the staff on the radio. As silly as it may seem, try practicing reports with a timer. You will find that it doesn’t take long to improve your technique and shorten your reports.

Content

You are the eyes and ears of the ER staff until you arrive at the hospital, so it is your job to paint the best picture you can of the patient’s current condition. Now this doesn’t mean that you have to tell a long winded story of what led up to this event. All that does is lose the attention of the ER staff. Remember, all of that information can be relayed once you arrive at the hospital. The staff is pretty much looking to either give orders or assign a priority to your patient, so you really only need to give them the information necessary to achieve those tasks.

Here is a list of essential information that should be included in your report:

  • Age
  • Sex
  • GCS
  • Chief Complaint
  • Pertinent Positives or Negatives
    -Example: Shortness of breath associated with chest pain.
  • OPQRST (if applicable)
    -Example: This can be used to clearly paint a picture of chest pain being cardiac vs non-cardiac, or to paint the picture of a patient with abdominal pain having probable appendicitis.
  • Vital signs (including skin color and lung sounds)
  • History, Allergies or Medications (if pertinent to the chief complaint)
  • Any treatment or interventions along with response.
  • Any other information that may help paint a clear picture of the patient’s condition.

There are always exceptions to these guidelines. You may be required to provide certain information in order to activate a STEMI, Trauma Code, or Stroke protocol. I typically prefer to add this information to the end of my report under “other information”. Do what works best for you.

Gathering Information

In order to provide an adequate amount of information, you must first gather that information. In order to do this, I find it best to maintain an organized system of writing down information that I will use during my call-ins. Some people write on their gloves, some people carry a notepad and some people are talented enough to go completely off memory.

When you are going through your questioning, assessment, etc, try writing down your findings in the order that you give your radio report. For example, if you are writing on a notepad, write the age, sex, GCS on the top line, the chief complaint on the second line and so-forth. This way you can essentially read right off your notepad from top to bottom when you do your call-in. This helps to avoid long pauses, repeating yourself or leaving out information.

To help facilitate gathering information in an organized fashion, I created a simple document that you can print on any 3×5 card. I typically clip a bunch of these together and carry them in my shirt pocket. When I call in my reports, I read from left to right, top to bottom. This way my reports are consistent and I minimize the chance of leaving anything out.

Below is a blank view of my 3×5 report card:

When I use this format, I fill in all of the pertinent information prior to making my call-in. Any information that I don’t plan to pass along over the radio is skipped over. For example; A patient complaining of chest pain would most likely require every field to be completed while a complaint of general weakness would not require the OPQRST.

The medical history, allergies and current medications are generally skipped over during the call-in, but written down to reference for documentation and the formal report given at the bedside.

The “TX/Other” section is utilized for treatment, response to treatment, mechanism of injury (for trauma calls) and anything else that might be needed to paint a clear picture.

This card is available for free download on this site.

Calling in the Report:

This is the part that requires some time and repetition to get right. This is where you need to learn to minimize the amount of words that you use in an effort to keep your report brief and formal. Remember, it should only take 30 seconds or less to deliver a brief but thorough report.

When reporting a chief complaint, stick to only the necessary information. Rambling on about things like the patient’s last doctors visit will eat up that 30 seconds and lose the attention of the staff on the other end of the radio. Here is an common example of “rambling” on the chief complaint:

County Hospital, Medic 325, Paramedic Eddy en route to your facility with a 57 year-old male with a GCS of 15. The patient states that he started complaining of chest pain this afternoon. He also states that he is short of breath and nauseous. He was seen at Dr. Smith’s office today and is now being transported at the request of the physician to rule out a possible MI.

In the above example, I told the hospital that the patient is being transported from a physician’s office with a complaint of chest pain with associated shortness of breath and nausea. While this does help to paint the picture of a cardiac event, it can be done in much less time with fewer words. The following example delivers the same message with less than half of the words:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI.

On a chest pain call like this, it would be wise to include the OPQRST, as that information can be useful to the base facility to differentiate between cardiac and non-cardiac chest pain. Here is an example of how you can deliver that information in a brief and effective manner:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI. Patient’s pain is with a gradual onset, non-provoked, dull in nature, non-radiating, 7/10, times 2 hours.

In the above example, we have told the base hospital everything they need to know about the chief complaint and we can now move on to the vital signs. Any other information in regards to the complaint itself can be relayed once we arrive at the hospital. At this point we are about half way done with our report and have probably only taken up about 10-13 seconds. All that’s left to cover is the vital signs, treatment and ETA. Here is an example of the complete report:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI. Patient’s pain is with a gradual onset, non-provoked, dull in nature, non-radiating, 7/10, times 2 hours. Blood Pressure is 146/82 with a strong radial pulse of 90, non-labored respirations of 16, sating 98% on 2 liters, and sinus on the monitor with no ectopy. Skins signs pink, warm and dry, lung sounds clear. History, allergies and meds on arrival. Pt has received 1 aspirin and 2 nitros with no relief. IV is established and our ETA is 10 minutes. Any questions or orders?

This example is actually on the longer end of the spectrum as far as radio reports go. For calls that don’t involve pain, you can skip past the OPQRST and probably come in around 20 seconds for the entire report. Chest pain, vehicle collisions, and others that require special protocols (STEMI, Stroke) are going to be the longer reports, while most other medical complaints will be rather short.

When it comes to radio reports just remember; short, sweet and to the point.

Examples:

Here are a few examples of some radio reports for different types of calls:

Trauma

County Hospital, Medic 325, Paramedic Eddy en route with a 25 year-old male involved in a 2 vehicle collision. Pt was a restrained driver of a small-sized sedan traveling approximately 30mph when striking another vehicle from behind. No LOC, passenger space intrusion, or airbag deployment noted. Pt complains of lower back pain with no obvious deformities. Blood pressure is 126/74 with a strong radial pulse of 80 and non-labored respirations of 18. Skin signs pink, warm and dry. Lung sounds clear. History, allergies, meds on arrival. Pt is in c-spine and we are utilizing BLS interventions only. ETA is 5 minutes. Any questions or orders?

-Note: Trauma is the only time that I skip straight to MOI prior to the chief complaint. I know of several paramedics that prefer to leave it at the end. Do what works best for you.

Respiratory

County hospital, Medic 325, Paramedic Eddy en route with a 36 year-old female GCS of 15 complaining of difficulty breathing x 2 hours. Pt presents with labored respirations, retractions and speaks in 1-2 word sentences. Blood pressure is 146/82 with a strong radial pulse of 120, labored respirations of 26, sating 93% on 15 liters and is sinus tach on the monitor. Skin signs pink, warm and dry. Lung sounds reveal wheezing in all fields. History of Asthma, further history, allergies and meds on arrival. Pt has significant breathing improvement post 2 Albuterol treatments and .3mg sub-q Epi. IV is established and our ETA is 8 minutes. Any questions or orders?

Cardiac Arrest

County hospital, Medic 325, Paramedic Eddy en route with a 58 year old male GCS of 3. Pt found pulseless and apenic, downtime of approximately 5 minutes prior to EMS arrival. Pt has sustained asystole post 3 rounds of Epi and Atropine. Pt is intubated and an IV is established. Continuing ACLS protocol en route. ETA is 10 minutes. Any questions or orders?

-Note: The hospital will be busy getting a bed ready for your arrival. The faster you get the report done, the faster you can get back to working and the hospital can start working.

Conclusion

These guidelines have worked well for me during my career as a paramedic. These guidelines are meant to be flexible and should work on pretty much any type of call. If you have a format that works well for you, I would love to hear from you and try it out.

Feel free to e-mail me with any questions, comments or suggestions.

A not-so-painful pain scale

Is it just me, or does anyone else think the “1-10″ pain scale is just short of being completely worthless? I find it really hard to document that a patient scores a 10 out10 on the pain scale when they are falling asleep during the transport. I guess it doesn’t really matter because it doesn’t typically alter or dictate our treatment, but there has got to be a better way.

On a side note, the chart with the faces could be used to evaluate the amount of years someone has been working in EMS…..

I have been doing some thinking on this subject and I think that a more objective scale based on the patient’s clinical presentation would be a better way to assess their pain level. The current scale is way to subjective and rarely results in anything less than 10. I just find it hard to believe that this is the worst pain someone has ever felt when they shout even louder from a poke on their finger to check a blood glucose.

Perhaps such a scale already exists and I’m trying to invent the wheel here, but I have yet to find anything. So I figured a point scale similar  to our GCS scale would be better. Here are some areas that I think we could evaluate to come up with a score:

  • Respirations
  • Pulse rate
  • Guarding
  • Agitation
  • Facial expressions (closing eyes, gritting teeth)

If anyone has suggestions or experience using another method to evaluate pain, I would love to hear from you.

Using Google “My Maps” to learn a response area

I recently started using Google Maps to assist in training new paramedics that come to work at my place of employment. Several of these people come from different cities, and in some cases different states. Either way, learning a large metropolitan area in a matter of weeks can be a challenge.

I like the fact that Google Maps is typically up-to-date and can be easily used on smart-phones both as a standard map and as a navigation tool. I have been able to show my trainees post locations, hospitals, frequent call locations and fueling locations both on my laptop and my Android phone. The best part is being able to share the map with them and allow them to use their own computers and phones to access the maps as well. So far this has proven itself to be extremely useful, so I figured I would share it with everyone.

Below is a video demonstration that I made to show everyone how easy it is to use Google Maps to orient either yourself or a trainee to a response area.


Download | YouTube MP3 Converter

Continuing education doesn't stop at the classroom

As EMS professionals, we have a problem. The problem doesn’t apply to everyone, but it’s definitely a problem. So many of us are perfectly content with obtaining the minimum required continuing education units to maintain our license. Sure, we may run our calls, treat our patients, follow our protocols and never get in trouble, but that doesn’t make someone a good practitioner. The medical field is evolving every day. New diseases are found, new medications are released and studies are done on a regular basis. There is so much information out there for us, and it’s absolutely foolish of us not to take advantage of it.

When I bring this topic up amongst my co-workers, I am often asked how any of this affects our treatment. While it is true that we are bound by protocols, that doesn’t mean that it isn’t beneficial to have a better understanding of what your patient is going through. Knowing that someone experiences severe pain on a regular basis could certainly affect the way you treat them. Knowing that the new blood pressure medication they take can have negative affects if combined with an antibiotic wouldn’t hurt either.

Classes are great, but the bulk of the information is lost halfway through your drive home if your only taking the class to get a certificate. We need to approach education with a different mindset. Instead of wondering how long it’s going to take, ask yourself what information you can take away from the experience. If the class doesn’t interest you, then find something that does. Perhaps your a cardiology genius. Well then take a class on pediatric emergencies. Given the right mindset, you will find that 48 hours worth of education in a 2 year period is hardly adequate to stay on top of your game.

There are plenty of little things that you can do to educate yourself and build your knowledge-base. Every time you transport a patient who has a disease or takes a medication that you have never heard of, take some time to research it and learn about it. This can take as little as 5 minutes and the information can be useful for the rest of your career. Keep a small notebook in your bag and write this stuff down for future reference. Other simple things you can do is try following up with the ER docs or attending nurses to see what kind of diagnosis they gave your patients. You might be surprised at what you can learn. Going to base-station meetings is priceless. This is the golden opportunity for you to meet with ER doctors and actually receive valuable feedback. Not to mention the benefit of maintaining a close relationship with the hospital staff.

There are plenty of free on-line resources that can be of huge benefit to EMS providers. Reading medical and EMS news articles helps to stay up to date with current events and evolving technology. Reading studies or participating in discussions also has great benefits. If you are looking to learn some valuable information and gain CE hours for free, check out FEMAs website for their on-line NIMMS courses (more on that later) or WebMDs free CE courses.

As you have probably heard before, the brain is a muscle. If you don’t use it, you lose it. Don’t be complacent and get by with the minimum. You owe it to yourself, the patients and the profession.

Irrigation Made Easy

I learned this little trick from my EMT preceptor back in the day and I thought I would share it with everyone. While running a call for a female that had a chemical intentionally poured on her face, my preceptor noticed that I was essentially tied up pouring water to irrigate her eyes. I was making a huge mess and it was difficult to break away to do things like take vitals or make a radio report. That is when he introduced me to this trick.

The Supplies:

You will need a few items to do this skill effectively. They include:

  • Saline bag – preferably 1,000ml.
  • 10gtt IV tubing (60gtt could work but would take much longer).
  • Adult nasal cannula.

The Setup:

Attach your IV tubing the saline bag and flush the line. Then cut off a portion of the nasal cannula hose above the connector. The end of the cut-off oxygen tubing should fit right over the IV connector on the 10gtt line. Now place the cannula over the patient’s head with the prongs over the bridge of the nose, facing directly into the eyes. Now open the IV line slowly and instruct the patient to constantly blink while the fluid flushes their eyes.

-TIP: Try cutting the oxygen tubing as close to the split as possible to cut back on the overall length of the tubing. This will help prevent snags and knots.

The diagram below not only shows the setup, but also makes it clear why I didn’t chose a career path in art.

And that’s it! You now are effectively irrigating the patient’s eyes and you have your hands free to do other aspects of patient care. If you have tried this or have any other tips or tricks, please feel free to e-mail me or comment below.

Disclaimer:

Please, always follow your local protocols. Make sure that you know what chemical or substance is in the eyes and that flushing the eyes is the appropriate to take. When it doubt, contact medical control.

Concealed Weapons and Trauma Care

Yesterday I made a post about my first few days carrying a concealed weapon. I received a lot of feedback including a request from Jeff – a fellow blog reader. He wanted to know how the average CCW holder could care for a patient suffering from a gunshot wound and what kind of supplies I would pack into a “gunshot wound kit”.

So to answer Jeff’s question, I would start off by saying that a standard first aid kit with 4×4 pads, gauze wraps, and perhaps a face shield would be sufficient in providing 1st line trauma care.  Besides, anything done beyond basic first aid would require that you be working under a medical license.

When it comes to packing a kit for treating penetrating trauma such as a gunshot wound, I would say the less the better. A big and bulky bag would be troublesome. The average CCW holder would probably be reluctant to bring it around with them.

Treatment

Trauma care for the CCW holder is quite simple and doesn’t extend beyond basic first aid. Keep in mind that 80% of all people shot with handguns survive. So chances are, if you shoot someone, they will probably be alive at least until the ambulance arrives.

People who are fatally shot typically die from injuries like blood loss caused from a severed artery or vital organ. People can also die from a tension pneumothorax (collapsed lung), spinal cord injury, or severe brain damage. As a layperson, you can’t be expected to know which one the person is suffering from. All you need to do is look for the life threatening injuries and treat appropriately.

Here are some steps to consider when treating someone suffering from a gunshot wound:

  • Make sure that the threat no longer exists. Don’t assume that just because you are now trying to help them that they wont try and attack again. Move any and all weapons out of their reach.
  • You should have already called 911 at this point. If you haven’t, do so now. From a legal standpoint, it’s best that you do it.
  • If the person was shot in the head, neck, or torso then have someone hold their head to make sure that they don’t move their spine. This will help to prevent injury to the spine or make an existing injury worse. This person should do this until EMS arrives on scene.
  • Assess for breathing and circulation. Look at the chest for movement and listen to the airway for breaths. If they aren’t breathing than you can initiate “rescue breathing” by using a face mask from your first aid kit. Make sure you pinch the nose and make a good seal around the mouth.
  • If no pulse or signs of circulation are present, then you can initiate CPR. But keep in mind, if the person has been shot several times, they may already be dead. I don’t expect you to leave them but don’t expect positive results.
  • You can dress bullet wounds with 4×4 gauze and direct pressure. Wounds to the extremities can be wrapped with gauze wrap to help maintain pressure on the wound.
  • Bullet wounds to the chest should be dressed with either a petroleum gauze or a piece of plastic such as a cut off piece from a chip bag. This will stop outside air from entering the chest cavity and therefore help to prevent a collapsed lung.
  • Unless the person is in immediate danger, leave them in place. Moving them could result in further injury like paralysis.

In order to confidently and effectively provide care to a person suffering from a gunshot wound, you need to have some training in first aid. There is just simply no way that this post could replace any formal training.

Another good resource for gunshot wound care can be found here: http://firstaid.about.com/od/softtissueinjuries/ht/07_gunshots.htm

Always keep your safety as the #1 priority. Remember, if the person tried to harm you to begin with, they probably wound’t hesitate to try and finish the job. As I have said before, the best concealed carry tactic is to never have to use the weapon. Be safe out there!