Your ambulance is dispatched to a scene for a complaint of seizure activity. You are arrive on scene to find a young male in his 20′s shaking violently on the floor. Your initial reaction is to protect his head and place him on high flow oxygen. You instruct your partner to place him on the ECG monitor and get your narcotics. Your just about ready to start your IV when you glance at the ECG and see a rate of 60 beats per minute. “Wait a minute, 60?”.  You then tug at his arm and pull it towards you with little effort. He then pulls it back with a few second delay. Having a pretty good idea of what’s going on, you stand back and say out loud “well I can’t find a vein, looks like we have to give rectal valium!” Suddenly his “seizure” stops and he immediately starts talking.

Obviously the patient above was not having seizure. Luckily you were able to figure this out. Had you have just assumed he really was seizing, you would have administered a controlled substance for no reason. Sometimes knowing when a life-threatening illness is not present, is just as important as knowing when one is.

Emt and paramedic school is great at telling you what to do when a patient complains of chest pain or has a seizure. Unfortunately, nobody really tells you the reality of treating patients in a pre-hospital setting. The fact is, people lie. People want drugs and people want attention. I really think that we need some some emphysis on teaching paramedics to detect when someone is “faking”.

In my opinion, part of doing a thourough assessment is determing whether or not the patient’s complaint is ligitiment. I wouldn’t give atropine to a patient in SVT, and I wouldn’t give nitroglycerine to a patient that was hypotensive. So why would I want to give valium to someone that wasn’t having a seizure?

Any seasoned emt or paramedic knows when a complaint is real or not. But this comes from experience in the field, not from training. At some point, we all had to learn our lesson from the one guy that fooled us. Why can’t this be taught as part of our detailed assessments?

I really think that we need to start training our paramedics the reality of working in the field. We need to promote having an open mind and realizing that things aren’t always as they seem.