I worked my first domestic earlier today. It was grim.

I think I did a good job, all in all, but I did miss an injury during my initial exam. They say that distracting pain or emotional distress can mask pain from other injuries… Imagine my surprise to find a probable fracture of the forearm after being on scene for forty-five minutes. In my defense, I arrived at the same time as the cops, the subject was up and alert, and neither the subject nor the cops felt I was a priority at first. I finally insisted on doing a cursory exam after the subject stated that they had been dragged and run over by a car; I found a (probably minor) head injury that the subject hadn’t mentioned at first at that time when I palpated the skull, also some lower back pain, but I really still did a cursory exam at that time.

Heh, that’s right; I told the cops what I was going to do on their scene, and they deferred to me.

Heady stuff.

Anyway, if your arm was broken, would you be waving it around? Wouldn’t you say something about it? I guess not if you didn’t notice.

It wasn’t until we managed to talk the patient into going to the hospital (increasing back pain helped convince them) and had the subject on the backboard that they complained of pain when someone grabbed their arm.

Here’s what I did right; provided good psychological first aid and emotional support, acted as an effective advocate for the patient (including suggesting and managing changing the patient into dry clothes before transport), effectively directed care even with an intermediate on scene, even in the ambulance, until the ambulance left, forged a relationship with the family dog such that he followed my instructions (woof!), avoided getting in the way of the law enforcement process, talked the resistant patient into going to the hospital. Here’s what I blew; the head-to-toe exam.

There’s actually a ‘PFA’ box on the state EMT call sheet/run form/patient care record to check for psychological first aid. I laughed the first time I was told what PFA stood for; in actuality, it’s a huge part of what we do.

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