Scene Signs: We Can Do More Than Just Respond to Emergencies

We could be doing a lot more for the public than just waiting for their medical emergencies to happen—and we should be.

Long before a kid sustains a head injury because he’s convinced he doesn’t need a bike helmet, we should be turning him into a believer—and a proud wearer of his own helmet. Before a high school student dies on the way home from his first prom, he needs to understand the effects of the alcohol that somebody will surely offer him. And before a woman in her 70s has the slip-and-fall injury that breaks her hip, maybe we can help her eliminate the hazards that will produce it.

What if next time you respond to a private residence, you make a few simple observations that will take almost no time at all and will cost nothing, but might detect the threat of a medical crisis long before the patient has a seizure, a diabetic crisis or an episode of acute pulmonary edema? You could be like San Diego County paramedics Paul Maxwell and Josh Krimston, who got tired of seeing kids drown, and persuaded the California legislature to pass an ordinance mandating fenced enclosures around swimming pools. Any of us could have done it. They did it.

It’s not enough for us to keep on responding to the same catastrophes, day after day and year after year. We need to become advocates. Every EMS system needs to establish formal follow-up pathways that link the observations of field providers to area social services, designated caregivers and, if necessary, law enforcement. These pathways need to be supported by policies, so when a field provider identifies a threat or a hazard, something happens.

It’s work. But it’s part of our job.

More than that, EMS advocacy is good business. What makes more sense: paying to care for the fractured hip of someone who will likely die within the year due to related medical complications, or correcting the situation that will cause the fall in the first place, thereby enabling the person to stay home and drink his or her own coffee for years to come?

I propose the use of a mental checklist like the one that follows, and a scoring system like the one Chris Hendricks poses on page 47. Both are tools that could be used to help EMS providers consistently identify suspicious circumstances in a home environment. Their observations could then be referred to ED physicians, family caretakers or social service agencies to facilitate short-term remediation. A mechanism like Chris’s PEAT (Physical Environment Assessment Tool) scale could support long-term data collection as well, some of which could be used to trigger improved building standards.

Checklist data could be fed to someone in the EMS system who would be responsible for allocating resources. During periods of low system demand, “re-visits” could be conducted to monitor the status of patients whose environments have been reported as risky.

Following are some specific assessments that field crews should make during every visit to a private residence:

Environmental factors might include the lack of strong grab rails in the shower and bathtub areas, especially in the residence of someone who lives with orthopedic instabilities or ataxias like Parkinsonism, alcoholic encephalopathy or Huntington’s disease.

Unstable or uneven walkways, loose railings and unstable stairs are also suspect. Even something as simple as a burned-out light bulb could lead to an injury under the right (or wrong) circumstances; an alert crew could correct that on the spot.

Is this occupant likely to be capable of managing his own nutritional needs? Open the refrigerator: Is it running properly? Does it produce an odor; does it appear clean? Does it contain milk, and if so, does the milk smell fresh? Does it contain fresh fruits and vegetables? (People who live on canned goods ingest excessive amounts of sodium, which can exacerbate heart disease, hypertension and CHF.)