23 March 2009

History taking

Sometimes, the things that happen just before the ambulance gets on scene are important. I've been on calls where the patient was moved and it takes 10 minutes to get the story straight because a patient laying in the middle of a big bed should not have a softball-size lump on his head from falling "right there", or "I took that pill the doctor gave me" turns into a 20 minute search for pill bottles and a game of 20 questions which never get me to the mystery pill (remind me to tell you that story sometime).

This call was memorable because as the first ambulance on scene, I got some of the information that the second ambulance didn't have and didn't think to ask for. Responding for a "sick person" call, arrive to find a middle-age woman very upset and pointing us to the living room where there is not 1 but 2 elderly folks in a state of disarray. The female pt had clothes on, sitting on the floor propped up against the couch; the male pt was laying on his back on the floor with a shirt and no other clothes. The room looked like a tornado had hit with model cars and trucks scattered about, the coffee table in pieces on the couch, a recliner on its side, and various other items strewn about. After the Asian and I split up and each assessed a patient, it was clear they both needed transport to the hospital and we called for a second ambulance.

While waiting for the second ambulance to arrive, the FD helped us do a spinal assessment and get both patients dressed enough to head out of the house. On arrival of the second crew, I try to give them a brief idea of what we know, including the male patient's medical history, vital signs and medication list. What they didn't ask, and I didn't think to tell, was the little detail of what we had done for the patient - getting him dressed and seated back in the recliner. We took both patients to the same hospital and made sure social services got involved with possibly placing them in assisted care because their needs were outpacing their family's ability to care for them.

Later in the day, I checked in with the other crew to find out how their patient was. "You'll never believe this! When the hospital stripped him down to put on a gown, they found a model truck in his ass!" Followed by the second crew member, "I don't even want to think about what those old people were doing!" I could have let this stand, after all where the truck was or why doesn't really make any difference, but I felt bad to have the patient get a reputation for something he wasn't doing, "Well, he could have fallen on it, there were a lot of models on the floor." Other crew, "No way! He was wearing pants." "Well, not when we got there he wasn't. We figured he'd probably want pants for the trip." The other crew appeared disappointed, but they'll probably still tell the story of the elderly gent with a truck up his butt and maybe we'll all remember to seek more details.

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