Can We Talk?



You have witnessed an accident and you’re taking care of one of the victims, doing all you can to stabilize the injuries they’ve suffered. You’re continually reassessing and talking with your patient until EMS arrives and since uncomfortable silence isn’t exactly an option in this situation, what can you talk about and why?


We’ll start with the “why” first.


Talking with someone who has been injured is essentially a continual reassessment of their basic neurological status. If they are initially alert and oriented to person, place, time and situation (A/O x 4), that is a very good thing because it means that their brain is getting the oxygen it so craves and gives you a solid baseline status. Plus, you always want to get that initial baseline assessment done to see if they get any worse. If they aren’t exactly A/O x 4, well, what we just said; make sure they don’t get worse OR if they get any better. Remember, an early indicator of a drop in blood pressure in the body is going to present as an altered mental status. This is hugely important because if you got all the external bleeding stopped and the patient’s mental status continues to decline, you may want to start looking for other signs and symptoms of internal bleeding, like increased heart rate (over 120 beats/minute), rapid breathing (over 24 breaths per minute), cool, clammy, pale skin, weak radial or pedal pulses and increased capillary refill time.


During this time of questioning you’ll be getting them to focus on these questions rather than the situation at hand, which could be a welcome distraction and you may actually help to calm them.


That’s the “why”. Now for the “what”.


Ask them very simple open-ended questions initially, like “Is it daytime or nighttime?”, “What is the year?”, “What happened to you?”, “Where are you?” This line of questioning is used to determine baseline mental acuity through open-ended questions. Avoid close-ended questions because you won’t really garner any information. If they are doing okay in the mental assessment, move on to other, more-detailed questions which can give you a little more information, which, in turn, you can pass on to EMS, LE or Fire.


Ask questions like, “What are you feeling?” (Symptoms) “What kind of pain is it?” “Where is it coming from?” “How bad on a scale of 1-10, with 10 being the worst?”—also note what you see, feel or smell—(Signs), “What are you allergic to?”, “What medications are you taking?”(this includes homeopathic or other nutritional supplements)(also can ask about recreational drug use here), “What was the last thing you ate or drank and when was it?”, “What’s the last thing you remember before this happened?”. This is a basic history. You can also add to it by asking questions pertaining to any medical problems (medical history), previous surgeries and implanted devices. From a personal aspect, talk with them about any emergency contacts or anyone you’d like them to call. Anything to keep their brain engaged, keep them talking and awake.


It is also important to note that all of these things can be talked about at ANY time during your assessment. Along with the aforementioned questions, ask them their favorite sports teams, pet names, breeds, etc. Ask them about their significant others, kids, brothers, sisters, tattoo artists. As you’re talking with them, you’ll notice that not only is it having a beneficial effect on them, it also will help you to stay calm and focused, which they’ll pick up on have more confidence in your ability to help them out and see them through this situation.


In the end, take your pulse first, make sure you’re safe, focus on only what you can do, do one thing at a time, do it like a boss and continually reassess. The rest of it is out of your hands.