ems,

If you’re a bystander to a medical emergency...

A group of amazing bystanders did such an excellent job on a call yesterday I figured everyone could use a guide of what to do if you witness a medical emergency. (Even for you doctors and nurses out there-you may be the BEST provider ever but the prehospital environment can be pretty different and these are some great specific ways to help the patient’s overall care)

1. Make sure its safe to help. Seriously. Please please please do not put yourself in danger. So many people get killed every year stopping on the side of highways, ect-not only is it the LAST thing we want to happen, but it can also make a situation that much worse. 

2. Call 911. Get help going. Its okay if you don’t know exactly whats going on. Its okay if you don’t know if anyone else has called. They’d rather you call and have it be nothing than nobody call at all.

3. Stay calm. Take a deep breath. This is not your emergency, it is theirs and you need to keep a calm head to help. 

All Patients

Other than doing CPR if needed the MOST important thing you can do to help EMS out is to write down the patient’s name, date of birth, social(if you can get it), medical history, and allergies. You might be able to get information from the patient, a bystander who knows the patient, or a wallet/medical alert bracelet. This saves US so much time and searching.

When EMS arrives, be prepared for ONE person to calmly explain exactly what you saw. Helpful phrases are if the patient complained of anything before the emergency occurred, and if they made any abnormal movements(like twitching). Telling me the patient had a seizure when I’m not sure what you think a seizure IS, is a lot less helpful than ‘he started jerking, foaming at the mouth, and he peed on himself’. 

Don’t be offended if we’re doing things while you’re talking. We have just a few minutes to assess the patient, figure out what may be going on, stabilize life threats, and figure out how to get to the ambulance with the patient. Multitasking doesn’t mean we’re not paying attention or that we don’t appreciate everything you’ve done-it just means there is a lot to do at once. 

If you’re a medical professional, identify yourself but don’t try to take control of the scene. We have specific guidelines based on what we can allow bystanders(even doctors) to do. Its like this-I know how to start an IV, but I can’t go in the hospital and start an IV on your patient because you’re the one responsible for them in that setting and I have no ability to practice there. Believe me, if we need you to do something, I WILL ABSOLUTELY ask you. As it is, I’m just incredibly appreciative that the patient had a solid basis of care established. 

Unresponsive with no pulse

3. If the patient is unresponsive, ask another bystander to find an AED immediately. If you are the only person there do the following-

 Feel for a pulse by putting two fingers gently on the side of the patient’s neck. If there is no pulse or you’re not sure, immediately start pushing hard and fast in the center of the patient’s chest between their nipples. Hum ‘Staying Alive’ to yourself to keep the right rhythm(you’re aiming for at least 100 compressions per minute and you want to compress at least 2 ½ inches down on their chest.). Don’t stop compressions unless someone is there that can switch out with you, you become so tired that you cannot continue, or an AED arrives. Don’t worry if the patient has no pulse but appears to be gasping. This is normal and you’re not hurting them-its just something that sometimes happens when someone is dying. 

4. When an AED arrives, open it up and turn it on ASAP. Thats literally all you need to do. Its going to talk you through everything else. 

Unresponsive with a pulse but not breathing or only gasping

5. Tilt their chin back and put your mouth over their mouth. Pinch their nostrils shut. If its a child, put your mouth over their mouth and nose. Give 1 breath and watch their chest to see if it rises. If it does not rise, try to tilt their chin back again and give another breath. Give rescue breaths every 6-8 seconds. 

Unresponsive and breathing with a pulse

6. Roll the patient onto their side so that if they vomit, they won’t choke. Keep them safe and warm and look for any clues to what may have happened(did they bite their tongue? Did they urinate on themselves?)

 Responsive with various complaints(in no particular order)

7. If they have chest pain-give them 4 tablets of 81 mg baby aspirin. Seriously. Saves lives. Carry it in your pocket everywhere. 

8. Provide comfort measures specific to the situation(aka cool compresses for the forehead, ect.) General rule is to keep the patient safe and warm. 

9. If they’re a family member or you have access-gather the patient’s medications together in one spot for EMS to take to the hospital. 

10. If the patient is a known diabetic and feels that their sugar has dropped, the best things to give them are things like orange juice and peanut butter crackers-basically complex sugars and carbs. While better than nothing, candy bars and sodas are too sugary and will shoot their blood sugar up really fast only to have it crash again later if they don’t get complex carbs into them. 

11. If the patient is responsive but confused and you’re not sure if they can swallow, DO NOT GIVE THEM ANYTHING TO EAT OR DRINK. 

12. If the patient has been exposed to something they’re allergic to and they are complaining of things like feeling like they can’t breathe, like their tongue is swelling, they have hives, or are vomiting, ask if they have an Epi-pen. If they do, pull it out of the package, pull out the cap(but don’t put your fingers over where the cap was!!!) and push the pen firmly against their thigh until you hear a ‘click’. Count to 10 and then release the pen. You don’t need to take off their pants to do this. If they don’t have an epi-pen, give them 2 benedryl tablets.

13. The best way in the world to calm down someone who is having a panic attack is to be calm yourself. Eliminate external stressors, removing them from the environment if possible. Sit quietly with them, and talk softly. Ensure they stay safe and warm(seriously. 90% of first aid is keeping folks safe and comfortable). Talk them through breathing slowly to the count of ten in through their nose and out through their mouth like they are slowly blowing out a candle. 

14. If someone is bleeding profusely, the best and #1 thing to do is apply pressure directly to the site of the bleeding with a (preferably gloved) hand. If pressure doesn’t stop the bleeding and its an extremity wound, tighten a belt above the wound until the bleeding stops. Secure the belt at this point until help arrives to take over. 

15. Birthing babies! If baby is coming there isn’t really anything you can do to stop it. The best indicators that birth is imminate is the patient reporting a feeling of needing to go to the bathroom OR (no shit) the appearance of a head/hair in between the patient’s legs. Mom will do the work here. Your job is to keep mom calm, and to gently support the baby’s head/body as it emerges. It will be slippery so- Don’t. Drop. The. Baby. If you see the umbilical cord wrapped around the baby’s head, gently and quickly unwrap it before the rest of the baby is born. After baby is born, vigorously rub it dry with a towel to stimulate crying. If the baby does not cry/remains blue and is not breathing, wrap your hands around the baby’s chest until your thumbs encircle and push hard and fast in the center of the chest until help arrives or the baby pinks up/starts crying. Keep the baby at the level of the umbilical cord until it stops pulsing. Tie off the cord in two places 4-5 inches apart with a string or shoelace and cut between the strings. If baby is okay(pink and crying), place on mom’s bare chest, and keep both mom and baby safe and warm.

16. If you stop at a wreck, unless the patient is not breathing or is in immediate danger, please DON’T pull them out of the vehicle. If they have a neck or back injury, you could cause them more harm. Instead, place your hands gently on either side of their neck to stabilize it and remind them not to move their head until help arrives to take over. 

…I think thats it for now unless anyone else has any other additions! Remember, stay calm, call 911, do CPR if needed, get patient information written down, and KEEP THE PATIENT SAFE AND WARM. You go lifesaver you! :)