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thecookieoftroy · 10 years ago

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Emergency Help Procedures for Beginners

So, today I had a pretty shell-shocking day, and, as a result, wanted to post a list of things to do when you find someone passed out in public.

First, let me recap my experience. Today, I’d just gotten off the morning shift at hospital and went to the underground train to get home. The hospital I’m interning at is the final stop of the train line, so it was immediately suspicious to me when I walked through the carriage and saw a shirtless man, maybe mid-thirties, slumped motionlessly in a corner seat.

1. Check for breathing. First, I paused to make sure he was breathing. As he was shirtless, it was easy to spy his chest rising and falling. When the patient is wearing thicker or more layered clothes, you can alternatively do this by watching throat movement or holding a hand close to their nose and mouth to feel the exhales, or hear them breathe by leaning your ear next to their nose and mouth. This is important because if the patient’s not breathing, their heart may be failing too, and then you either need to immediately administer CPR yourself or, if you don’t know how (which is the case with me), immediately engage fellow bystanders by speaking loudly, speaking at them directly, asking them if they are a doctor, medical student, nurse or MTA (ideally), or if they have a driver’s license. For a driver’s license, you need to know first aid, so in an emergency that’ll do, too. Younger drivers can be more ideal because they did the first-aid course more recently and may recall more.

2. Check the pulse. Since I could see him breathing visibly, I didn’t immediately engage him. Falling asleep on public transport can happen, sometimes, even without a shirt in the summer. Since he was unnaturally still in his sleep, though, I thought it may be drug induced, so I sat down opposite him and checked his pulse at his wrist. You can generally check the pulse with your fore- and middle finger between the radius and its parallel tendon (simpler put, about three inches below the ball of your thumb on your lower arm, depending on arm and hand size). Otherwise, you can feel the carotid artery below the hinge of your jaw. I recommend finding these prominent pulse points on yourself so you can do it on others more easily. It really helps if you’re already familiar with them. Of course, if you don’t work in a medical profession, you may not be able to feel a pulse if it’s very weak. If you feel a weak pulse or no pulse at all, something is very wrong and you need to engage your immediate bystanders loudly and explicitly. Get their help, get them engaged. If you’re on public transport, get someone to find the driver intercom so that he can stop the train and let you get the patient out of the train with other people’s help.

3. Try to get the patient to respond. Since I could feel this man’s pulse quite strongly, the next step was to try and get him to wake up or otherwise respond. First, I said hello increasingly loudly. Don’t be afraid to yell. If the condition’s serious, a little yelling is absolutely worth it. The most important thing to do is not be shy or afraid to take action. Since there was no response, I next took his shoulder and gave him a light shake. I shook his knee a little, his shoulder a little harder, and he still wasn’t waking up.

(4. Check for possible causes.) This type of deep sleep and non-responsiveness can be drug induced, so I checked the insides of his elbows for puncture marks. There weren’t any, but I noticed his face was red and flushed, like he’d been drinking. If you aren’t familiar with medicine (have a medical parent or close friend in a medical profession), or if you can feel yourself start panicking and getting hysterical, this step is good but not 100% necessary, if you can tell you’re not dealing with the situation well and are bad at compartmentalising, concentrate on the basics. Check the vitals, get others involved who may be more well-equipped to handle the situation, and keep trying to get the patient to respond.

5. Get help. At this point it was dawning on me that this was serious and I was going to need to get the emergency services involved. I panicked a little; I didn’t know exactly how to proceed or if I had missed anything, and since the man’s vitals were fine and non-life threatening, I called my mother, who is a veteran MD of internal medicine of 30 years. IT IS BETTER TO CALL EMERGENCY SERVICES IMMEDIATELY, but you can also defer to a nearby medical professional, or, if there really isn’t anything else you know to do, if you have a family member or close friend that works as a doctor or nurse and the patient’s vitals aren’t in immediate danger, you can call them, too, and they can walk you through the next steps. I described the situation, and she asked me again if he had any puncture wounds on the insides of his elbows or if he smelled of alcohol. He did indeed smell of alcohol, and so she said that the next step was to get to the train driver’s intercom and get him to stop the train or to get him out of the train with the help of the bystanders. A crowd of bystanders had already gathered at this point, since they’d heard me on the phone talking about the patient’s status, so when I said “okay, I’ll get him out of the train and call Emergency Services,” the response was thankfully immediate. About half a dozen people gathered to collectively carry this man out, and I hung up on my mom to call Emergency Services.

6. How to make the Emergency Call.

The conversation I had with my mother is absolutely one you can have with Emergency Services. The employees who answer those calls are trained to ask you the right questions so that they can asses how to handle the situation. You don’t have to know everything when you call them, they are prepared to calm you down and walk you through an emergency even if you have absolutely no idea what to do. However, here are some thing’s you should tell them when they pick up:

1. Where are you? Since emergency numbers are nationwide, start with your city and then where in that city you are. Take your time, panicking and rushing will only scare you more and confuse the responder. 2. State sex and approximate age of the patient. This can give the MTAs an idea of what may be wrong. If it’s an older patient, it may be a stroke or heart failure; if it’s a younger one, it may be alcohol or drugs. 3. List up the patient’s vitals and the things that made you worry about the patient. In my case, that was listing up that he was breathing with a good pulse, unconscious, shirtless, but completely unresponsive. Unresponsiveness or saying that someone is not reacting is a key word for Emergency Services, so if someone is in that state, SAY IT. It’s absolutely vital and will get their attention. 4. If you don’t know how to proceed, TELL THEM. THEY ARE TRAINED TO HELP YOU.

7. Finishing up. After you’ve arranged with Emergency Services where to pick up the patient, stay with the patient until they arrive, and stay on the phone if you’re not medically trained. Update them if there’s any change in the patient’s condition, otherwise just wait and keep a lookout for the MTAs. Ask another bystander to stay with you, the more the better. Waiting can be tough, but stay calm, do some breathing exercises if you feel yourself starting to panic. If other people are waiting with you, it may be easier to stay calm. While you’re waiting, try to get the patient to respond and regain consciousness, and if they are, try to ask them their name, date, and ask them if they know where they are. These can be important indicators for a concussion or other neurological problems. When the MTAs arrive, list up all the things you told the person on the phone. Let them take the lead and handle the situation. They will probably try to get the person to respond themselves and conduct their own examination, but it may be best to stay until they decide on what to do. Don’t leave the second they arrive, try to help them as best as you can. Anything you can give them can help someone’s life.

The patient I helped ended up fine, he woke up and although he was disoriented at first, he knew his name and where he needed to go. He was able to stand and ultimately the MTAs didn’t need to bring him into the hospital, but it’s ALWAYS better to be safe than sorry. If you’re not sure if the patient needs help, call Emergency Services anyway. They will always be able to help you asses the situation.

The worst part was that the place the patient was trying to go to was on the opposite end of the train line, which meant he’d fallen asleep between the city and his station, taken the line to the end, and then taken the train all the way to the other end before I’d noticed him and helped. He’d been on that train for at least over an hour without any of the passengers on that train trying to help him when he could’ve very well had alcohol poisoning, a concussion, or worse. So please, please: if you see someone unconscious or passed out in public, help them and possibly save a life!

#reblogging it over here #cause it's important

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