Instuctors, how do you deal with this?

[wildrivermedic]

Last week, assisting with an EMT class by running a few scenarios, I had a student come up to me saying, "I want to be the patient!" She then laid out what was a pretty good scenario:dispatched for a diff. breathing, responders find a 46 yr old female complaining of chest pain and radiating pain down both arms. The story - not revealed until and unless asked for it - is that she was beat up by an ex last week. The pain and SOB were caused by injuries.

Things ran well and the students headed down the cardiac pathway as expected. When a student inflated a BP cuff on the woman's arm she yelled in pain. Another student who could see the "patient's" face said "I don't think she's acting". It turns out that the story was not a scenario, but the truth. This woman had been to the ER yesterday.

After checking in with her briefly. and getting her assertion that she was fine and really wanted to do this, I let the scenario continue. Watching the physical exam made me flinch.

Should I have ended it? I'm somewhat familiar with theories of emotional trauma recovery, the allure for the survivor of re-traumatization as well as the healing potential of storytelling. Acknowledging the fact that EMT class is not the place for therapy, what do you think I should I have done as the instructor?

 

[Aidey]

I'm confused, who came up with the scenario, you or the pt?

 

[wildrivermedic]

The patient came up with the scenario.

 

[mycrofft]

How bizarre. She needs referral to law enforcement and spousal abuse resources. From now on, you might want to control your scenarios at any rate, your class is yours to run and the scenarios are to enhance learning, not for entertainment value or to present a "zebra".

There is another possibility, which is Munchausen syndrome. Not for anyone but LE and such to determine.

You need to decide now if she can stay in the class, or if she will move to another one. If she sees this sort of activity or your class generally as a therapeutic possibility (consciously or not), then she needs to address those issues but not using your class and your students.

(This is another example of why simulation in classrooms is likely to misfire, besides the fact that it is not possible to simulate medical presentation and findings with enough veracity to make it worth the risk and trouble).

 

[Aidey]

It is definitely strange, but it may not be as psycholgically dysfunctional as mycrofft is making it out to be. Making up scenarios on the spot is hard. It is much easier to modify a true example.

 

[medicdan]

As an instructor, I prefer to control and manage what objectives students are gaining from each lab-- and tailor the scenarios to their development through the course... so no impromptu scenarios for me... but...

I think this student deserves a conversation in a private place-- and should be referred to a social worker, LEO, or mental health provider for follow-up. if this student is willing enough to expose this traumatic injury in front of her class, she is likely screaming for attention, and she deserves the resources we can offer her.

 

[Mountain Res-Q]

Beyond what happens in the class, what, if any, obligation would or should the instructor have to act on the information? Had you encountered this on the job, you might have notified LE... what about in this setting?

On a personal note, I have several deeply ingrained convictions and morals. One of these is YOU NEVER PICK ON SOMEONE WEAKER THAN YOU (physically or mentally)... I probably would have stopped the scenario simply out of anger... I have spent most of my life helping the weak and needy... and to see that someone is hurting the weaker pisses me off to no end...

 

[mycrofft]

Not to sidetrack, but a careful role play concerning students' approaches and feelings about abusive situations, moderated by a trained person, could be useful as a unit for an EMT class. ("Add one more night to the EMT curriculum, Ernie...cha-CHING"). Plus a handout on legal and ethical responsibilities.

Aidey, my response is colored by experience with telephone hotline and other community training. Some folks have unresolved issues and bring them up in non-therapeutic situations because it gives them an emotional "fix" and can trigger assisting, but not therapeutic, helping activities by other classmates or the instructors. Sometimes it is what they use to continue in an abusive situation rathe than escape (and hence survive). Sometimes it evolves into a means to get cheap child care, borrow a car, get groceries or money, etc., as an adaptation rather than progress.

Folks in abusive situations don't usually trust this secret with groups, and groups don't usually have the training and resources to really help. As with c/o chest pain, take it seriously but don't get caught as the "cure"/hero.