we've all been there what did you do?

[irish_handgrenade]

Ok we have all had the call for the unresponsive pt and when you arrive on scene it is painfully obvious that the pt is completely full of it. How did/do you handle this situation?

 

[94H]

Nasal Airway

 

[NomadicMedic]

Assess the ABCs and if nothing else is indicated, simply transport. <_<
If someone is going through all of the hassle of preteding to be unresponsive, they must want to go to the hospital rather badly.

I usually do enough on scene that the play actors just can't keep up the charade long enough. Of course, if I can't rouse them with a trap squeeze or sternal rub, they'll get an NPA. That wakes most of them up.

 

[lightsandsirens5]

Nasal Airway

Oh no you sure as hell don't. Not automatically.

We are out there to actually CARE about PEOPLE. Not torture those who we determine don't "need" us.

Don't even get me going on this one. I will try to control myself here. Sorry in advance for anything I might say later in this thread.

 

[abckidsmom]

Depends on the faker in question. You can count on me to load 'em up to tranport, then talk 'em awake in the truck.

Frustrating? Sure. But the nature of EMS is that you play with the hand you're dealt, and if people are sick enough to fake unconsciousness, well then they're sick enough to get a ride to a hospital.

Whatever the problem is that makes them do this (because it's something that normal people just. don't. do.) it's worth investigating. Even if it's "just" attention-getting psych behavior... let 'em have a ride.

 

[MrBrown]

Tell patient they do not require treatment or transport, get back in ambulance and drive back to ambulance station.

 

[abckidsmom]

Depends on the faker in question. You can count on me to load 'em up to tranport, then talk 'em awake in the truck.

Frustrating? Sure. But the nature of EMS is that you play with the hand you're dealt, and if people are sick enough to fake unconsciousness, well then they're sick enough to get a ride to a hospital.

Whatever the problem is that makes them do this (because it's something that normal people just. don't. do.) it's worth investigating. Even if it's "just" attention-getting psych behavior... let 'em have a ride.

Tell patient they do not require treatment or transport, get back in ambulance and drive back to ambulance station.

I love the unity of voices on this forum! So cool to see that every time you call an ambulance, anywhere in the world, you're going to get the exact. same. treatment from the providers who show up!

(I like you a lot, Brown, and I intend to see how this Aussie system works in real life one day. Care to pitch in for the plane ticket?)

 

[cstiltzcook2]

Dana- I love it.
Perfect summation of this whole deal. No further responses needed.

Can I close the thread? hahahaahaha

 

[JPINFV]

http://www.emtlife.com/showthread.php?t=21520

 

[rwik123]

Assess the ABCs and if nothing else is indicated, simply transport. <_<
If someone is going through all of the hassle of preteding to be unresponsive, they must want to go to the hospital rather badly.

I usually do enough on scene that the play actors just can't keep up the charade long enough. Of course, if I can't rouse them with a trap squeeze or sternal rub, they'll get an NPA. That wakes most of them up.

Or just before the airway, say " hey partner wanna grab me that big green hose that we'll have to shove down the patients nose" sometimes that'll wake them up.
But I agree to not do the npa automatically. I do not wanna cause or inflict pain on a person just for giggles.... But if protocols call for an airway for an unresponsive victim, I won't withhold it, even if I know they are faking it.

 

[Hockey]

Bilatteral IO's


Or I sing to them. If I don't get a reaction, they are dead. Seriously. If you're a bad singer, it works...EVERY SINGLE TIME

 

[JJR512]

Per Maryland protocol, if no other reason can be found for the patient to be unresponsive, oral glucose is to be administered between the cheek and gum. Bear in mind that most MD EMT-Bs cannot check blood sugar levels, hence the blanket protocol.

Administering oral glucose in this manner to a faker probably won't make them "come to", of course. At least that's my guess.

 

[NomadicMedic]

Per Maryland protocol, if no other reason can be found for the patient to be unresponsive, oral glucose is to be administered between the cheek and gum.

Really? Maryland protocol has Basics admin oral/buccal glucose to an unresponsive person?

I find that bizarre, if not downright dangerous.

But yes, I googled and it's in the "ALTERED MENTAL STATUS: UNRESPONSIVE PERSON" protocol...
"Administer glucose paste (10-15 grams) between the gum and cheek.
Consider single additional dose of glucose paste if not improved after 10
minutes. (NEW ’10)"

(http://www.miemss.org/home/default.aspx?tabid=106)
Shocking.

 

[JPINFV]

With proper monitoring, I don't see bucal administration as all that dangerous. However, it's not an administer and forget intervention.

 

[truetiger]

I'm not convinced an NPA is torture, if protocols state unresponsive pts get an NPA, follow your protocol. It gives the pt one last chance to reconsider before they get to the ER and the ER staff inserts a foley.

 

[Veneficus]

this is patient specific, if they are faking there is generally a reason. I do my best to find what the reason is. Look around, there are always clues, even in the hospital.

I discovered at some point that most people who are fakers generally need help of the nonmedical variety. No reason to try and fit a square peg in the round hole. Is there something you can do in order to help them?

My first EMT instructor once told me:

"The 2 most important questions you will ever as a patient is:

Can you walk? Have you tried?"

I have several times simply told patients that I knew they were faking, I wasn't carrying them, and if they wanted to go the the hospital they were to walk to the truck and not sit on the cot because that is for sick people.

Strangely enough it worked rather well in my experience.

For the truly hell bent on faking, I try to do as little as possible now. After all, if it is attention they seek, there really is no indicated medical intervention.

 

[irish_handgrenade]

this is patient specific, if they are faking there is generally a reason. I do my best to find what the reason is. Look around, there are always clues, even in the hospital.

I discovered at some point that most people who are fakers generally need help of the nonmedical variety. No reason to try and fit a square peg in the round hole. Is there something you can do in order to help them?

My first EMT instructor once told me:

"The 2 most important questions you will ever as a patient is:

Can you walk? Have you tried?"

I have several times simply told patients that I knew they were faking, I wasn't carrying them, and if they wanted to go the the hospital they were to walk to the truck and not sit on the cot because that is for sick people.

Strangely enough it worked rather well in my experience.

For the truly hell bent on faking, I try to do as little as possible now. After all, if it is attention they seek, there really is no indicated medical intervention.

Probably the best answer to this question.

 

[kravturtle]

There's always the hand-drop test. Although, that's usually frowned upon...

 

[8jimi8]

There's always the hand-drop test. Although, that's usually frowned upon...

Let me catch someone trying to hurt a patient.

 

[usafmedic45]

Even if it's "just" attention-getting psych behavior... let 'em have a ride.

Yup....this is why I argue for BLS trucks in emergency services. LOL

Let me catch someone trying to hurt a patient.

Please.....you just have to remember to pick the hand without a ring or at least remove the ring first.

Or try the "Hey, you know there's big money in kidneys and this guy's got two. You get the ice, I'll get the prepaid cell phone!"