Communication with the patient and their family members or close ones has an essential role in patient care. In order to create a feeling of safety, it is important that the patient can speak their native language.
A 71-year-old has fallen off a roof while doing construction work. He can’t move his limbs and his wife has called the emergency response centre in panic. The Emergency Medical Services arrive.
Pm: Hi, I am paramedic Mikael. What happened?
P: I was repairing the roof when I suddenly lost my grip and fell.
Pm: Take it easy. Do not try to move.
P: I can’t move. It hurts so much.
Pm: Can you say how high you fell from?
P: I fell off that roof up there. It’s probably seven metres.
Pm: How did you fall? With your back
first, legs first, or how?
P: I fell so that my feet touched the ground first.
Pm: Where does it hurt the most?
P: My leg hurts enormously. So does my back. My right arm is in pain. And my neck feels tender.
Pm: Can you describe the pain?
P: The pain in my legs is sharp and excruciating. The pain in the arm is not that bad.
Pm: Does the pain radiate anywhere?
P: The pain feels all over my body.
Pm: How strong is the pain on the scale of 1–10?
P: I’d say 10.
Pm: Has it got worse?
P: The pain has stayed the same.
Pm: I’m going to examine your body using my hands. Let me know if it hurts anywhere.
The paramedic palpates the patient’s chest, abdomen, pelvis, head, neck, back, arms and feet.
Pm: I’m going to start you on a drip now. It may pinch a little.
Pm: Now I’m going to take your blood pressure and attach the saturation device.
Pm: I will listen to your breathing sounds. I’ll also take your temperature and blood glucose.
P: Alright. Can I have some pain relief?
Pm: I’ll give you pain relief intravenously.
P: OK. I hope it helps.
Pm: Take it easy. We’ll try to move you gently without causing any more pain. We’ll place you on this vacuum mattress and then move you into the ambulance.
Pm: Let me know when the pain eases.
P: The pain has eased … I’d rate it 7.
Pm: We’ll drive to hospital now for further examinations and treatments.
P: Sounds good.
Pm: Let me know if your condition changes during the drive.
P: Ok. Good thing the hospital is nearby.
Pm: I will ask you a few things during the journey. Could you tell me if you have any diseases or medications.
P: I have hypertension, heart failure, coronary artery disease, asthma, COPD and epilepsy. There are so many
medicines, and I don’t remember their names by heart. They are in MyKanta.
There has been a bicycle accident where a 6-year-old child has injured herself. The driver has called the emergency response centre. An EMS unit has arrived at the accident scene.
P: I’m in pain.
Pm1: What’s your name?
P: Vilja.
Pm1: What happened to you?
P: I fell from a bike. My leg hurts, and my hand hurts too. I can’t get away from here.
Pm1: Take it easy. I’ll help you. Where do you live?
P: In that house over there. I shouldn’t have come here by my new bike. I didn’t break it, did I? My head hurts.
Pm1: Is your mum or dad at home?
P: You mustn’t tell my mum, she will be angry because I came here.
Pm1: We need more help. Will you summon?
Pm2: More help summoned.
Pm1: Vilja, are you listening to me? I have to loosen your clothing a little. Can you show me where it hurts the most? I must look at your foot and hand. Let me know if it hurts.
P: My foot hurts.
Pm1: Does it hurt now when I don’t touch it?
P: Yes it does. Where’s my dad?
More help arrives fast. Pm2 takes the driver aside.
Driver: I hit her, I was looking at my mobile phone and didn’t notice anything until I heard a thump. It’s all my fault.
Pm2: Let’s watch from a distance here. The child is being taken care of. There’s nothing to worry about. Where were you going?
Driver: I don’t remember. Maybe home. I want to get out of here.
Mum: Vilja, what have you done? Haven’t I told you that you are not allowed to come here! Now look at your new bike. It’s completely broken and you won’t get a new one. That woman knocked you down, didn’t she? What have you done to my child?
Pm2: Try to calm down, please. The mother could go to Vilja and stay by her side.
The paramedic is now with Vilja and examines her.
Pm1: (Chest) I’ll look and touch you here. Does it hurt? The sternum is stable.
Pm1: (Abdomen) I’ll press your abdomen a little. Does it hurt? The abdomen is soft, not tender to touch, there are two old bruises on the abdominal skin.
Pm1: (Pelvis) I’ll now examine your sides. Does it hurt? Yes. Pain on the right.
Pm1: (Brain) Does it hurt here? Yes. Pain in the head. The helmet split in half.
Pm: (Back) Does your back hurt? No.
Pm: (Extremities) Does it hurt when I touch your arms and legs? The hand hurts. There is swelling in the right
thigh, no malposition. The paramedic asks the other paramedic: Did you document that?
Pm1: I will attach this small device onto your fingertip. Will you let it stay there, please. It doesn’t hurt. Saturation is 95. Then I’m going to attach these little stickers to your chest. That won’t hurt either. When the stickers are at the right place, I’ll show you what we can see on that little screen. Sinus rhythm, pulse is 145. I’m going to apply this cuff around your upper arm. It squeezes a little. You can let me know how it feels when you hear
a little buzz.
Pm1: We’ll apply it around the uninjured arm. The blood pressure is 100/60. We’re going to place you on that fancy mattress over there, but before we do it, we’re going to put this collar around your neck. I’m pretty sure you haven’t had one like this before.
Pm2: Don’t be scared, I’m going to hold you like this, so that we can apply the cool collar. It may feel a bit
uncomfortable.
Pm1: We’re now going to move you onto that mattress. Please let us know if it hurts.
Calming down the patient
Take it easy!
No panic!
Don’t worry!
You’ll be fine!
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