More EMS Scenarios for the Real World

Scenario-based education is a great learning tool for EMS people. I believe that scenarios are one of the best ways for EMTs and Paramedics to get their heads in the game and think deeply about potential problems they might face in the field before the tones go off and the pressure comes on. EMS scenarios allow the EMS person to look at potential problems, consider potential solutions, and test out the results of their actions in a safe environment. They can help identify areas where providers need to study up on additional information and can go a long way towards helping increase a provider’s comfort level when they’re faced with the real-life version of the scenario out on the street. Whether the scenarios are in a classroom or formal training setting, are shared between providers at the station, or are put up on Facebook or other social media setting, they’re valuable learning opportunities and can even be a lot of fun. I especially enjoy the recent collaborative scenarios that are put up in places like www.EMS12lead.com or on the smarter EMS-related Facebook pages because the collaboration and discussion of topics that follow the scenario in the comments section are always enlightening and entertaining.

I’ve written quite a few scenarios and case-studies on this blog and in JEMS that I’ll link to at the bottom of the article. I think they give a good overview of the topics they cover and present the information in a way that makes you think about the topic in a more real-world setting.

The problem with the scenarios I see on Facebook and elsewhere, however, is that they always seem to cover calls where the patient we are given is suffering from an awesomely severe medical or traumatic incident. I’m not really complaining about that fact, because discussing how to manage a challenging patient is the point of scenario-based education, but there is an emphasis placed strictly on managing patient care in most scenarios and I believe there are many more, less-awesome challenges that an EMS professional will be tasked with that could also lend themselves well to this format.

As an example of the other, perhaps less-awesome but still valuable scenarios that teach good lessons, I’m going to give you three of them that I’ve come up with. Read them, think about them, and see how you would handle these scenarios that are every bit as “life-or-death” as that last scenario with the gunshot victim that you read on Facebook yet are sadly way more common. These scenarios are just as appropriate for the newest EMT as they are for the most seasoned leader of any EMS agency. You might even want to forward this article up or down your organizational chain of command to see how those people might do with the cases provided. Here we go:

Scenario #1

Your ambulance is dispatched to a private residence in a quiet residential part of your coverage area. It is an area of town with smaller, yet well-kept homes where people tend to live in their houses for a long time. When you arrive at the single-story home you’ve been sent to you notice that the house is small and doesn’t seem to be kept up as nice as the other homes. The lawn has been mowed recently, but the bushes haven’t been trimmed, the sidewalk hasn’t been edged, and everything looks to be overgrown. The house seems to be suffering from deferred maintenance all around and everything is showing its weather-worn age. As you approach the house, you notice that the windows are all covered up with blankets on the inside which prevents your view from the outside area. You knock on the front door and a weak voice yells “Use the back door” which you walk around the house and enter.

When you make it inside, you see why the patient didn’t want you to open the front door. It is practically barricaded from the inside and cannot be opened. The interior of the house is in bad shape. It hasn’t been cleaned in years, and while the house doesn’t quite appear like it could get a spot on the TV show “Hoarders” it is certainly in the running for the “Most cobwebs in a corner 2015” award. The home’s lone occupant, a 74 year old male, is sitting on a couch in a dirty white T-shirt and threadbare slacks. He appears emaciated, dirty, and scared of you as you approach. He tells you that he’s sick and wants to be checked out but firmly states that he doesn’t want to go to the hospital. You and your partner check him out. He’s tachycardic, has a fever, and has skin tenting suggesting dehydration. He complains of diarrhea, nausea, and general malaise. As you look around his residence you aren’t able to find any food other than a box of crackers, a jar of peanut butter, and a few cans of soup. There are bowls in the kitchen sink that haven’t been washed for so long that there is mold growing in them. The patient says that he has no family in the area and that he has lived in the house alone since his wife passed away several years ago. When you ask him when the last time he had something to eat was, he stares at you with sunken eyes and tells you that he doesn’t remember.

Questions:

  • What do you have to offer this patient?
  • What does this patient need that you have the ability to give him?
  • What does this patient need that you know how to find for him?
  • What is the best solution for this patient?
  • Can you transport the patient to the hospital without his consent?
  • If you could, why would you? If you cannot, why wouldn’t you?
  • Do you feel that you know enough of the resources available to you as a provider of healthcare and social services so that you can help this patient get the help that he needs?

Scenario #2

You and your partner got into work early this morning and have come up with a great idea. You’re going to run to the grocery store and get some breakfast to cook at the station for you two and the other crew to help start your 24-hour shift off right. As such, you do a quick check of your ambulance and run down to the local supermarket for supplies, sundry items, and breakfast foods you can use to whip up a scrumptious morning feast.

As you’re walking the aisles in your uniforms, a lady comes up to you and says “Excuse me, do you work for the ambulance service?” She appears to be in her 50s and seems shy as she comes up to you. You say that you do and continue to speak with her. She tells you “two years ago today your ambulance came to help my son down on 15th street. He had taken too much heroin and ended up dying. I miss him so much and I just wanted to thank you for trying to help him.” She then begins to cry and leans up against the frozen sausage case for support as her tears come more quickly. She’s visibly upset and keeps crying as you try and console her.

Questions:

  • Is this person a patient?
  • What should you do?

Scenario #3

Lucky you. Today you’re scheduled to work with Larry, or rather “L-Roy” as everyone calls him. L-Roy is a good guy, a great medic, and a lot of fun to work with. Everyone likes him and he seems to like everyone back. Every shift you get to work with the guy has been a whole lot of fun, even though you tend to get slammed with calls. Today though, something’s different. L-Roy isn’t his usual gregarious self. He seems sullen, quiet, and irritable. He’s pessimistic and complains openly about every call your unit is sent to. He’s acting very out of the ordinary. When you ask him what’s wrong, he says “oh nothing, you know how it is” but you hear him talking on his cell phone to his wife a couple of times during the shift and it sounds like they’re having a fight… a bad fight… like a potential divorce fight… As the day goes on L-Roy talks about how life just wouldn’t be worth living if he couldn’t see his kids anymore and about how “that (expletive) wife of mine would be better off if I were just dead so she could be done with all of the crazy crap that I keep putting her through.” He asks out loud why he can’t just “get his head together.” After listening to L-Roy throughout the shift you’re really starting to get scared that he might hurt himself. He’s obviously going through a really rough time and could probably use some help, even though you don’t believe that he’s the kind of guy who would reach out for it himself.

Questions:

  • What do you think you should do?
  • Is there something in place within your organization where you can report these issues?
  • If so, is this something you should report?
  • If not… Why not?
  • Do you know about the Code Green Campaign to prevent EMS provider suicide?

Good luck.

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For more real-world scenario-based education, check out my article from 2009 on this blog “Scenarios, a lot of EMS, a Little Einstein” and also Greg Friese’s piece on EMS1.com “4 Patient Care Scenarios that are Actually Useful”

You can also check out my JEMS Cases of the Month which cover many topics, or look at some of these scenarios on this blog:

  • Barefoot in MN

    Thanks for these ! yes, the exotic calls are fun but the “routine” calls are people, too. Just because we may have seen “this sort of thing” before, doesn’t make it routine for the patient in front of us.

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