Need help with EMT lingo.
October 16, 2014 7:00 PM   Subscribe

Hi--I'm writing a short story in which the main character is an EMT. I would like the scene to be realistic, but I'm not an EMT. I'm specifically interested in how EMTs talk to each other on the scene of an accident.

I am writing a scene in which my EMT is called to an accident where two teenagers have flipped an ATV (one is non-conscious and one is wounded and combative). I've done a Google search and found some medical/emergency lingo but none that is specific to what I'm interested in. For instance, is there lingo for the first examination of a patient on scene? Is there lingo for immobilizing patients that would be used on the scene of an accident (I saw one site refer to "board and collar") ? I realize there may not be any lingo for these actions, but knowing that would be helpful too. Thanks!
posted by sm00 to Writing & Language (12 answers total) 1 user marked this as a favorite
I was an EMT, but only for a couple years and only in one jurisdiction, so take all this with a grain of salt, but real quick: different jurisdictions and different squads have different names for things, but I'd start by making sure the scene is safe for me and my crew and taking a guess at the mechanism of injury. The I'd take c-spine (manually immobilizing the patient's cervical spine to prevent further injury; basically, hold his head and neck still) and check for airway, breathing, and circulation (when in doubt, go back to the ABCs) and level of consciousness. For LOC I would check if the patient was alert and oriented to his surroundings. If he's oriented, he knows where he is, who he is, what day it is, and what happened to him. If he's not alert, does he respond to my voice? Does he respond when I tweak the tendon in his shoulder really hard?

Once I know all that, I want a rapid trauma assessment. I would tell someone to do a rapid, but I think some places just call it an RTA . That's a very quick (60-90 seconds, depending how much you find and how fancy you get) top to bottom check to see what you're dealing with and how you want to prioritize, and if you haven't needed any additional resources before, do you want any now. (Really, you can start this as soon as you're on scene or even earlier, but things to consider: do I have enough of the right kind of equipment/people/units to take care of all my patients? Do I need someone to get this kid out from under an ATV? Do I need people with special equipment to get him up a high-angle hillside safely while he's strapped to a backboard? Is Mr. Lucky getting a helicopter ride to shock trauma? Is his friend combative enough that I need to call the cops? Is his friend about to decompensate and leave me with two unstable patients? Where am I relative to my ambulance and how easy will it be to get out of here?)

A rural jurisdiction would probably handle it differently from the fire-and-rescue heavy area where I worked, but if I were taking care of two patients in a serious (maybe way off in the woods) ATV accident, I would not want to do it as an EMT-Basic with me and one other EMT, *especially* with two patients to manage. Backboarding alone is a pain in the ass with two EMTs, because theoretically one is holding c-spine the whole time, and the other is doing the assessment and initial interventions, and then rolling the person onto the board and getting them immobilized with spider straps, collar, and head blocks. You can go a lot faster with a bigger crew and might very well need special equipment or more highly qualified providers like paramedics, depending what your assessment tells you.

To your specific questions:
Board and collar=I would call this neck and back, but if I wanted to tell someone to do it to a patient on scene, I'd more likely tell them to backboard him, the c-collar and spider straps are implied.

Good luck!
posted by jameaterblues at 7:50 PM on October 16, 2014 [3 favorites]

It really depends on regional variation and even variation in different EMS services. For example, I've never heard anyone in my area use "neck and back" for "board and collar" as jameaterblues describes, nor are the terms "do a rapid" or "RTA" used in my area (at least not that I know of, I'm not an EMT but I work with them every day and I've never heard them call it that). We definitely use "board and collar" all the time, though, as in "and then we boarded and collared him". I also would agree that an EMT would say "unresponsive" rather than "non-conscious". They would probably also think about the patient's GCS (Glasgow Coma Scale) and whether he's "protecting his airway" - if an unresponsive patient is not protecting their airway, they need to be intubated for airway protection. "Combative" and "agitated" are words we use a lot for the type of patient you're describing.

It's important to consider what type of EMTs are in your story. Are they EMT-Bs ("basics"), EMT-Ps ("paramedics" or "medics" for short)? I assume they are paramedics who can use medications. If so, they will likely want to chemically restrain the combative patient for safety. There are also physical restraints that can be used in the meantime while you're getting your meds on board, like 2 point or 4 point restraints, usually referred to as "2 points" or "4 points" (I'm a little uncertain about the rules governing when medics can put these on, this might vary by jurisdiction, they might not be able to put patients in physical restraints like those until a physician has seen the patient and ordered them). The meds used are typically intramuscular benzodiazepines or "benzos" like Versed or Ativan.

If you're really serious about the story, why don't you arrange to do a few days of ridealongs with EMTs in your area (choosing the busiest jurisdiction near you)? Interested students do this sort of thing all the time, so it shouldn't be unusual. Also, there's really a TON of lingo in medicine which is hard to communicate well in this format, and so if you'd like an eye to read over your story when you're done, I'd be happy to help.
posted by treehorn+bunny at 8:16 PM on October 16, 2014 [3 favorites]

Also I should note, in the regions where I have worked, we always say "hold C spine" rather than "take C spine" for manual immobilization of the neck, unless referring to our own role, i.e. someone asks "are you gonna take C spine? Then I'll roll the patient" (rolling the patient on their side to palpate their spine is called 'logrolling' the patient) versus saying something like "holding C spine is tough when the patient's so agitated!"

Another comment on jameaterblues' remarks is that "LOC" is a really common EMT verbal abbreviation, people actually do say the letters "LOC" rather than saying "loss of consciousness" or "level of consciousness", for example: "19 year old patient, no significant past medical history, who was the restrained driver in an ATV vs. tree with rollover, no helmet, no LOC, ambulatory on the scene with a GCS of 12."

What jameaterblues describes as an RTA is what I would call a brief primary survey, although primary survey implies that you take a little more time than 1 minute to go head to toe on the patient and assess for injuries. Here's a quick video of an EMS primary survey that uses a lot of the wording I would expect.
posted by treehorn+bunny at 8:33 PM on October 16, 2014 [3 favorites]

Couple of things come to mind...

Your example of a two-person ATV wreck is going to be handled somewhat differently depending on where it happens. In a very rural area, with a volunteer-operated, unstaffed-apparatus system, you might get a whole bunch of people (typically EMTs or First Responders) showing up in personal vehicles, followed a few minutes later by someone with the ambulance, and then depending on severity they might be almost immediately calling for a helicopter. (The helo might land right there, if there's a workable landing zone, or they might have a pre-plotted LZ somewhere else where they meet the helicopter. All depends.) So anyway, you need to choose where all of this happens.

Another thing to keep in mind is that EMS has a chain of command that doesn't really lend itself to a lot of back-and-forth discussion. Setting aside a lot of stuff about how command structures work (which varies), there's certainly going to be a single person who is in charge of each patient (though it might change over time), and then a bunch of people assisting. The person in charge is going to be running the show, but basically acting (in a typical situation) according to a pretty well-understood script. The orders they're going to give are, hopefully, going to be pretty closely anticipated by everyone else.

But just to address the specific question of how the ambulance crew might talk to each other, it's my general experience that on scene, an experienced crew won't actually talk to each other all that much (on a routine call). There's a lot of talking to the patient, both to get information from them and to keep them calm and to give them instructions, but not a ton of verbal communication between the crew. Having a lot of discussion between providers tends to make patients nervous. And after you've run a particular type of call with the same crew a few dozen times, you don't really need to talk all that much anyway. So it's a lot of fairly terse instructions from the officer-in-charge to the rest of the crew, maybe vitals reports from the crew to the officer and everyone else, and maybe requests for clarification if an instruction isn't clear or is ambiguous.

The amount of communication goes up pretty dramatically if the call isn't routine. A bad trauma might qualify, depending on the EMS system and how often they get those kind of calls. ("Routine", of course, is totally subjective. A busy suburban department that does a dozen car wrecks a week is going to waltz through the collar-and-board drill differently than someone who hasn't done it since EMT school.) Basically, as the "pucker factor" goes up, so does the amount of verbal communication between the crew. More complex cases tend also to have more people in the back of the unit (and a combative patient might mean a couple more) so there's a lot more need for micromanagement.

Anyway, in writing your story what I would do is pick your setting (geography, time of year, weather at the time, etc.) and then I'd try to talk to someone who has some experience actually working in that area if you can find them. They are going to be able to help you with the realism a lot better than anyone will be able to otherwise.

If that's not an option, IMO the only halfway-decent TV show about prehospital care (at least in recent memory) is Paramedics, which was a companion show to Trauma: Life in the ER. It is not really applicable to rural EMS, though.
posted by Kadin2048 at 9:20 PM on October 16, 2014 [3 favorites]

Also worth mentioning for extra realism: if the patients are unconscious and there are no family members along with them to be bothered, odds are the responders are gonna be cracking pretty horrible jokes the entire time. EMTs are huge on very dark humor, it's one of the healthier ways to get through what can be a super stressful job.
posted by Itaxpica at 9:26 PM on October 16, 2014 [2 favorites]

Yet another (former/retired) EMT chiming in:

In addition to the terms mentioned upthread (unresponsive, LOC, etc.) for states of unconsciousness, a really common one for consciousness is "A and O times three", meaning alert and oriented upon three successive checks. At least where I practiced, that was the usual standard and jargon for responsiveness.
posted by fifthrider at 9:38 PM on October 16, 2014

Upon checking some other sources, I discover that the conventional definition for "A&O x3" is for alertness to person, place, and time. Checking it three times was apparently a peculiarity of my particular ambulance corps.
posted by fifthrider at 9:54 PM on October 16, 2014

EMTs arriving at the scene of an accident (should!) first do a scene size-up to establish scene safety and evaluate the mechanism of injury. "Scene size-up" is pretty standard terminology. So is "mechanism of injury" though it might be "MOI" or just "mechanism."

Complex scenes like that will require other resources. It varies by area, but typically Rescue helps if there is a need to lift an ATV off of someone, or extricate him or her from being physically trapped. EMTs are very likely speak of "entrapment" or "no entrapment" in their radio traffic to Dispatch, because Dispatch will need to know whether to send other resources.

Basic EMTs with a severe trauma patient may call for "ALS back-up" or "ALS intercept," advanced providers who can start IVs or give medications. Many services would have these on the crew already or at least have dispatched them to the scene already. There is an incredible amount of variation in how different systems operate.

There are basic EMTs and various levels of advanced EMT (depending on the state) who may or may not be paramedics. They all tend to be collectively referred to as "medics."

If more resources are expected it's likely the first arriving units would "establish command," that is officially institute the Incident Command System, which establishes roles and chain of command.

The first assessment of the patient might well be called the "primary survey," but this varies. It could always be called a quick "head-to-toe."

Immobilizing is called "immobilizing." Or "backboarding." Or simply "boarding." A "c-collar" is generally used. (How progressive is the service? This practice is being widely questioned, and protocols are changing many places. Could the EMTs discuss this among themselves?)

The one who is combative could be dealt with by using lots of help and restraining him. He could be sedated if need be, but there are problems. Many sedatives drop blood pressure ("BP"). And they can mask symptoms. Is his LOC dropping because of brain trauma or because of the meds? If nobody is listening they may call sedating him "snowing" him. If this (or his injuries) reduces him to total unconsciousness they may say he is "gorked."

Curiously LOC can mean "level of consciousness." or sometimes "loss of consciousness." Medics will happily use both terms in the same conversation. "He had an initial LOC of about 2 minutes before waking up. But now his LOC is dropping again, and I'm thinking subdural."

And, as you will gather from the length of all these answers, we love to talk.

Good luck; I'd love to read the story!
posted by wjm at 5:10 AM on October 17, 2014

As a writer, very harsh critic and former EMT, I'm going to stop you right here. Unless the fact that the main character in your story is an EMT is ancillary and not really what you're going to cover in the whole story...don't write it.

As you can see, there are peculiarities to different ways a job can be done, and EMT is so freaking specific, and those peculiarities are so tied to time and place that unless you've lived it, you're going to get it wrong.

Now, if your audience only knows what it knows from TV and the movies, it may not make a difference. But EMT's will know, medical professionals will know and most importantly, YOU'LL know that you were fudging and slurring your way through it.

As with Fire Fighter, Soldier, Police Officer and Supreme Court Judge, you have to walk more than a mile in those shoes to write it well. You'll discover that certain kinds of people are drawn to the work, that a certain temperament and brain-wiring is necessary to the job. If you're not keyed into that it won't sound right, there will be something off about it.

Knowing a few words is helpful, but do you know that most folks can't get a stick on the first go? Or that if you give someone a shot of Narcan, that you have to get someone to sit on him while you do it? (Guess who got THAT job?) Did you know that in Catholic hospitals the Head Nurse/Nun might snap your bra strap to insure that you're wearing one? (Sister Mary-Ralph, St. Joseph's, Phoenix.)

So, I'm going to say, "Write what you know."

Good luck to you!
posted by Ruthless Bunny at 10:12 AM on October 17, 2014

Oh, and Vitamin H might come in very handy for a combative patient.

ETOH is a good one.

This page in general is fun.
posted by Ruthless Bunny at 10:16 AM on October 17, 2014 ?
posted by sebastienbailard at 12:07 PM on October 17, 2014

Response by poster: Thanks everyone for the wonderfully helpful and thorough responses!! I love the idea of a ride-along...I just assumed that it wouldn't be possible. I will look into it.

I also appreciate the offers of review...I may take you up on it once I finish. :) I will say that the EMT aspect is just one aspect of the story, and it isn't meant to be a story about life as an EMT. I know I'm not qualified to write that.

Ruthless Bunny I appreciate your feedback and understand that I would certainly need much more than a quick study of lingo to write something that focuses more on the EMT aspect.

Thanks again all! Much appreciated.
posted by sm00 at 7:48 PM on October 17, 2014

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