Homepage / Uncategorized / A Complete Secondary Assessment
FDIC 2017 – Structural Response to Aviation Incidents: Engine Company Operations I Got Lost Going to a Call – So I made sure everyone knew about it Crossover Podcast Ep 102 Mrs Happy Medic and Mike the Cop Arby’s Roast Beef Ad angers EMTs, not sure why Strippers and Cocaine watch – 2017 Seizures! Seizures Everywhere! Nothing is certain except death and taxes. I can help you with both What to do when the powers that be – just can’t. Episode 99 the Crossover Ep 98 – Off Duty and Fancy Free NO is Never Easy to Hear Ohio Cop vs Ambulance Crew Member on Video – Crossover Show Investigates! An MCI With Wings: Aviation Incidents EMS Today 2017 First in Ambulance MCI at EMS Today 2017 Crossover Show Learns How to Take a Joke To Haul or Not to Haul – Should the Complexity of a Refusal Influence Transport? Crossover Show – Ep 91 – ACLU cameras Tip of the Helmet – Bj’s Brewhouse the Crossover Show – Episode Eighty Eight Eminence Based Medicine If You Don’t Give Him Insulin He’s Going to Die Lost Cause Strikes Again the Crossover Podcast – Ep 85 – Florida Cry Baby “I Can’t Breathe!” you keep using those words… the Crossover Show – 84 – TN Bus Crash Happy 150th Anniversary San Francisco Fire Department! Thank You For Your Service? A Complete Secondary Assessment the Crossover Episode 81 – Let’s Talk Politics! Aircraft skids off runway, rescue task force ill equipped Crossover Show – Ep 79 – Do we need so much active shooter training? How to Ignore Everyone in the Room: Be an Intern Your Meme is Bad and You’re Not One of Us Anymore Goodbye tarps, I never loved you The Crossover Episode 76 – Flashback to the Beginning You found me how? Less CSI, More Columbo EMS Festival Standby – You can’t just park a car there the Crossover Show Ep 72 – Florida EMT photo game A&O vs able to make decisions Kilted to Kick Cancer Cops vs Firemen Writer calls for Medics to risk more in shootings, misses the target What’s with the French? the Crossover – Ep 69 – Twelve Ninety Désolé the Crossover Show – Ep 67 – Traffic Stops and Profiling Actually, Officer, No. It Really isn’t that hard to try When Patients Don’t Play by the Old Rules Letters in the File – Oklaloosa Selfies the Crossover Podcast – Ep 64 – Turning Passion into Retirement Why Pokemon GO is so much like EMS Us Against Us Apathy is worse than absence So Now I’m Back! Changes are a-comin’ The Sounds of Silence I know that feel, Bro TCS – Ep 59 – SHOOT HIM! CISD with OK GO part VI the Crossover – Ep 56 – Rooms for Shooting the Ballad of Big Dave the Crossover Episode 55 – Text me Bro Why vs How and Book vs Street A Mother’s Day Crossover Show Dear Valencia County Fire Chiefs Dear Random Township Fire Department at FDIC the Crossover Show – ep 50 – Revenge of the Vine Stars Strippers and Cocaine need your help Educational Standards in EMS Engine Company First Strike MCI – FDIC 2016 the Crossover Show – Ep 48 – What’s in your feed? Washing the Chief’s Car What Should I Do With This Knife? – The Crossover Ep 46 Firefighter Jokes Medical/Legal Advice, Google Style the Crossover Show – Episode 45 – Cop Vines and the Cajun John Wayne You Make the Call ebook Now Available To the Intern Who Froze the Crossover Show – Episode 44 – Day of Remembrance New at Uniform Stories – Raising Revenue BLS Fire Officer or Paramedic – Who Makes Scene Decisions? the Crossover Show – Episode 43 – Viewer Questions Why Budgeting Matters – Our Plumbing Nightmare the Crossover Show – Episode 42 – Protesting a Rally with a March DC FEMS MD Quits, calls FD Leadership “Toxic” the Crossover Show – Episode 41 – America Ball The more things change… Hey Board of Supervisors, You’re Remembering the Wrong People the Crossover Show – Episode 38 – How not to Get Tazered the Crossover Show – Episode 37 – What Makes a Good Chief? Johnny and Roy lied to me – I write receipts Defining System Abuse – A Response to Ambulance Chaser the Crossover Show – Episode 36 – Perception vs Reality Good Morning America skims over Fatigue in EMS Police-24,336,756 EMS-4 EMS Bike Program from the ground up Become a Patron of the Arts – Support the Crossover Show! Engine Company First Strike MCI in San Bernardino Video Shows Woman Banging on Ambulance Accusing Them of Organ Harvesting


A Complete Secondary Assessment

That’s what our policies require and it makes perfect sense.  A complete secondary assessment to rule out all known causes of illness or injury to allow providers to make a good faith report of condition to the patient to inform their decision.  We have tools and education to perform this task and it really isn’t hard to put it all together.


Or so I thought.


On a call for the syncopal.  This is our bread and butter.  We find the patient pale, a bit moist with his shirt clearly previously soaked through (symptoms for 25 minutes now) but he is alert and oriented and refusing all care.  Being caring human beings we impressed upon him the need for an assessment.  After all, “what if we find something we can treat?  Wouldn’t it feel nice for that dizziness to go away and your head to stop sweating?”

Strong radial, irregular, wife says he’s got a history.  No chief complaint verbalized but his body is clearly telling me otherwise.  Meds and history paint the picture of an old a-fib but the ECG is showing PACs in II about 7:1.  Clearly something has changed.  The beats that should be irregular are regular…except that one little bugger.  He is calm and normotensive as we begin the chat that will convince him he should be seen by a physician sooner rather than later.  This conversation usually ends with them telling me they are going to hospital and there is nothing I can do to stop them.  Iceboxes to Eskimos.

The transport crew arrives and I ask them to set up the cot while we run a 12 lead and give a brief report.

“But he isn’t having chest pain.  We don’t need to run a 12 lead.”

I was told later that the glare I shot him was visible from the space station.

“We need to get a better picture of what’s going on as we have sudden onset syncope with an abrupt change in baseline ECG.  He is clearly no longer able to maintain homeostasis and we owe it to him to look for anything and everything we can to paint a clearer picture for his continuing care.”

I didn’t say that to the medic, I said it to the patient’s wife who was standing nearby.  She seemed suddenly concerned and I was able to put her at ease.


Later, down at the ambulance I had a chance to speak to the transport medic.

“We don’t run 12 leads on non chest pain patients, it isn’t in the protocol.  Besides, he said before we got there he didn’t even want to go.”


I followed them to the hospital and assisted with the hand over, then helped the EMT reload the cot.  As the medic came out we discussed the importance of a complete secondary assessment when we can’t reliably determine the cause of the chief complaint.

“He didn’t have a chief complaint.”

“His body sure as hell did.  Quit trying to pretend you’re just here to push Epi and instead use your tools and education to find the cause of your patient’s illnesses.  Assess, diagnose, intervene and reassess.  Just keep that wheel turning.  OK?”

“We don’t diagnose.”

Lost cause.

Related posts:

One Comment

  1. Christopher November 13, 2016 10:53 am

    *smh* Yes, we do diagnosis. That’s what a protocol is, treatment for a field diagnosis. The medical director of a “small” county in the East Bay once told me, “[you] diagnose every patient you come across. You just can’t bill for it. End of discussion.”

Post a Comment

Your email address will not be published. Required fields are marked *