Hazards of the patient assessment

CarolinaFireJournal - Jason Boan
Jason Boan
04/29/2011 -

In the last segment we talked about how the patient assessment helps the responders as much, as if not more, than the patient. By doing a thorough assessment, lots of hazards to the responders can be identified and avoided. Now you have your patient loaded into your unit and you’re on the way to the hospital.


There are as many potential hazards to the crew and patient while driving down the road as there are on the scene. The driver has an enormous responsibility on their shoulders. Whether driving non-emergent, or emergent, the driver has to be on his or her toes. We all like to think that people will get out of our way because we are bigger, louder and have flashing lights letting them know we are coming. In reality, we know from experience that most drivers don’t pay any attention to that.

A lot of people “panic” when they see us come up behind them. Emergency vehicles are supposed to pass on the left. Which means other drivers should slow down and pull to the right. People, however, do some crazy things when an ambulance is behind them. People speed up, move to the left, and sometimes just ignore us all together.

In some states, like here in South Carolina, drivers only have to yield to blue lights. This creates some problems for us. When driving emergent we technically are held to the same laws as every one else, plus some. Being the emergency vehicle we are held to a higher standard and we have to be above reproach in the public eye.

Most of us consider the back of our ambulance a safe place and we are comfortable there. On a scene we are doing what we can to get our patient there. But it can also be a dangerous place. You are in the back of a moving vehicle, and more often than not, you are not in a seat with a seatbelt on. Ambulance companies have made big strides in making the back of the ambulance as safe as possible, but there is still a lot that can happen back there. Your partner’s driving has a huge impact on the conditions in the back. They need to make the ride as smooth as possible.

Aside from the moving vehicle, every procedure you do to your patient is hazardous. There are IV needles, syringes to administer drugs, intubating, and the drugs themselves. You are using a needle in the back of a moving vehicle, what more needs to be said?

There are several manufacturers that make needle-less systems for drug administration. These are only good after you perform certain procedures. Whether it is starting an IV, using an IO needle or drill, taking a BGL or drawing up certain medications. When starting an IV, you should have everything you will need ready and with in reach before you uncap the needle. Never recap a needle. Never put the exposed needle down. Put the needle directly into the sharps container. Most services use safety needles now, these are great but not a reason to become careless.

Epinephrine still comes in the glass ampule. To use this you are breaking a glass vial and inserting a needle into a very small opening. If you have a patient that you suspect of having a respiratory disease, you and the patient should wear a mask. A mask should also be worn when administering nebulized medications, suctioning or intubating. The mask does not keep everything out of you but will help filter a lot of it.

These are some of the hazards of assessing and treating your patient while enroute to the hospital. There are many more that we need to be aware of. Accidents happen, but there are a few simple steps we can take to help minimize them: plan ahead, use caution and be patient. Take preventive steps by knowing what you are going to do, what you need, have everything laid out within reach and wearing the appropriate protective gear. It doesn’t benefit the patient if you become a patient.

Jason Boan has 14 plus years in emergency medicine, starting as a volunteer EMT/firefighter in high school in Texas onto six years as a combat medic in the U.S. Army. Boan has been in involved in EMS in South Carolina for the last six years. He currently works as a paramedic for Aiken County EMS and part time at Ft. Jackson EMS.
Comments & Ratings

  9/14/2013 7:25:21 PM

he needs to report t 
he needs to report to emepoyle health immediately.the source patient has to be tested for HBV, HCV and HIV.if he is positive for any of these, appropriate and immediate treatment can be given to the nurse who got stuck.this is NOT something that should wait until the next day if he potentially was exposed to HIV, he needs to have medications in his stomach in minutes - not days.do not assume that an elderly patient is low risk for HIV. MANY of my AIDS patients are over 65 years old!!!! And in years to come, you'll only see the AIDS population getting older, as we have medications that allow them to have normal lifespans now.

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