Communication on the Scene of a Road Crash with Crash Victims
South Africa is often referred to as the “Rainbow Nation”. It is blessed with an abundance of diversity in nature, cultures and languages. With the 10th largest road network in the world, the southern part of Africa is recognized as a popular tourist travel destination with a wide variety of experiences on offer.
Perhaps nothing explains the South African diversity better than having 11 official languages. This however also presents unique challenges to our first responders attending to road crashes and other emergencies. It is easy to get “lost in translation” when having to communicate not only with our own citizens but also with tourists from non-English speaking countries.
We decided to approach our first responders and paramedics to gain insights into the processes and techniques they may follow to ensure effective communication with crash victims when attending to the scene of a road crash:
When you find the road crash victim and the person can communicate - what are the most important questions you will ask the person with reference to medical history, allergies etc?
If you can communicate with the patients, one of the most important things to tell them is to stay still and wait for the paramedics. This is imperative as moving around could aggravate any injuries the patient may have.
Gaining medical information is not imperative for the first responder, but it can assist the paramedics if the information is made available. Paramedics and medical professionals generally utilise the acronym SAMPLE to gain important medical information
S = Symptoms and signs that the patient is experiencing, eg nausea, pain etc. Ask where the pain is and how high it is.
A = Allergies that the patient knows of. [Any medication or sulphur]
M = Medication that the patient takes – if the person takes high blood pressure medication, we can insinuate that the person has high blood pressure. [Chronic medication]
P = Past medical history in the last 5 years- previous operations, surgical history or illnesses (ACS, stroke, diabetes or any other)
L = Last meal eaten/Last oral intake.
E = Events leading up to the incident. E.g. patient was feeling dizzy and blacked out etc
These are not hard set in stone and may change depending on the patient and the illness or injury.
What are the biggest concerns for the first responder with regards to the health history of the road crash victim/ patient?
Special attention is always paid to the mechanism of injury. In a road traffic collision, the nature of the rapid acceleration and deceleration can often lead to spinal injuries and or blunt force trauma to the chest area. We will always ask the patient if they have any chronic conditions related to high blood pressure, cardiac complications or diabetes.
Often at this stage, we will investigate if the patient can recall everything that happened and if there was any loss of consciousness. This stage of questioning allows us to better understand any possibility of a neurological disorder or perhaps a medical condition which led to the collision.
The SAMPLE history gained by the paramedics is absolutely vital. By using this information, we can ascertain what signs and symptoms the patient is presenting with, giving us an initial diagnosis.
Knowledge of allergies is also important, as this may be the reason why the patient is having trouble, or if the patient is allergic to the various medications that we may administer.
Medical history that can influence the physiology of the patient. Past medical and surgical history will indicate if the patient is suffering any medical condition, such as diabetes, high blood pressure etc and past surgical history will indicate major surgeries, such as bypasses.
This question can be far ranging but depending on the type of crash, finding out if there were any particular symptoms experienced by the patient ( eg chest pain ) prior to the crash and if the patient has any significant medical history of an illness that may affect driving are of vital importance.
There may be important co-morbid diseases to be aware of. (Heart problems, obesity, bleeding tendencies and general health).
What are the most important emergency procedures to avoid where no health/ medical history is available?
All life-saving procedures should be done when they are required. Most complications can be treated by medical professionals.
Each patient is assessed as an individual and the risk of performing a procedure or administering a certain medication is always assessed against the benefit of performing the procedure or administering the medication. Having the history allows the paramedic to make a more informed decision.
Any medical person requires consent from the patient to assist them. There are different types of consent that can be obtained from patients in different situations.
Informed consent: This is where a patient is fully conscious and able to communicate. The patient is able to fully understand you and gives verbal permission for you to treat and assist them. (e.g. the patient tells the paramedic, “Please help me”)
Expressed permission: This is nonverbal consent, e.g. the person can’t talk but say, gestures for help or the parent of a child gives permission to treat their child who is a minor.
Implied consent: This is where a person is unconscious and there are no family members present and the patient requires medical assistance, the practitioner uses implied consent to provide medical assistance.
Paramedics will try to ascertain the information but will still treat the patient even if this information is not available. As for the first responder, no procedures should be attempted on the patient if the responder is not properly equipped or trained.
These procedures can include and vary from CPR to the improper use of medical equipment. Attempting any emergency procedures, if done incorrectly can cause further harm, and even death, to a patient.
Everything is to be treated as a worst-case scenario. Ensure the spine is correctly and safely immobilized. Conduct the necessary vital sign assessments. Precaution is always the best method of prevention.
- Thrombolytics (ONLY APPLICABLE TO STEMI patients and not road crash victims, unless MI caused accident and where no other injuries are suspected)
- Allergies to specific medications. But with no history, we will proceed treatment as needed.
What is the medication you may need to stay away from administering to those unable to communicate?
Each patient and scene are different and will be assessed and managed differently by the emergency care practitioner. Again, depending on the situation and illness/ injury and its severity the risk of administering the medication is weighed against the benefit of administering it.
First responders should as a general rule not give any medication to patients under any circumstances. Without knowing the indications and contra-indications of medication, the first responder may cause further harm and even death to a patient. Medication should only be administered by a registered, medical professional.
- Thrombolytics (ONLY APPLICABLE TO STEMI patients and not road crash victims, unless MI caused accident and where no other injuries are suspected)
- Only contraindicated medication for specific problem (like giving morphine for pain when the patient is hypotensive)
Where the person is injured to the extent that he/she cannot communicate, what are the evidence as to the identity and medical history you would be looking for?
- The most common way is to check for identification the person may have on their person or in their car.
- There may be someone who knows the person who is also on scene.
- Family members can also be of assistance.
- We will look for any form of communication on the patient such as a bracelet etc.
- There are hundreds of products that you can register with to store your medical details.
- These can range from medical alert bracelets, apps for mobile devices, emergency information stickers for vehicles. This can give emergency personnel vital information, should the patient be unable to communicate.
What are the best types of medical identification you have found on the scene of road crashes?
- The most common devices or forms of identification are those found on the patient.
- These items are generally best as paramedics will do a quick search of the patient for any forms of emergency medical identification.
- Other options that are generally good or sufficient are emergency stickers on vehicles as well as apps on mobile devices.
- Medic Alert bracelets or tattoos are the most definite as we know they belong to the patient in question.
- Medical aid cards are often used to identify people.
- ICE- Cell phone number on phone if accessible.
- Wallet with all medical details.
- ID books and driver licence.
Have you ever come across some of the following reasons why road crash victims are unable to communicate - and what advice would you offer to emergency personnel in these situations?
- Crash victims who are deaf or mute.
- The elderly and those suffering from Alzheimer’s.
- Young children.
- Intellectually handicapped crash victims.
Any other reasons you have come across?
- It is not uncommon for paramedics to treat patients that have the above-mentioned ailments.
- Dealing with patients with these and other ailments can be a very difficult and timeous process for both the patient and the emergency professional.
- Therefore it is imperative that community members should have some sort of medical identification that will give paramedics the information they require.
- Advice to paramedics is to use all means necessary to gain the medical information that is required. Contacting interpreters or legal guardians of children can sometimes give the means to acquire the information.
- Paramedics can use various means of communications to get the information required.
- Regardless of the reason, we will get the persons full attention and have only one person to speak to the patient at a time.
- We will also speak slowly, use hand gestures if needed but it all depends on the situation.
Advice on the above scenarios could include the following:
- Crash victims who are deaf or mute: Often initial recognition of these patients can be difficult. If you can establish that they are deaf or mute, then the simplest way to communicate can be using a pen and paper. Show patience - these patients can still communicate, sign language or even writing if need be. Get something for them to write on or use a cell phone keyboard to communicate.
- The elderly and those suffering from Alzheimer’s: The biggest challenge with these patients is addressing their fear or sense of disorientation. Work on trying to keep them calm, and contacting the family, loved one or caretaker to assist. Be prepared for lots of questions on what happened and have patience. If that’s not possible, treat the patient symptomatically and communicate with the patient as to what you are doing. Often these patients can easily be overwhelmed.
- Young Children: Children fear losing control over their bodies and are often scared of strangers. When dealing with children, win their trust and try to keep them in contact with people familiar to them. Also, speak to them on the same level, rather than speaking down to them. Be friendly and keep the child’s focus. A friendly smile during a traumatic time always helps a child.
- Intellectually handicapped crash victims: Win their trust and keep them close to their parents or family members. Communicate openly with them, and don’t speak to them as if they are stupid. Be friendly and patient. Treat symptomatically
- Mentally ill/ disturbed patients: They are always a challenge. Don’t stay and play. As soon as the patient is in your ambulance, go to a hospital and put on child lock and lock the doors of ambo. Be at least 2 guys in the back and keep the Dormecum close.
Is special caution required where crash victims may be drunk or drugged?
Personal safety should always be looked after first. If the patient is in any way violent request help to the scene before attempting to assist the patient.
Paramedics do need to take special care and precautions when dealing with patients that they have believed to be intoxicated, aggressive, high or psychotic.
Local authorities should be called to the emergency as patients that may be intoxicated may be difficult to attend to, and investigations need to be completed. Unfortunately, intoxicated patients may not be able to give you medical information, and the alcohol consumed my compound any injuries or ailments that the patient may be suffering.
Patients to be treated as per their vitals and symptoms. We will heed the evidence on scene and communicate to the doctor at the medical facility on hand over.
Where the seriously injured are unable to communicate but there are others in the vehicle - how would you ascertain that the info from them can be relied upon?
- Depends on the situation. We sometimes say that paramedics are “medical detectives” -The best way is matching and comparing the information given with the patient’s condition.
- You can never be completely sure when information is given by others. Information can be verified using ID or drivers licence documents
- We will ask the others how they are related to the injured, how well they know them. Again, while we will heed what they say, we treat each patient symptomatically.
- We always try and speak to direct family members only to obtain a medical history, even if we have to phone the father or mother at 2 am.
- Paramedics will still treat a patient, even if we cannot access the medical information. We cannot forgo treatment due to the lack of personal medical information.
- Paramedics will try to gain access to this information via various legal measures, even by calling the family members or loved ones of the patient.
How would you approach people e.g. foreigners who are not English speaking to gain insights into medical information, allergies etc?
- The first challenge is to establish which language the patient speaks. You would need to be able to communicate with the patient to get consent for medical procedures.
- Sometimes very difficult but we try and get a friend that speaks both languages to obtain a history and explain what we are doing. And keep the dorms close especially in flight.
- There are several interpreter services that can be utilised and called telephonically during emergencies to help with interpreting from the patient to the paramedics.
- In the rare occasion that this is not possible, utilising translation apps such as Google Translate on mobile devices can provide a rudimentary translation of the patient and emergency personnel.
What would be your best advice to road users with regards to making identification and medical history easily available?
We would advise motorists to investigate further means of making your medical information available to medical services in an emergency, should you be unable to do so. By having this information available, this can aid paramedics in giving you the correct and appropriate care that you require.
- Keep your ID or drivers licence, medical aid details and next of kin contact details with you or in your bag where it would not be able to fall out.
- Some services provide a wrist band with a unique number and a contact number for emergencies.
- Store an ICE number on your phone.
- Put a medical aid card in your wallet and a spare one in your vehicle.
- Get a key holder with your medical details on.
- If you suffer from any chronic condition, invest in a medic alert bracelet.
- Medical stickers should be visible on your vehicle.
- Emergency apps on mobile devices could direct paramedics to services who may have your details.
Any aspects not discussed in this Q&A which is important to share with our road users and emergency providers/ first responders?
- Be safe,
- Make space for the EMS vehicle,
- If there are EMS on scene, don’t stop - drive past to your destination
- Your safety first
- Save your local emergency number on your phone!
A word of appreciation to the following individuals for their kind assistance:
Robert McKenzie, KZN EMS
Russel Meiring, ER24
Nick Dollman, Netcare 911
Kyle Van Reenen, Crisis Medical
Pieter Oosthuizen, Life Healthcare