Small Investment, High Yield

     This month we'll cover a few topics. The first is a method of teaching triage my students and I call "bottle drills." I learned this from my good friend and mentor, Jon Politis.

     How do you teach triage without staging a full-blown multiple-casualty incident? And do so in one class session, so each student gets practice triaging? I'll tell you.

     I ask all of my students to bring in two-liter soda bottles. I always bring a few extra, just because. Before class I use standard mailing labels (the kind you run through your printer) and create "patients." If you create the "patients" in a word-processing program in mailing-label format, you can print them out over and over again.

     The labels are stuck to the bottles. The data on the labels should match the triage system you're teaching. For example, the START method must cover the components of respiratory rate, radial pulse/cap refill and ability to follow commands. A few sample patients might include:

• A patient with a minor head laceration who walks over to you and offers to direct you to the accident scene (walking wounded--green).
  
• A patient with a penetrating wound to the anterior chest; pulse 126, respirations 32, blood pressure 98/68, skin cool and moist (red).
  
• A patient found sitting against an overturned vehicle with an obviously fractured leg and a bruise on his forehead. His respirations are 24, radial pulse 96, BP 106/58. Upon request he is able to point to where it hurts (yellow).

     More complex tags can be created that specify, for example, whether the airway of an unresponsive patient remains open after intervention. You may wish to create several sets of patients. Your classroom MCI can have as many or as few patients as you wish.

     As the students perform triage, they must actually tag each patient. I use surveyor's ribbon, which I purchase for about $1.50 a roll at my local hardware store. The students receive rolls of red, yellow, green and black ribbon, which they tie around the bottles when they make triage decisions. This ribbon is easily removed for the next student.

     Triage is about decision-making. This small-investment, high-yield classroom exercise not only allows students to practice making decisions, but also to actually "tag" each patient. You'll be amazed at the anxiety this simple exercise can generate--and you won't have to run a MCI drill to get experience for your students. It makes a great training session for experienced providers, too.

To glove or not to glove...
     April's Question of the Quarter, which asked when you teach students to don their gloves, brought some passionate and well-articulated responses.

     Fifty-three percent of respondents said students should be taught to glove up for every call, while 47% believed BSI should be determined on a call-by-call basis and (gasp!) gloves may not be required every time. Virtually all, however, believed that decision-making is important.

     Many noted that their trainees' level of experience made a difference in their approach. Others felt that if we give EMT-level students the ability to assist with medications and make other important decisions, BSI should be a no-brainer. All interesting points.

     I don't prejudice the discussion by offering my opinion when I ask the question each quarter, but I will chime in at the end--I'm the tiebreaker. Many of the things we do in EMS move far to the left, then right, then ultimately settle somewhere in the middle. I was out there in the late '70s and early '80s, when your level of coolness was based on how much blood you had on you (yes, we were dumb). I was there later in the '80s, when HIV became more prevalent and we resembled mummies from layering on so much BSI. And now I think we may be approaching the middle. Wear what you need, when you need it. And err on the side of caution.

Question of the Quarter
     The end is near. Have you ever felt that way as you near the completion of a course? Students are stressed and wondering if they'll pass. Frankly, we often have the same feeling, even if we don't show it.

     When our students leave, are they ready for the street? Can we, in fact, send people out the doors of our classrooms and into the backs of ambulances by themselves? Agencies certainly want that. What role does orientation, on-the-job training and mentoring have to do with being ready for the street?

     The question: Do you expect your students to be "street ready" upon graduation from your class? Why or why not? E-mail me your thoughts at danlimmer@mac.com.