Your Captain Speaking: An Acronym for Every Call

“Samantha, I run this acronym through my head on every call. Actually, I run it over and over again—even if the scene is normal, but especially if it’s chaotic or confusing. And after the call when I’m writing the report. If there’s an EMS secret that makes sure I don’t miss the basics, this is it.”

There are things we need to consider on every call, medical or trauma. Here’s where I start: Never skip the basics. Any organization, from sports teams to the military to EMS, can get in trouble if it strays from the basics.

A good leader will recognize this and get the team reset. I focus on the basics using this acronym: PSI ME GLOC ABCD. It isn’t easy to spit out, but it puts things in the correct order on a call of any kind.

PSI ME GLOC ABCD in Action

The tones drop for a vague “sick” call, off we go. While en route I start through my list for both my partner and myself.

P stands for personal protective equipment—our universal precautions. Before COVID-19 we would just wear gloves, but depending on the type of call, that changed to much more PPE. We learned to double-glove. In the beginning of COVID-19, we’d just wear surgical masks; that evolved to two-layered masking or N95s, not to mention face shields and gowns. If the call is along a roadway, we’ll need reflective vests and flashlights. We review together what we’ll need to be wearing and grabbing.

S stands for scene safe. Some of this can start miles from the call. If the “sick” call’s in a bar after midnight, it would be prudent to ask the dispatcher if the scene was reported safe. Scene safety starts with the radio call and continues through the windshield as you approach the location. If it’s not safe, you stage and don’t open the door—just as the captain of an airliner can refuse to release the parking brake if they’re not satisfied they can begin a flight safely.

Scenes can go from what appears safe to unsafe. There can be warning signs if you pay attention. Recognize the change. Beyond physical safety, maybe a patient is more contagious than you were led to believe. “Scene safe” is not a one-and-done evaluation on a call.

I stands for initial triage. Note that’s initial, which means we need to repeat it a few times. Scenes change.

Many years ago we responded to an MVC with two cars. One driver, a female, was hurt badly; her car was otherwise empty. She was verbally clear about where she hurt and wanted me to hurry up. We had her trauma-packaged and ready to go when a man walked up to me holding a 1-year-old in his arms and asked, “What should I do with the baby?”

Baby? What baby?! The baby, who was unhurt, was in the backseat, and the bystanders had taken it out of the car before our arrival. Sometimes not all the patients are where we think they should be. That call troubles me to this day. The mother never asked how her baby was to give me a hint, but neither did I ask the patient or bystanders if anyone else was involved. Afterward I started to check nearby ditches for others down.

Initial triage also means to reevaluate the patient(s) frequently. If I’ve done a procedure or given a medication, is the patient doing better, the same, or worse?

M stands for mechanism of injury. This is pretty straightforward from your training and CE, but we look for the subtle, not just the obvious. On a medical call, what is near the patient? Lots of different medication bottles, perhaps? What odors are present? For an MVC, where is the damage to the car? Did air bags deploy?

E stands for equipment. What equipment or additional equipment will we need? By now we’re getting a feel for what the call is really about. In some cases we can determine a need for additional responders or equipment even before getting out of the ambulance.

G stands for general impression. Now we’re eyes-on with the patient. Do they look up as you enter the room? What position are they in? What’s their color? How active are they? Can you hear their respirations from across the room? Look around and take a moment to let the scene talk to you.

LOC stands for level of consciousness. The gold standard for evaluating it is the Glasgow Coma Scale (GCS). Now we’re interacting with the patient and if they’re responding verbally can attempt to drill down on their orientation.

ABC stands for the classic airway, breathing, and circulation. Now we debate if it should be changed to CAB, but for my 22 years it was ABC and worked for all types of calls, medical or trauma. Our opinion: CAB for cardiac arrests, ABC for everything else. We could go on at great length for specific items to look for and check here, but that’s not our purpose. Just don’t get stuck on one element and forget the other two.

D stands for decide and do something. This could be the most important step of all. Getting a patient history can take a long time and in some cases is very necessary, but in others deciding what to do is way more important. Decide your course of treatment and follow through by doing it.

The More Things Change

Situations can change as we go through a call. Sometimes things are going well, then suddenly turn into a giant cluster. PSI ME GLOC ABCD always gives you a path. Fall back and restart the acronym.

Here’s a true story: We entered a room expecting “My grandfather fell down” and indeed found grandpa on the floor, but with a knife in his abdomen being held by a family member. To restart the acronym here, our PPE was still OK, but was the scene still safe?

(Turned out it was. The wound was self-inflicted, and the family member was simply holding the knife in place. The family didn’t want the police to respond so limited its 9-1-1 call to, “My grandfather fell down.”)

When you complete your patient care report, PSI ME GLOC ABCD lets you review the order of the call and document all these important aspects. Your reports will be more complete, consistent, and professionally written.

If you’re not systematic in your approach, it’s easy to slip and miss critical steps. Feel free to devise your own acronym, but it will need to include all the items mentioned, pretty much in the same order. Lock it in as your own but run through it on every call. It’s not in any textbook spelled out like this, but it works.

Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air for 22 years and an Air Force pilot for 22 years.

Samantha Greene is a paramedic and field training officer for the Illinois Department of Public Health Region IV Southwestern Illinois EMS system, a paramedic and FTO for Columbia (Ill.) EMS, and a lieutenant for the Madison (Ill.) Fire Department. She was recently recognized as a GMR Star of Life.