EMERGENCY! Essential Question: Who Do You Call? Learning Targets: Students will: Use subjective and objective information to make sense of an emergency situation. Use evidence to form a hypothesis. Deliver an effective oral summary. Lesson Overview Be prepared for an emergency! In this lesson, the students take a first person role as a Level I Emergency Medical Technician first responder. An adolescent has an accident skateboarding while at a day camp. A junior counselor calls the camp director, a trained first responder, who responds to the call and delivers the initial care to the patient. Students learn about subjective and objective information and apply this new knowledge as they perform a primary and secondary survey of their patient. They summarize their findings in the form of the D-Chart, a standard format in the medical profession. 1
Lesson Agenda Opening (15 min) Work Time Health Science Bingo (5-10 min) Emergency! (5 min) The First Responder (5 min) Making Observations (15 min) The ABC s of Emergency (15 min) Emergency Simulation: D-CHART (20 min) Closure (5 min) Patient Transfer of Care Materials Projector Skateboard accident video Young Allied Health Professional student packet D-CHART Patient Assessment Form (for teacher reference) FACILITATION NOTES Video Alert. This lesson contains some mildly graphic imagery of a skateboard accident patient. Be aware of negative student reactions to media and provide a verbal warning prevideo. Narrative Arc. This lesson and others in the unit take advantage of the first person narrative storytelling style. You may choose to have students read each narrative independently with accompanying warm-up questions, engage in a think-pair-share, or act out the scene. Use your creativity to craft an engaging opening sequence with the scenarios, and plan ahead for each enactment. o If you can invite a first responder or EMT to play a role in this lesson s enactment, do so; if not, watch the short videos provided below to model proper procedures to the class. Don't worry if it isn't perfect just remind the class that you are not a trained first responder. o You may also consider inviting a Red Cross volunteer to teach First Aid/CPR to the class. Simulation. Invite a volunteer to be a patient for today s lesson. Alternatively, you can have a student assume this role, briefing them beforehand. To increase engagement, you can also have students work in small groups, each with their own patient (one student patient, four young first responders). If following this model, prepare an activity for the whole class to prepare the patient s makeup. 2
Modeling. Take 5 minutes to watch the primary and secondary survey videos to understand and model correct procedures. See below for links. System for Organizing Student Work. The Young Allied Health Professionals will have many handouts, annotated readings, and processed work with this module. In advance, determine how you will support them in consistently keeping their work organized. https://vimeo.com/channels/managementactiveclass/124448650 offers a brief overview. IN ADVANCE Have volunteer patient be ready for the simulation in make-up and attitude they should be prepared to act wounded. You should be ready to enact the narrative emergency scenario. Be prepared with the technology required to project the video: https://www.youtube.com/watch?v=ko8a0qjqpj8. Project only the first 30 seconds with the sound off. This short video has the purpose of building background knowledge what kinds of injuries might a first responder expect on the scene of a skateboarding accident? A first responder would expect possible broken bones, head injuries, and lacerations. Review this short video of the primary survey: https://www.youtube.com/watch?v=n8trhehlaqu. Review this short video of the secondary survey to model accurately for students. https://www.youtube.com/watch?v=7xanz0ijges (2:48). o To watch a full interaction including both primary and secondary surveys, see this video: https://www.youtube.com/watch?v=hxqamx2ayik (10 minutes). This models professional patient care and will provide you with a general overview of the first responder experience. For the school setting, skip checking pelvis or inquiring about genitals. Decide if you want to include the D-chart activity or allow additional time for the simulation. Vocabulary Content acronym, airway, circulation, respiration Tier II summary, summarize, episode, observation, standardization, subjective, objective 3
Opening (15 min) Health Science Bingo (5-10 min) Say: Good afternoon young professionals! Did I just call you a young professional? Yes! In this class you will take on the roles of different health science professionals on the job from the scene of an emergency to the operating theater as you follow your patient from health to recovery. You will learn what different allied health workers do, and do some work yourself. You will even get to practice suturing, or giving stitches, but your patient won't be human. For now, let s take a moment to get to know each other and learn a little about each other. In today s handout, you have a <Health Science Bingo> game. In a moment, you will: 1. Walk around the room and introduce yourself to a new person by looking them in the eye and saying Hello, my name is. 2. Ask if any of the boxes apply to them. o Ask the question and listen to their answer. 3. Have your partner write their name on your sheet. 4. Next, you will share something about yourself and sign their sheet. 5. Finally, you will shake hands and say Thank you, (name) and they will say Thank you, (name). Model this with a volunteer, keeping your answer short but interesting. o Remember the final shake, thank you, and repeat of the name. This activity has multiple purposes. First, it helps the YP s get to know each other; second, it activates background knowledge, which supports connecting new content to background knowledge a predictor of new learning; and finally, the formal greeting and closure model professionalism. Hand out the day s packet, inviting the YP to turn to the Human Bingo page. Debrief. As young allied health professionals, we need to know our teammates and have some clear norms for how we will function as a group. If things were chaotic at a hospital, could you imagine how that would affect patients? Use equity sticks to solicit responses. 4
Emergency! (5 min) You are the director of a summer day camp. As part of your training to work with children, you became a certified first responder. In the middle of your morning office work as children are arriving for the day, you receive a phone call from a junior counselor. She reports that a 13-year-old male camper is unconscious and bleeding on the sidewalk in front of the community center building. You leave your office at a run. Share <Emergency Scenario: First Response>. 1. Have the young professionals close their eyes. 2. Ask: What scenarios are you seeing when you picture the scene provided by the junior counselor? What might have happened from worst-case to best-case scenario? Increase engagement by acting out this call. In advance, set your cell phone alarm to ring. After the ring, take the call by acting out the scenario, taking care to verbalize as many details as possible. o Provide adequate think time for the young professionals. o Invite the young professionals to turn to a colleague and pair-share their ideas. o Call on volunteers to give their imagined scenarios for the patient. o Capture their ideas on an anchor chart or on the board. Work Time The First Responder (5 min) As a first responder to emergency events, figuring out what is wrong with a patient is like solving a mystery. You collect data like clues to help you narrow down what is happening to the patient. This begins with the emergency call. You imagine every possible reason for the general symptoms listed in the call from worst case to best case scenario. As you run to the incident, your mind cycles through all the possibilities: what could be wrong with the patient? By answering this question, you are trying to figure out what happened to the patient to give him/her the best care. Reveal the patient, with makeup to reflect the wounds from the <Emergency Scenario>. The patient makes an appearance with a skateboard (can be a cardboard cutout or paper that reads skateboard ). At first, the patient can moan in pain. After that, the patient should become unconscious and should not respond to any questions. 5
Ask students questions such as: What do you notice about the patient? Are there any new clues now that we are on the scene? What should I do first? Next? How do you know? Listen for: a skateboard is located near the accident patient. Check to see if they are breathing or bleeding. Stabilize their neck. Make sure the scene is safe. Making Observations (15 min) 1. Ask the YP s: The skateboard is a clue about what has happened. In a first responder s mind, they work through the list of possibilities. What scenarios are more likely based on this clue? Which ones are less likely? o Mark through any scenarios on the chart paper that have been eliminated. 2. Explain to the young professionals that the initial assessment by first responders combines subjective with objective data. Subjective data is based on what someone tells us. For example, someone saying his legs hurts is subjective data. Objective data is something you can observe or make an observation about: he has a four-inch laceration, or cut, on his leg. Objective data often can be measured: an increase in temperature, low blood pressure, a tumor, or a four-inch laceration. 3. Ask the YP s: What is an observation? o o Invite volunteers to answer the question. Listen for: An observation is when you directly hear or see something. 4. Project the first 30 seconds of the <Skateboard Accident Video> with sound off: https://www.youtube.com/watch?v=ko8a0qjqpj8 o Ask: What injuries might you expect someone to have who just crashed on a skateboard? o Listen for: Possible broken bones, head injuries, and lacerations. 5. Since our patient is unconscious, we will have to look for objective data. Ask the young professionals to turn to a partner and share what they observe about their patient. o Have students complete the <Subjective-Objective Observations T-Chart> in their student packets, observing the patient to gather information. o Use equity sticks to solicit examples of objective observations. o List observations on the board. 6
The A, B, C s of Emergency (15 min) 1. Ask: When you have a serious accident, certain systems within the body can be damaged. Which systems would present the greatest risk to your patient? (Scaffold, if necessary: The body is made up of various systems and subsystems that rely on each other to function properly. Some examples of systems include the nervous system, the digestive system, the circulatory system, and the respiratory system). o What could kill your patient before they even get to the hospital? 2. Call on volunteers to answer the question. Listen for: blocked airway, not breathing (respiratory system); heart not beating, bleeding out (circulatory system). 3. Explain to the young allied health workers that first responders and EMT s focus on the A, B, C s: airway, breathing, and circulation. Ask: Why are the ABC s priorities? 4. Say: Keeping the airway clear is a very important intervention by first responders and EMT s to maintain adequate respiration, or breathing. The acronym for checking respiration is ABC check the Airway, Breathing, and Circulation. [Circulation promotes movement of oxygen throughout the body and is also the letter that reminds you to check for any major bleeding another major risk]. 5. Ask: What is respiration? o Invite volunteers to provide an answer. o Listen for: Respiration is the act of breathing. Tell the young professionals that without oxygen, the brain tissue begins to die after about 3 minutes. That is why the A, B, C s are a priority on any accident scene. 6. Say: Let s see how trained first responders do a primary survey. https://www.youtube.com/watch?v=n8trhehlaqu (1:47) 7. Invite/Select a volunteer to come and check the patient s ABC s based on what they saw in the short video. If using the multiple patient/small group model, have one person from each group check their patient. o How can you check to see if someone has an open airway? If they are breathing? If they have circulation? (Listen for: watch to see if they are breathing, check their pulse, watch the rise and fall of their chest, ensure there is no life-threatening bleeding, if they can talk they can breathe, etc.). For this simulation, the patient has clear ABC s. 8. Share: Our patient does not have any immediate threats to their ABC s. This means we can move on and continue a secondary survey: a quick head-to-toe exam. 7
o If the patient had a threat to their ABC s, as first responders, what would we have to do? (Listen for: Treat the threat so it does not kill the patient.) o Why would we want to do a secondary head-to-toe survey before transporting them to the hospital? (Listen for: To catch any immediate threats, to document history and other important information.) 9. Select a different volunteer to assist you with the secondary survey, starting with the head and working towards the feet the video that will quickly show how to model this. The D-Chart: Communication Is Important (20 min) You will now use your observations to help you write a report of your initial encounter with the patient. While the paramedics give more advanced treatment to the patient and prepare him for transport in an ambulance, you sit and write your report. 1. Explain: Even first responders must communicate their observations, findings, actions, and any other data to the providers at the next level of care for the emergency patient. 2. Inquire: Why would it be important to take and pass on notes? 3. Say: These notes are standardized meaning that they follow a form that everyone in emergency services uses. The format generally follows the acronym D-CHART. An acronym is when each letter in a word is the beginning letter of a related word. An example of an acronym is LOL, or laugh out loud. Acronyms also help us remember: ROY G. BIV is used to remember the order of the colors in a rainbow. o Ask: What acronyms do you use? If we think about reporting from the scene of an emergency, what might the acronym D-CHART stand for? (Chief complaint, history, assessment, treatment (Rx), transport). 4. Take a few suggestions for what each letter might stand for in the acronym to activate background knowledge. Ask students to turn to the <Patient Assessment Form>. 5. Invite the young professionals to work with a colleague to try to complete the D-CHART notes for the clinic records. 6. Tell the young professionals that they can re-read the script and use their observations to help them write the patient assessment notes. 7. Circulate and assist pairs as necessary. Refer to the Patient Assessment Form for teacher reference if needed. 8. When pairs have completed the form, ask the young professionals: Which parts of the D-CHART report are subjective and which are objective? How do you know? 8
9. Invite pairs to discuss the sections of the report to prepare their responses to the questions. 10. Use equity sticks to cold call on pairs to provide answers. Closure (5 min) Patient Transfer of Care: Role Play You are now ready to complete the transfer of the patient to the Emergency Medical Technicians aka the EMTs. The final step in the process is to talk to the EMTs about the case and the actions you took to support the accident patient, essentially summarizing your written D- CHART report. 1. Ask: What does it mean to provide a summary for or to summarize the report? o Invite volunteers to answer the question. o Listen for: Providing the main points of the report. 2. Explain that they will choose a colleague. One person will be the certified first responder, and the other will be the EMT. 3. Tell the young professionals that they will have two minutes to role play the transfer of the patient by providing the EMT with a verbal summary of the case. 4. When the pairs have finished the patient transfer role play, ask the young professionals to respond using the Thumb-O-Meter. Thumbs up indicates that the summary was very clear and thumbs down indicates that the summary was hard to understand and they can also choose in between. o If you were the EMT, how easy was it to understand the summary of the patient s case? Did you understand the scene of the accident? Was it clear what support the first responder provided? o If you were the first responder, how clear was your summary? What parts needed more work? If this was difficult, don t worry. Certified First Responders and EMTs go through many hours of training to assess accident scenes, understand common medical emergencies, and practice appropriate treatments. If you like constant excitement, can handle the pressure of life and death, and can stand the sight of blood, the First Responders of the allied health professions might be an interesting career choice. EMT s, paramedics, and emergency room nurses and doctors are often the first link into the health system for those experiencing a critical incident or 9
accident. If you have good judgment under pressure and the ability to respond in a crisis, as well as the patience to learn new skills, these careers might be of interest to you. 10
Name: Date: EMERGENCY! Who Do You Call? Today s Learning Objectives: I can: Use subjective and objective information to make sense of an emergency situation. Use evidence to form a hypothesis. Deliver an effective oral summary. Be prepared for an emergency! In this lesson, I will take a first person role as a Level I Emergency Medical Technician first responder. An adolescent has an accident skateboarding while at a day camp. A junior counselor calls the camp director, a trained first responder, who responds to the call and delivers the initial care to the patient. I will learn about subjective and objective information and apply this new knowledge as I perform a primary and secondary survey of the patient. I will summarize my findings in the form of the D-Chart, a standard format in the medical profession. Today s Activities: Health Science Bingo Emergency Scenario Making Observations Patient Assessment: D-CHART 11
Health Science BINGO! Find a young professional who... Had broken a bone. Ask: What did you break and how did it happen? Has had an X-ray. Ask: What did you have X-rayed? Has a friend or family member that works in a hospital. Ask: What do they do? Wants to work in the health sciences? Ask: What do you want to do? Rides a skateboard. Ask: What is your favorite trick? Has had stiches. Ask: How many stitches did you get and why? Has seen the medical TV show Grey s Anatomy? Ask: What is realistic about medical TV shows? Has ridden in an ambulance. Ask: How old were you? Has a favorite TV show set in a hospital. Ask: What is the show and why do you like it? Is not afraid of blood. Ask: How would this help you as an EMT, nurse or doctor? Has had a tooth knocked loose or out. Ask: What happened? Has been hurt playing a sport. Ask: What sport were you playing? Knows their blood type. Ask: What type are you? Has visited someone in the hospital. Ask: What medical professionals did you see there? Has had blood drawn. Ask: Did you look? Has been helped by a medical professional (doctor, nurse, EMT, etc.) Ask: What did they do to make you feel comfortable? 12
Emergency Scenario: First Response You arrive on the scene to find the unconscious, bleeding body of the accident patient surrounded by the junior counselor and bystanders. You survey the crowd to determine that the scene is safe and that there is only one patient. Next, you put on latex gloves and begin to inspect the patient for immediate threats to his life by assessing his ABCs: airway, breathing, and circulation. The counselor tells you that the patient was skateboarding at a high speed when he tried to jump a railing and crashed; she reports that she already called 911. Even as you survey the patient s injuries and try to bring him to consciousness by touching his shoulder, he remains unconscious. You note that he is breathing normally but he has sustained a severe facial laceration, a deep cut in the skin. The laceration extends from the side of his nose through both of his lips, exposing bone and teeth. You begin to work to stop the bleeding. After caring for the patient s face, you request that the junior counselor hold his neck to stabilize his C-spine a vertebra in the neck. This helps prevent spinal injuries when you turn him on his side a practice used so patients do not aspirate, or inhale vomit. You then collect data on his vital signs. During the course of your assessment, you also identify that the patient has a broken arm. You proceed to splint his arm, as you wait for the ambulance to arrive. You place a blanket over the patient and pat his shoulder, saying, You re doing fine. Everything will be OK. You check his pulse again and his heart rate has decreased. The City Emergency ambulance arrives and you transfer the patient s care to the Emergency Medical Technicians the EMTs. 13
Subjective-Objective Observations T-Chart Subjective Observations Objective Observations 14
The D-CHART Patient Assessment Form D Dispatch What was reported to you in the emergency call? What info were you given? C Chief Complaint What does the patient say is his or her chief complaint? If there is no information, make your best guess. H History History includes the patient s age, sex, how the injury happened, any allergies and medications being taken, and other medical history. 15
A Assessment Include a statement about how and where you find the patient upon your arrival. Include results from the primary survey (ABC s): Share results from the secondary survey (head-to-toe exam): R Treatment (Rx) Describe all treatments and interventions done in the field. T Transport Describe how the patient was transferred and to what location. Record time and patient status. 16
Facilitation Documents: The D-CHART Patient Assessment Form for Teacher Reference D Dispatch (Subjective- based on what dispatch heard from someone else.) What was reported to you in the emergency call? The junior counselor communicated that a 13-year-old male camper was unconscious and bleeding. He was located outside the community building lying on a sidewalk. C Chief Complaint (Subjective- based on the opinion of the patient.) What does the patient say is his or her chief complaint? The patient is unconscious and does not communicate a complaint. H History (Subjective- based on being communicated by the patient or others at the scene not directly observable). History includes the patient s age, sex, how the injury happened, any allergies and medications being taken, and other medical history. The patient is a 13-year-old male. He sustained injuries while skateboarding at high speed and jumping a railing. A Assessment (Objective- based on data collected with instruments.) Level of Responsiveness Heart Rate Respiratory Rate 17
Skin Color Blood Pressure Pupil Response Temperature R Treatment (Rx) (Objective- based on it being what you actually did for the patient.) Describe everything you did to treat the patient in the field. In the field, the patient s bleeding from his facial laceration was controlled. His arm was splinted and his spine stabilized. He was provided a blanket and words of comfort and his heart rate decreased in response. He was prepared for transfer of care to the EMTs. T Transport (Objective- based on it being what you actually did for the patient.) Describe how the patient was transferred and to what location. The patient was transferred to the City Emergency Ambulance service EMTs. 18