The CBAs of EMS
So far it's been a quiet Saturday morning. The ambulance has been checked out and the breakfast dishes are washed and put away. Suddenly tones drop for an unknown problem -- man down at a church. You and your partner jump in the ambulance and race to the scene. While en route you think about all the possibilities of what could be going on. If only dispatch could've gotten more information from the caller. Upon arriving you see a small group of people surrounding a bench outside on the sidewalk. You make your way to the center of the mass of people and see a man in his sixties sitting on the bench clutching his chest. What do you do next?
Since the beginning week of EMT class, instructors drilled into your head the ABCs: Airway, Breathing and Circulation. When in doubt go back to the basics and keep the patient's ABCs going. Whenever a student just so happens to sign up to ride on my ambulance, I try to instill the CBAs of EMS into their overworked brains. Quite simply, it's the order of treating a patient. First, Communicate; second, Basic Life Support; and lastly, Advanced Life Support. By going back to the scenario and following these steps you can always remember how to treat the patient. Without talking to the patient (communication) you wouldn't find out if the patient is having chest pain, was hit in the chest by something or in this case is grasping the cross on his necklace.
Communication
The ability to verbally communicate with others is one of the major differences between man and animals. To be able to explain to a fellow person what we are feeling or experiencing is a major evolutionary trait -- so let's use this important tool to our advantage. Walking up to a patient and calmly asking, "What is the matter today?" goes a long way. With a calm and caring voice, we instill confidence and hope in our patients. You can't treat what you don't know about. Whereas trauma cases are simple and straight forward, medical calls are not that simple -- you can't see a chest dysrythmia. Not only that, but you still have to get consent to treat a patient.
Communication with the patient is not the only communication we use during a call. We have to communicate with dispatch, our partner, the first responders and the hospital. Just like you, they all have a job to do so our patient has the best chance of survival.
Basic Life Support
After talking to the patient, you begin caring for the patient. Vital signs are taken and oxygen is usually started. Depending on the protocols you use, EMTs can start giving the patient nitroglycerin and aspirin if it's a chest pain call. Bandaging and splinting is performed depending on the situation.
Every call will need some sort of BLS care. Depending on your certification level this might be the highest care the patient gets. EMTs usually have no trouble performing BLS care. However, some paramedics tend to forget the BLS part and focus on ALS only.
Advanced Life Support
This is what makes all the school and hard work pay off. Here's your chance to do all the neat things you've been training on: cardiac drugs, intubation tubes and other advanced procedures that have shown to benefit patients. After talking to the patient and getting their complaint and BLS care has been done, ALS care begins. Start that IV, interpret the EKG strip and get the drugs ready if needed. Studies come out all the time, changing procedures and protocols almost daily it seems. New drugs come out monthly and EMS personnel need to keep updated on them.
ALS care can usually be performed by both EMT-Is and Paramedics depending on local protocols. It may be something simple such as starting an IV or just placing the patient on a monitor. Treat the patient according to local protocol and do what's best for the patient.
So what's the next step?
So you're up to doing ALS care on the patient, but that doesn't mean you can't back track. For example you have a chest pain patient and you give him a dose of nitroglycerin. After the nitroglycerin you have to ask the patient if it did anything. That's communication with the patient. Then you have to take a blood pressure to see if the nitroglycerin did anything for that. That's a BLS skill. So with the information you have obtained from talking to the patient and getting his blood pressure you can now decide if more ALS is warranted. Does the patient need another shot of nitroglycerin or do you need something else?
Conclusion
Even on CPRs we must follow the CBA rule. Before beginning BLS compressions on the patient, we must determine what happened to the patient and whether there is a DNR order. After starting CPR, we intubate the patient and push drugs. Once again we communicate with a bystander or first responder, then we start BLS care followed up with ALS care.
As long as you remember your CBAs along with your ABCs then you as an EMT, or EMT-I or even an EMT-P can give the patient the best care possible and get them to an ER ASAP. If you can't remember CBA as Communicate, BLS care, and ALS care then remember them as Come Back Alive. Go home safely after each and every shift.
Ryan Tackitt is a paramedic with East Texas Medical Center EMS in Waco, Texas. He has been in EMS for eleven years, and also works as a preceptor at McLennan Community College.
