Unknown Medical

You make your way through the afternoon rush hour for an “unknown medical” at a private address in the oldest part of your town. It’s raining lightly but getting colder, and you’re expecting snow.

You pull up to the curb in front of a second-story apartment. PD is on scene. They’ve cleared you to come in, but it’s still an unknown medical. So you grab your gear, secure the rig and trudge up a flight of worn wooden steps that look and sound like they haven’t had any lovin’ since the Civil War. A young cop is standing in an open apartment doorway on the right, at the top of the stairs. As you get closer, you hear him engaged in polite conversation about someone’s choice of hospitals. He introduces you to Henry Small, who’s complaining of abdominal pain.

Mr. Small looks like he hasn’t had much lovin’ either, but he’s alert and coherent while sitting upright, and his skin color looks about normal. He’s 50, he says he lost his appetite about three days ago, and he just feels sick—like he needs to throw up. He doesn’t appear inebriated, but he says he’s been drinking beer and wine all day. He wants to go to the hospital, and he can’t afford a cab.

Q. Why can’t dispatchers ever say nausea? Or headache? Or dizziness? What’s an “unknown medical,” anyway? Do people just call 9-1-1 with shortness of breath and say, “I have an unknown medical”?

A. That’s been a closely guarded secret for a very long time. I think it’s listed in a clandestine book of translations or something that every dispatcher is required to memorize. (Seriously, they swear people just don’t tell 'em any better.)

Anyway, Henry’s vitals are within normal limits. He doesn’t get dizzy when he stands up, so you decide to risk walking him downstairs. You help him lock his apartment and get him halfway down the stairs, and suddenly he suffers a bout of projectile emesis—all over the stairs, the railing, the back of your partner, Jerry’s head and neck, and the wall. It ain’t pretty. But one thing’s for sure: appetite or no appetite, he has definitely been eating. Hmm, maybe hot dogs.

Q. You know, this work would be so much easier if somebody could think of a way to accommodate emesis, especially when you have no warning and no way to dodge it.

A. Well, Henry did say he felt nauseous. You’re probably not going to get a better warning than that in your life. But there is a simple tool you can use, and it just doesn’t fail. It’s cheap, it weighs nothing, and it occupies no space at all. So, you could always have one handy. Get some 30-gallon plastic bags, like the ones you use to line your trash cans. When you think somebody is likely to express themselves, unfold a bag and put it on them like a bib. Use a piece of two-inch tape around the back of their neck, like a strap, to keep the bag in place. And explain that if they need to throw up, they should do so in the bag.

Keep a close eye on them in case they don’t pay attention or don’t understand. In that event, you can quickly and easily grab the loose open end of the bag and assist them. That’ll be easy to do; half of the open end of the bag will be secured by the tape. So, the other half will be hanging down in front of them.

During transport, try to position the patient in a semi-Fowler’s position (unless they’re shocky.) But shock or no shock, keep the closed end of the bag dependent so as to control its contents. Once you arrive at the hospital, you can offer the bag as part of your turnover report, in case anyone wants to examine its contents. If they’re not interested, you can empty it into a toilet, then tie a knot in its open end and discard it.

But that’s not all. As you know, the most versatile tools in EMS are the ones that can do more than just one thing. A plastic trash bag is a great container for people’s personal belongings. (You can apply a piece of tape as an identifier.)

And lastly, don’t forget—this thing is also a trash container.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.