I arrived on the scene to see a soldier nearly unconscious. Around him were five other people, one of whom I recognized as the company medic. I saw a blood pressure monitor and a blanket being wrapped around the injured soldier. From the lack of activity, I would have thought the soldier was dead. But I could see him moving.
“Does anyone want to tell me what’s going on?”
Arriving on scene
As an Observer Controller, basically the Army’s version of a consultant, I only had the authority to take control of a situation if I deemed it to be dangerous. Any other time, my responsibility was to teach the soldiers how to make the right decisions and evaluate their performance. While there was an injured person lying on the ground, I didn’t see any reason to completely take control of the situation. There was a medic from the unit I was training on the scene and he was perfectly capable of handling the situation if he’d just get off his hands and do something.
It had been an uphill battle with this medic. He always wanted to tell me about how things were done on his civilian job. He was an EMT on an ambulance as a civilian. But now he was the company medic for a National Guard unit deploying to Iraq.
When I asked what was going on, I was informed that someone was looking for the phone number to the hospital. This information had been part of their orientation and I was more than a little irritated that nobody had it on hand. I provided the soldier at the phone with the number and went back to the medic.
He began explaining that the soldier on the ground had fallen off a truck and hit his head. I already had this information so I asked what he was doing about it. The medic told me he had checked the soldier’s blood pressure and covered him with a blanket. When he started to ramble on about what he would do if he had his ambulance, I couldn’t take it anymore.
“Thanks captain obvious! Is he conscious?”
The medic told me that the patient was conscious, but barely.
“Where’s the SOAP form? Why aren’t we getting all of the subjective information we can get while he can respond?”
The medic stared at me for a moment. Then the lights came on. He informed me that he didn’t have anything to write with.
“SOMEONE GET A PEN AND A PIECE OF PAPER TO WRITE DOWN EVERYTHING THIS CLOWN SAYS!”
The soldier by the phone rushed over with a pen and a notepad. He informed us that the ambulance was 15-20 minutes out. The medic finally started collecting the subjective information. By the time the ambulance arrived we had two copies of the SOAP form, one safety pinned to the casualty and one kept by the medic.
A SOAP form is the document medics use to record the patient’s information. It stands for Subjective, Objective, Assessment, and Plan. In this case we were able to get relevant medical history (subjective) and a blood pressure recording every five minutes (objective).
When the ambulance arrived, the patient was unconscious. The EMT approached the medic while the other soldiers loaded the stretcher on the ambulance. As the EMT started asking questions, the medic told him that everything he knew was on the SOAP form pinned to the patient’s shirt. The EMT looked over at the patient being loaded and ripped the form off. He scanned it quickly and screamed “Good job medic” as he jumped in the ambulance to leave.
Later that day, the medic came to speak with me. “I’m sorry for blowing you off before. I didn’t know you were a medic.”
I gave him a gentle squeeze on the shoulder. “I’m not a medic.”
That medic got his act together and I never had another problem with him. By the time that National Guard unit deployed, I was confident that he was ready to take on his new role. He already had all the medical knowledge he would need. He just needed to understand that he would now need to perform those tasks with only what he carried on his back.
Unconscious or not, SOAP is important
Being a first responder is a heavy responsibility. We often refer to EMTs and other qualified personnel as first responders, but they’re often not the first on the scene. They may be the first on the scene that can take action, but you are wasting valuable time waiting on them if you do nothing.
When the first qualified medical personnel arrive on scene they are going to ask a lot of questions. What happened? How old is the patient? Are they on any medications? Were drugs or alcohol involved? Is the patient allergic to anything?
Any question they ask is that much more time before the patient gets treatment. Take the time while you wait to record any details that could possibly help so that you can get that patient moving as quickly as possible. Even if your patient isn’t unconscious, the medical staff will be very busy checking objective information and may forget to ask something subjective. So have as much as possible ready for them.
Seconds Save Lives!
For more information on preparing subjective information, see Dr. Pehrson’s article on medical planning. His tips are even more valuable when dealing with an unconscious person.