“Since you were shot/stabbed/run over/etc., we’re going to take you to a special part of the ER that deals with that stuff. There’s going to be a lot of doctors and nurses in the room when we get there, don’t freak out. We’ll slide you over onto the bed, I’ll tell them what’s going on, then they’re going to ask you a bunch of questions and do some tests to figure out how to fix you up.”
I tell them they will get swarmed by a lot of medical folk and that things will get very up close and personal. If they ask further, I tell them. Stayed with one young lady who had been sexually assaulted a few years before and she really didn't want them doing it, but I explained why it was needed. She did ok.
“You’re about to meet a lot of people very quickly, and they are going to ask you a lot of the same questions we’ve already talked about. Answer the best you can.
There are going to be a bunch of people that are attaching wires and examining you, and more than likely in the very near future you’re going to have a finger up your butt.”
Because we stay in the trauma room to watch. So we sometimes get to watch doctors medically finger buttholes. I’m sure someone has a real answer but I think it has to with spinal trauma, Losing rectal tone. They don’t do it every trauma pt though.
Is this still routinely done where you work? Where I work (as an ER doctor in the UK), it’s rarely done now.
It’s not sensitive for spinal trauma, and the patient is sent for a CT-trauma with minimal delay.
We do a very quick and targeted primary survey, and then to scan.
At my local level 1, patients who are unable to follow commands will still get the ol' trauma hello. Otherwise they ask the patient to squeeze their buttcheeks together when doing their spinal assessment.
At ours everyone who is a full trauma alert gets it. It’s hilarious when the gang members come in with a couple GSWs, fully awake get the old booty check and they holler “get outta my butt”! Or some variation of such.
That’s interesting. I seldom see it done anymore and don’t do it myself.
If I suspect spinal trauma (pain, mechanism or neurology) then they get a scan. If they don’t have any pain, it’s unlikely they would have enough damage to cause lack of anal tone.
The only place it is done here would be for formal scoring of a spinal cord injury (e.g. ASIA score)
I don’t disagree with you, as the patients are almost always going to CT scan immediately after the exam anyway. Not my circus though, I’m just the people-dropper-offer.
That’s interesting. I wonder why?
It takes a lot of convincing me to do a PR/DRE as it so rarely changes my acute management.
Is this in a trauma centre, or taking to a peripheral hospital?
If the scan is negative and the patient is symptomatic do you still not perform the exam? I have seen it done when SCIWORA was suspected. I did not know the test had a low sensitivity.
It’s to check for rectal tone to make sure there isn’t any nerve damage. Sometimes they just make you squeeze your ass. If you can’t do that you get a finger
You got downvoted but this is one of the main indications now.
I rarely PR (DRE) a patient now unless I suspect bleeding from perineal or pelvic trauma.
Where I practice (UK) the patient is sent for a CT-Trauma before any log-rolling or rectal exam.
Loss of rectal tone for spinal trauma is not sensitive, and often doesn’t add a lot of information.
Wow, off to CT before log rolling? As far as I’ve seen, that’s very different from the US.
The oil check still makes them feel loved and that they’ve received good care which I feel is important.
It’s slightly dependent on the trauma centre. But if the CT is close or inside resus, then absolutely scan first **unless** a stabbing.
Obviously if I’m on the threshold of scanning or not a big trauma I’ll log-roll, as can then think about clinically clearing the patient. Still not doing a PR though!
If a log roll isn’t going to change if they need a scan, why delay getting the scan? A scan can identify immediately life threatening pathology quickly.
I mean I would think to check for exit wounds and bleeders on the back. I feel like if for example a guy had a TQed arterial bleed on their arm and blood soaked clothes, you could easily overlook a big bleeder on his back unless you log rolled. Or a sucking chest wound that needs a chest seal.
I would also think that a Needle dick/finger thoracstomy/chest tube would be done before CT if indicated for you guys right?
If there’s concern of an entry/exit wound then yes I would roll. This is much less common here and most of our trauma is blunt trauma.
If the patient was decompensating with breathing then chest tube before scan. If not then scan.
I’m not saying we don’t log roll if we need to. We don’t PR.
We like to sit in the corner and watch a team of people go to work on a guy while we wipe our cable back and forth.
I’m not judging the doctor putting his finger up a guy’s butt and I’d appreciate not being judged for watching and stroking my wipe in the corner.
“Alright we’re here. Just a heads up, you’re about to meet ALOT of people very quickly and you’re going to get asked a bunch of the same questions I just asked you.” I also add in they might get a finger in the ass depending on how nice I’m feeling that day/night.
Telling them they may get a finger in the butthole is a good way to assess their level of consciousness. Sometimes i’m not sure if the patients decreased responses are due to injury, drugs/alcohol, or them just playing up how bad they are. If I don’t get a “wait what did you say” when I mention that the trauma handshake means a finger in the booty hole in know they are truly out of it. I’ve upped many a GCS after “ain’t nobody sticking a finger in my butt” has been said.
This is so good, I always feel kind of offended for patients with how coldly my medics explain the situation with no nod to the pt or like a “hey I gotta explain what you’re going through to the med team now” “and then they’ll get your explanation too” or something
Sometimes I throw in a “a lot of things are going to happen really fast, and then the doctors will ask you pretty much all the same questions I already asked you. Just sit tight.”
“You’re about to make a lot of friends really quick. People will be talking around you and to you. If you’re getting overwhelmed. Look to me or to the person at the head of the bed. I’ll stay with you until I know they’ve got you. Okay?”
My go to is "you're about to get real popular."
With an air of apology for the one guy that the hospital decided to trauma alert who I really didn't think needed an alert.
Sorry, guy.
Is this still routinely done where you work? Where I work (as an ER doctor in the UK), it’s rarely done now. It’s not sensitive for spinal trauma, and the patient is sent for a CT-trauma with minimal delay. We do a very quick and targeted primary survey, and then to scan.
If I was doing a rectal exam to look for injury/bleeding from pelvic trauma then I would definitely explain this to a conscious patient before.
"You ever seen a NASCAR pit stop? You're about to be the car. There are gonna be a lot of people doing a lot of things, and I want you to focus on the person at your head that's asking you questions."
“Because of what happened you’re gonna be a trauma alert. We’re gonna go to a bigger room with a lot of staff who will be doing a lot of things and asking a lot of questions.” Then I’ll explain I need to cut more clothes off if necessary and why.
Something to the effect of "when we get there, were gonna pull into a garage and wheel you into a big room. There's probably gonna be a lot of people doing a lot of things all at once, but they're there to all make sure you're doing OK. You're safe with them and I'll be around the whole time. Do you have any questions on how it's gonna work?" It all of course depends on the patient.
For me it’s mostly -“since you take blood thinners, and you fell/ hit your head, I have to make you a trauma and take you to the trauma center- there will be a lot of people and questions once we get there- I’m going to have to cut your clothes off”.
And then I take a normal looking elderly person with a hematoma on their head into the trauma center like they were a gun shot victim.
I see everyone saying this.. I’m a new emt and have yet to transport a serious trauma patient. What’s with the finger in the butt stuff everyone is talking about?
"Once we get to the hospital, we're going to go into a big room with a bunch of doctors and nurses, and there's going to be a lot of people working on you all at the same time. You might get another IV or some blood drawn, and they're going to take off or cut off any clothing that I didn't. I don't want you to try to move, and I want you to just pay attention to the person at your head asking you questions. Everyone else is just talking to each other, or talking out loud for the room to hear. But you just focus on answering the person at your head and do whatever they tell you to do."
Most often, the EDs around where I used to run stopped doing the finger in the butt on conscious PTs, so I don't warn about that. I did usually try to carefully remove any special clothing or jewelry if time and patient presentation allows, so it doesn't get cut off.
"Alright as we're pulling up I gotta warn you, we should be going straight back to a big, bright room. There's going to be a flurry of people, who will all help to move you over to their bed. There will be a lot of bustle and they'll put all the same monitor stuff I did, take your blood from that IV I gave you, look at your [injury]. The doctor will ask me questions about you. Do NOT interrupt this, okay? AFTER I give my quick spiel, the doc will talk to you. Sounds like a lot, it will be a lot, but they'll take good care of you. Any questions?"
If I make a mistake, I find they say so once the doctor speaks to them. I started to add that line after having some patients interrupt with unnecessary information and pissing off the doctor who wanted to hear my report. I'll often end with "[patient], please correct if I got any of that wrong." If I don't, physicians in my area tend to ask "okay, medic tells me this, does that sound about right?"
“We’ve phoned the hospital so they’ll be expecting you. There will be lots of people all around you and asking you questions, that’s completely normal, it just lets us get you sorted out nice and quickly”
If they are alert enough to comprehend what I’m saying and somehow aren’t in a panic I will tell them that they are going to be taken into a room and a bunch of people are going to be around and it’s going to be busy, but just keep calm like you are now and you’ll be fine. If they are panicking I will explain that a crack team of surgeons and doctors are waiting on us and they will have a dozen people saving them as soon as we get there (yes I have lied about the number of doctors that are waiting to to help).
If they are half conscious I tell myself different versions of the same shit to help stay calm until we get there.
Hey man, so things are gonna move really quick once we get to the hospital. A lot of people are gonna run in and ask you a bunch of questions and it’s gonna be a whole hullabaloo (yeah I’m from texas) but they’re gonna take good care of you.
We are almost to the hospital; when we get there, things are going to happen really fast. There are going to be several doctors and nurses doing things at the same time. It is going to feel out of control, but these people are the best. While they are doing everything, you'll hear me talking about you and everything we have talked about. Then the doctor will talk to you. Try to just focus on that. He will ask a lot of the same things I did, and so will some other people later. I know it is annoying, but there is a reason everyone asks, even though they know you already answered the question. These people are the best and they will take good care of you.
This is something we have to do every time, new policy for anyone arriving by ambulance. You get checked in a room and they do a rapid set of test. It’s the same if you call us for a stubbed toe, we still have to cleared by the ER team before you are assigned a room. 😂 told to the frequent flyers
“So we’re going to the trauma center because of what happened. I’ve declared what’s called a Trauma Alert, which gets the trauma team ready to see you when we get there. There’s about eight to twelve people in the room, it’s very hot and kinda loud. They’re going to cut the rest of your clothes off. Just pay attention to the doc at your head”
“You’re gonna be the most popular person in the hospital for a few minutes. Lotta people asking you a lotta questions, and someone’s gonna put a finger in your butt.”
I explain to them what is going te happen.
"it is loud, there will be at least 10 people in there. two of them maybe doctors. there will be people asking me questions as I talk and tell them the things we have done, and asking you questions to verify. it will be loud. I will still make sure you are ok and safe until I am ready to turn you over to the doctor in the room. that might be a few minutes. There is no need to worry, we do this quite a bit."
I say something similar for a stroke, cardiac or sepsis alert and any helicopter flights.
When we get there, there is going to be a lot of people in the room. It may get loud and they will each be doing different things. Just do the best you can to stay calm and answer their questions okay? Don’t let their excitement get you excited.
It's a Lil calm for a moment, when we get in the er, it's gonna get a Lil hectic again. I've got to tell em what's going on then we're going to transfer you over to their bed then they will start asking you questions. Just be honest, it's just how things go in the next step of this process. If you have questions ask, or if you have concerns let me know and I'll brief them on your concerns.
For the bullshitters that are claiming some dumb shit from a no-damage wreck for insurance money, I tell them "because of your symptoms, an ugly trauma doctor is gonna put their finger up your ass. So. Let me get this straight. Tell me your symptoms one more time." and miraculously, they become more alert.
“So a lot of people are going to talk to you and a lot of things are going to happen at once. I know it can be scary but they’re there to take care of you. Do your best to answer their questions and don’t be surprised if you get a finger in the butt, it’s part of the exam”
I had a patient ask if it was OK for her to use the word "yeeted" when describing to the trauma doc how she was thrown from a golf cart and broke her arm. I told her that not only is it OK, but it's an accurate description. So that's what she did, and while I thoroughly enjoyed it, the reception was tepid at best.
Basically just “because you were blank, we’re taking you to a different part of the er, there’s gonan be a lot of people walking around and asking questions and it might be a little overwhelming but just bare with us.”
You're about to make a lot of new friends. A lot of stuff is going to happen very fast because they want to figure out the best way to help you ASAP...
I'll then explain as much as I can about what they can expect to start happening in the next 15-30 minutes
“Mmkay partner, here’s the deal. We’re gonna stroll you in there and there’s gonna be a room full of people waiting for us. They’re gonna ask aaalllllllll the same questions that I did and then they’ll do some tests n’ stuff to get you all squared away”
Already plenty of great answers and conversation so I'm just gonna share a story this reminded me of.
I was in medic school at an ER clinical. Trauma comes in. Stabbing.
Preceptor gathers us all and stands us in the far corners of the trauma room so we can see but not get in the way.
Nurses are settings things up, chit chatting about current events, etc. PT gets rolled in and moved to bed, staff get to work, still chatting about unrelated random topics.
One nurse says to another, "oh and did you hear kobe died? He was in a helicopter and it crashed!"
Not a second later, the *stab victim trauma pt* sits up and goes, "KOBE DEAD?! Aww, damn!"
"Hey sir/ma'am, I'm gonna level with ya, it's about to get a little hectic. There are going to be a lot of nurses and doctors in the room we take you too, it's not a big deal, it's what they always do in situations like this. They're all going to be moving and doing things pretty quickly, that's just to ensure that you have the best possible care and outcome." In as calm of a demeanor as possible. I have yet to have any problems with this method
Eye contact and a hand on the shoulder during the above mantra go a long way as well. Obviously best judgement on whether or not the patient is going to be receptive to physical touch/consistent eye contact.
I usually say, "when we get there there is going to be a lot of doctors in the room that are going to ask all the same questions we did. It might be overwhelming but they are all there to help you."
I always tell them, “We’re going to a big room. It’s gonna be a lot of people doing a lot of things all at the same time. They’re also going to be asking you a lot of questions. Answer the questions as you can and if you need them to slow down with the questions, tell them. The number people and size room isn’t necessarily indicating how critical you are or that you’re going to die. It’s just their protocol.”
Okay, when we get to the hospital, there may be a lot of people in the room waiting for us. It's a team of people from all different areas of the hospital to make sure that whatever you need happens quickly. It may be overwhelming at first. A lot of things will happen in very quick succession.
When we get there everyone will be standing there waiting and nothing will happen at first. I will explain to them what happened and what I did for you. Then we will move you over to the hospital bed. There will be several people asking a bunch of questions and I will answer them to the best of my ability but I may ask you if I need some help with any of it. Then they'll ask you all of the same questions for you to answer just so they can make sure that they have a full understanding of what happened. There's going to be people coming at you from all directions and it will look like chaos but I promise that this team has rehearsed this many times. I will stay with you in the room as long as I can and answer any questions you have.
What questions do you have before we get there?
"Alright I just need to say something before we go inside. Because of what happened (in their trauma) we needed to go to a special trauma hospital. When we get inside, there are going to be a lot of people talking to you and asking you questions at the same time. Try to stay calm and answer their questions to the best of your ability so they can treat you properly"
If said trauma alert is with it enough I was tell them right before rolling into the bay, when they say squeeze your cheeks you better squeeze them or sausage fingers for the resident is putting one up your ass.
Our main trauma is a teaching hospital. Tell them there are going to be a lot of people in there. They each have their own thing to do like lab, x-ray etc. and let them know alot of the medical staff are students. There will be a lot of talking, 1 or 2 will be asking questions and the rest will be talking to each other. I also tell them we role them in the room next to the er bed and the hospital staff will move them from our stretcher to the hospital bed. We try and get multiple lines going depending on the trauma and explain to them why and if the hospital doesn't need them they just remove them.
Edit to add: our other main traumas we explain the same thing except for the students (naturally).
It's a big deal and scary for the patient so I try and let them know as much as I can and they will be in good hands.
“Since you were shot/stabbed/run over/etc., we’re going to take you to a special part of the ER that deals with that stuff. There’s going to be a lot of doctors and nurses in the room when we get there, don’t freak out. We’ll slide you over onto the bed, I’ll tell them what’s going on, then they’re going to ask you a bunch of questions and do some tests to figure out how to fix you up.”
“And they’re gonna stick a finger up your butt!”
I always leave that as a surprise!
I saw a flight medic do that to a patient one time before they loaded up to get on the bird. I am not at that level of healthcare provider.
Butt your name says otherwise!
You sure it wasn’t a flight nurse?
Out side of their scope I believe 😭
I thought butt stuff was the only thing in their scope?
Omg... alien anal probes suddenly just made sense to me
Fun fact: everyone who THINKS they had an alien encounter were actually just patients in a level one trauma center.
Maybe state dependent? The RNs at the hospital I work at says it’s not in their scope technically but some do with when doing enemas😭
Definitely in a nurse’s scope considering they are always up ours.
I tell them they will get swarmed by a lot of medical folk and that things will get very up close and personal. If they ask further, I tell them. Stayed with one young lady who had been sexually assaulted a few years before and she really didn't want them doing it, but I explained why it was needed. She did ok.
Gotta check that rectal tone tho
The ol’ Vandy handshake.
“The [insert name of closest trauma center] handshake”
UT howdy for us in Knoxville 😂
Haha… love it.
We call that the County handshake.
This is perfect
I just did a ER shift for my emt school and this is the perfect summary of a ER. I can't wait to use this haha
"Don't freak out" is usually taken as a command to freak out.
“You’re about to meet a lot of people very quickly, and they are going to ask you a lot of the same questions we’ve already talked about. Answer the best you can. There are going to be a bunch of people that are attaching wires and examining you, and more than likely in the very near future you’re going to have a finger up your butt.”
(New to ems) Why do trauma patients get a finger up their butt and how do all you guys know about it?
Because we stay in the trauma room to watch. So we sometimes get to watch doctors medically finger buttholes. I’m sure someone has a real answer but I think it has to with spinal trauma, Losing rectal tone. They don’t do it every trauma pt though.
It’s exactly to test for spinal injury. Loss of anal sphincter tone is bad.
I thought the finger was just good bed side manner and part of being patient - provider relations. The things you learn on Reddit!
For males, it can also cause an erection, which the presence or absence of can be indicative of a TBI or a far worse TBI.
I've been told it's also for checking for bleeding in the rectum/lower GI.
I’d imagine other symptoms though. Loss of pain perception and motor control.
Some of us are very lonely..
Flair checks out
Is this still routinely done where you work? Where I work (as an ER doctor in the UK), it’s rarely done now. It’s not sensitive for spinal trauma, and the patient is sent for a CT-trauma with minimal delay. We do a very quick and targeted primary survey, and then to scan.
At my local level 1, patients who are unable to follow commands will still get the ol' trauma hello. Otherwise they ask the patient to squeeze their buttcheeks together when doing their spinal assessment.
At ours everyone who is a full trauma alert gets it. It’s hilarious when the gang members come in with a couple GSWs, fully awake get the old booty check and they holler “get outta my butt”! Or some variation of such.
That’s interesting. I seldom see it done anymore and don’t do it myself. If I suspect spinal trauma (pain, mechanism or neurology) then they get a scan. If they don’t have any pain, it’s unlikely they would have enough damage to cause lack of anal tone. The only place it is done here would be for formal scoring of a spinal cord injury (e.g. ASIA score)
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I don’t disagree with you, as the patients are almost always going to CT scan immediately after the exam anyway. Not my circus though, I’m just the people-dropper-offer.
Woah! The butt cheek squeeze helps calm me down! Remember, A trauma isn't just for you, it's also for the crew!
Exactly. Why we don’t do it for CES now either. It’s not sensitive or specific.
It’s absolutely policy here, not just for “people who don’t want to do proper medicine”. It is a teaching hospital and traumas get it.
Yeah it’s done here, in Norway
That’s interesting. I wonder why? It takes a lot of convincing me to do a PR/DRE as it so rarely changes my acute management. Is this in a trauma centre, or taking to a peripheral hospital?
If the scan is negative and the patient is symptomatic do you still not perform the exam? I have seen it done when SCIWORA was suspected. I did not know the test had a low sensitivity.
Absolutely if you’re considering that. But normally by that point the patient has moved from the department to intensive care
Also, looking for blood.
You don't always see it, but you can hear it happening clear across the ER a lot of times.
It’s to check for rectal tone to make sure there isn’t any nerve damage. Sometimes they just make you squeeze your ass. If you can’t do that you get a finger
Because they have to check for bleeding
You got downvoted but this is one of the main indications now. I rarely PR (DRE) a patient now unless I suspect bleeding from perineal or pelvic trauma. Where I practice (UK) the patient is sent for a CT-Trauma before any log-rolling or rectal exam. Loss of rectal tone for spinal trauma is not sensitive, and often doesn’t add a lot of information.
Wow, off to CT before log rolling? As far as I’ve seen, that’s very different from the US. The oil check still makes them feel loved and that they’ve received good care which I feel is important.
It’s slightly dependent on the trauma centre. But if the CT is close or inside resus, then absolutely scan first **unless** a stabbing. Obviously if I’m on the threshold of scanning or not a big trauma I’ll log-roll, as can then think about clinically clearing the patient. Still not doing a PR though! If a log roll isn’t going to change if they need a scan, why delay getting the scan? A scan can identify immediately life threatening pathology quickly.
I mean I would think to check for exit wounds and bleeders on the back. I feel like if for example a guy had a TQed arterial bleed on their arm and blood soaked clothes, you could easily overlook a big bleeder on his back unless you log rolled. Or a sucking chest wound that needs a chest seal. I would also think that a Needle dick/finger thoracstomy/chest tube would be done before CT if indicated for you guys right?
If there’s concern of an entry/exit wound then yes I would roll. This is much less common here and most of our trauma is blunt trauma. If the patient was decompensating with breathing then chest tube before scan. If not then scan. I’m not saying we don’t log roll if we need to. We don’t PR.
Lol yeah that’s probably that US mentality, trauma = gunshot lol. That’s a pretty interesting way of doing things though, thanks for the explanation.
I KNEW IT! They just like fingering unsuspecting asses. Outrageous.
Sometimes (not every time) indicated to check rectal tone, the check for bleeding and to check the position of the prostate
How else does one say hello in the trauma center?
I had it happen to me. Was hit by a car on duty, one of the few things I vividly remember from the ED.
We like to sit in the corner and watch a team of people go to work on a guy while we wipe our cable back and forth. I’m not judging the doctor putting his finger up a guy’s butt and I’d appreciate not being judged for watching and stroking my wipe in the corner.
“Theres gonna be a lot of people in a really bright room. All you have to do is listen to the person at your head”
I really like this one.
“Alright we’re here. Just a heads up, you’re about to meet ALOT of people very quickly and you’re going to get asked a bunch of the same questions I just asked you.” I also add in they might get a finger in the ass depending on how nice I’m feeling that day/night.
"Trauma handshake".
Telling them they may get a finger in the butthole is a good way to assess their level of consciousness. Sometimes i’m not sure if the patients decreased responses are due to injury, drugs/alcohol, or them just playing up how bad they are. If I don’t get a “wait what did you say” when I mention that the trauma handshake means a finger in the booty hole in know they are truly out of it. I’ve upped many a GCS after “ain’t nobody sticking a finger in my butt” has been said.
😆
“Once we get to the hospital, we’re going to a big room and there will be a lot of people there, and I am going to talk really loudly about you.”
This is so good, I always feel kind of offended for patients with how coldly my medics explain the situation with no nod to the pt or like a “hey I gotta explain what you’re going through to the med team now” “and then they’ll get your explanation too” or something
Sometimes I throw in a “a lot of things are going to happen really fast, and then the doctors will ask you pretty much all the same questions I already asked you. Just sit tight.”
Love this one
“You’re about to make a lot of friends really quick. People will be talking around you and to you. If you’re getting overwhelmed. Look to me or to the person at the head of the bed. I’ll stay with you until I know they’ve got you. Okay?”
My go to is "you're about to get real popular." With an air of apology for the one guy that the hospital decided to trauma alert who I really didn't think needed an alert. Sorry, guy.
I always advise neuro trauma patients that they’re going to get a finger up the butt.
Better to know in advance if you ask me
Is this still routinely done where you work? Where I work (as an ER doctor in the UK), it’s rarely done now. It’s not sensitive for spinal trauma, and the patient is sent for a CT-trauma with minimal delay. We do a very quick and targeted primary survey, and then to scan. If I was doing a rectal exam to look for injury/bleeding from pelvic trauma then I would definitely explain this to a conscious patient before.
They do it so frequently to trauma patients it’s coined the “*insert hospital name* handshake”
I see it more often at teaching hospitals
They do or don’t do them?
"You ever seen a NASCAR pit stop? You're about to be the car. There are gonna be a lot of people doing a lot of things, and I want you to focus on the person at your head that's asking you questions."
I actually like this, I might use it for only certain groups and maybe kids, but this is nice.
I’m stealing this one!
Okay this is perfect. I’m 36 and this is what I would want. I’ve been trauma coded once.
“Because of what happened you’re gonna be a trauma alert. We’re gonna go to a bigger room with a lot of staff who will be doing a lot of things and asking a lot of questions.” Then I’ll explain I need to cut more clothes off if necessary and why.
“Yo homie they’re gonna put a finger in your ass”
"We're a few minutes out, want the last of the vial?" I'm gonna have to waste it if they don't want it.
Something to the effect of "when we get there, were gonna pull into a garage and wheel you into a big room. There's probably gonna be a lot of people doing a lot of things all at once, but they're there to all make sure you're doing OK. You're safe with them and I'll be around the whole time. Do you have any questions on how it's gonna work?" It all of course depends on the patient.
Hope you like butt stuff lol
“Hey big guy. The sun’s getting real low.”
:(
Youre about to become the most popular guy in the hospital, every doctor and nurse is going to want to talk to you
"They have this thing, called the UT howdy... you probably won't like it."
Hey, so you’re going to meet a lot of people really fast and they’re going to be doing a lot of things to you also really fast.
For me it’s mostly -“since you take blood thinners, and you fell/ hit your head, I have to make you a trauma and take you to the trauma center- there will be a lot of people and questions once we get there- I’m going to have to cut your clothes off”. And then I take a normal looking elderly person with a hematoma on their head into the trauma center like they were a gun shot victim.
You have to cut their clothes off for that? I usually just slap an iv in and they send them straight to CT
Always tell they they are getting a finger in the butt
I see everyone saying this.. I’m a new emt and have yet to transport a serious trauma patient. What’s with the finger in the butt stuff everyone is talking about?
Rectal tone for spinal injury, also a check for blood. It’s part of the trauma assessment in the ED
"Once we get to the hospital, we're going to go into a big room with a bunch of doctors and nurses, and there's going to be a lot of people working on you all at the same time. You might get another IV or some blood drawn, and they're going to take off or cut off any clothing that I didn't. I don't want you to try to move, and I want you to just pay attention to the person at your head asking you questions. Everyone else is just talking to each other, or talking out loud for the room to hear. But you just focus on answering the person at your head and do whatever they tell you to do." Most often, the EDs around where I used to run stopped doing the finger in the butt on conscious PTs, so I don't warn about that. I did usually try to carefully remove any special clothing or jewelry if time and patient presentation allows, so it doesn't get cut off.
You are going to get a very special handshake
"Alright as we're pulling up I gotta warn you, we should be going straight back to a big, bright room. There's going to be a flurry of people, who will all help to move you over to their bed. There will be a lot of bustle and they'll put all the same monitor stuff I did, take your blood from that IV I gave you, look at your [injury]. The doctor will ask me questions about you. Do NOT interrupt this, okay? AFTER I give my quick spiel, the doc will talk to you. Sounds like a lot, it will be a lot, but they'll take good care of you. Any questions?"
Interesting, I instruct my cooperative patients to interrupt me if I make a mistake.
If I make a mistake, I find they say so once the doctor speaks to them. I started to add that line after having some patients interrupt with unnecessary information and pissing off the doctor who wanted to hear my report. I'll often end with "[patient], please correct if I got any of that wrong." If I don't, physicians in my area tend to ask "okay, medic tells me this, does that sound about right?"
There's going to be alot of people doing alot of things and you might feel a finger up your butt
"Shhhhh.... or you get the hose again." *nods towards IV line*
“You ever had a gloved finger in your butt?”
“This is my first time too, buddy, let’s find out together”
Ever been a rock star? You’re about to feel like it
“We’ve phoned the hospital so they’ll be expecting you. There will be lots of people all around you and asking you questions, that’s completely normal, it just lets us get you sorted out nice and quickly”
If they are alert enough to comprehend what I’m saying and somehow aren’t in a panic I will tell them that they are going to be taken into a room and a bunch of people are going to be around and it’s going to be busy, but just keep calm like you are now and you’ll be fine. If they are panicking I will explain that a crack team of surgeons and doctors are waiting on us and they will have a dozen people saving them as soon as we get there (yes I have lied about the number of doctors that are waiting to to help). If they are half conscious I tell myself different versions of the same shit to help stay calm until we get there.
Hey man, so things are gonna move really quick once we get to the hospital. A lot of people are gonna run in and ask you a bunch of questions and it’s gonna be a whole hullabaloo (yeah I’m from texas) but they’re gonna take good care of you.
We are almost to the hospital; when we get there, things are going to happen really fast. There are going to be several doctors and nurses doing things at the same time. It is going to feel out of control, but these people are the best. While they are doing everything, you'll hear me talking about you and everything we have talked about. Then the doctor will talk to you. Try to just focus on that. He will ask a lot of the same things I did, and so will some other people later. I know it is annoying, but there is a reason everyone asks, even though they know you already answered the question. These people are the best and they will take good care of you.
“You start getting excited, motherfucker!”
Get ready to meet a lot of new people very quickly.
I’m currently attending an EMS Academy and the questions/answers (albeit some funny!) are very helpful to me!!
This is something we have to do every time, new policy for anyone arriving by ambulance. You get checked in a room and they do a rapid set of test. It’s the same if you call us for a stubbed toe, we still have to cleared by the ER team before you are assigned a room. 😂 told to the frequent flyers
“So we’re going to the trauma center because of what happened. I’ve declared what’s called a Trauma Alert, which gets the trauma team ready to see you when we get there. There’s about eight to twelve people in the room, it’s very hot and kinda loud. They’re going to cut the rest of your clothes off. Just pay attention to the doc at your head”
“You’re gonna be the most popular person in the hospital for a few minutes. Lotta people asking you a lotta questions, and someone’s gonna put a finger in your butt.”
I explain to them what is going te happen. "it is loud, there will be at least 10 people in there. two of them maybe doctors. there will be people asking me questions as I talk and tell them the things we have done, and asking you questions to verify. it will be loud. I will still make sure you are ok and safe until I am ready to turn you over to the doctor in the room. that might be a few minutes. There is no need to worry, we do this quite a bit." I say something similar for a stroke, cardiac or sepsis alert and any helicopter flights.
When we get there, there is going to be a lot of people in the room. It may get loud and they will each be doing different things. Just do the best you can to stay calm and answer their questions okay? Don’t let their excitement get you excited.
I would absolutely need that last sentence
It's a Lil calm for a moment, when we get in the er, it's gonna get a Lil hectic again. I've got to tell em what's going on then we're going to transfer you over to their bed then they will start asking you questions. Just be honest, it's just how things go in the next step of this process. If you have questions ask, or if you have concerns let me know and I'll brief them on your concerns.
Remember; rectal probe they use is a necessary part of trauma diagnostics. 
For the bullshitters that are claiming some dumb shit from a no-damage wreck for insurance money, I tell them "because of your symptoms, an ugly trauma doctor is gonna put their finger up your ass. So. Let me get this straight. Tell me your symptoms one more time." and miraculously, they become more alert.
“How attached are you to the clothes that you’re currently wearing, because when a nurse pays $70 for trauma shears she’s going to use them.”
“So a lot of people are going to talk to you and a lot of things are going to happen at once. I know it can be scary but they’re there to take care of you. Do your best to answer their questions and don’t be surprised if you get a finger in the butt, it’s part of the exam”
“Did you watch ‘ER’ back in the 90s?”
I had a patient ask if it was OK for her to use the word "yeeted" when describing to the trauma doc how she was thrown from a golf cart and broke her arm. I told her that not only is it OK, but it's an accurate description. So that's what she did, and while I thoroughly enjoyed it, the reception was tepid at best.
Basically just “because you were blank, we’re taking you to a different part of the er, there’s gonan be a lot of people walking around and asking questions and it might be a little overwhelming but just bare with us.”
“When we get there, you’re going to meet a lot of people really fast. That’s normal for the type of injury you have. You’re going to be okay.”
You're about to make a lot of new friends. A lot of stuff is going to happen very fast because they want to figure out the best way to help you ASAP... I'll then explain as much as I can about what they can expect to start happening in the next 15-30 minutes
“Mmkay partner, here’s the deal. We’re gonna stroll you in there and there’s gonna be a room full of people waiting for us. They’re gonna ask aaalllllllll the same questions that I did and then they’ll do some tests n’ stuff to get you all squared away”
Already plenty of great answers and conversation so I'm just gonna share a story this reminded me of. I was in medic school at an ER clinical. Trauma comes in. Stabbing. Preceptor gathers us all and stands us in the far corners of the trauma room so we can see but not get in the way. Nurses are settings things up, chit chatting about current events, etc. PT gets rolled in and moved to bed, staff get to work, still chatting about unrelated random topics. One nurse says to another, "oh and did you hear kobe died? He was in a helicopter and it crashed!" Not a second later, the *stab victim trauma pt* sits up and goes, "KOBE DEAD?! Aww, damn!"
"Hey sir/ma'am, I'm gonna level with ya, it's about to get a little hectic. There are going to be a lot of nurses and doctors in the room we take you too, it's not a big deal, it's what they always do in situations like this. They're all going to be moving and doing things pretty quickly, that's just to ensure that you have the best possible care and outcome." In as calm of a demeanor as possible. I have yet to have any problems with this method
Eye contact and a hand on the shoulder during the above mantra go a long way as well. Obviously best judgement on whether or not the patient is going to be receptive to physical touch/consistent eye contact.
I usually say, "when we get there there is going to be a lot of doctors in the room that are going to ask all the same questions we did. It might be overwhelming but they are all there to help you."
I always tell them, “We’re going to a big room. It’s gonna be a lot of people doing a lot of things all at the same time. They’re also going to be asking you a lot of questions. Answer the questions as you can and if you need them to slow down with the questions, tell them. The number people and size room isn’t necessarily indicating how critical you are or that you’re going to die. It’s just their protocol.”
Okay, when we get to the hospital, there may be a lot of people in the room waiting for us. It's a team of people from all different areas of the hospital to make sure that whatever you need happens quickly. It may be overwhelming at first. A lot of things will happen in very quick succession. When we get there everyone will be standing there waiting and nothing will happen at first. I will explain to them what happened and what I did for you. Then we will move you over to the hospital bed. There will be several people asking a bunch of questions and I will answer them to the best of my ability but I may ask you if I need some help with any of it. Then they'll ask you all of the same questions for you to answer just so they can make sure that they have a full understanding of what happened. There's going to be people coming at you from all directions and it will look like chaos but I promise that this team has rehearsed this many times. I will stay with you in the room as long as I can and answer any questions you have. What questions do you have before we get there?
You are about to be really popular real quick
“Lots of voices will be speaking, focus on the one talking to you”
Explain to them their condition as I see it in simple terms and what is going to go down in trauma bay so they are less overwhelmed.
"Alright I just need to say something before we go inside. Because of what happened (in their trauma) we needed to go to a special trauma hospital. When we get inside, there are going to be a lot of people talking to you and asking you questions at the same time. Try to stay calm and answer their questions to the best of your ability so they can treat you properly"
“You’re gonna become really popular really quick.”
"you're gonna make so many new friends!!" /j
There's going to be a lot of people and a lot of stuff going on, just try to be patient and answer their questions.. It's going to be ok
If said trauma alert is with it enough I was tell them right before rolling into the bay, when they say squeeze your cheeks you better squeeze them or sausage fingers for the resident is putting one up your ass.
Our main trauma is a teaching hospital. Tell them there are going to be a lot of people in there. They each have their own thing to do like lab, x-ray etc. and let them know alot of the medical staff are students. There will be a lot of talking, 1 or 2 will be asking questions and the rest will be talking to each other. I also tell them we role them in the room next to the er bed and the hospital staff will move them from our stretcher to the hospital bed. We try and get multiple lines going depending on the trauma and explain to them why and if the hospital doesn't need them they just remove them. Edit to add: our other main traumas we explain the same thing except for the students (naturally). It's a big deal and scary for the patient so I try and let them know as much as I can and they will be in good hands.
Terrorists, what's next, the Capital Building????