[EMS] Roleplaying Guide.

[Andre Campbell]

In this guide, I will be presenting different situations you can occur, so you can get some inspiration about how to roleplay different situations/accidents. Also, you could maybe learn some general medical knowledge here, cause things will be well explained.

General information:


Pulse/heart rate: A persons pulse represents how many times per minute his heart beats (BPM - beats per minute). A normal pulse rate when in rest, will be 60-100 BPM. The pulse can be measured by either placing your hand directly over the heart, or normally it is measured by places two fingers on the persons wrist or neck, or finally with electronic equipment, such as an ECG (eletrocardiography). A persons pulse will rise during physical activity and in stressed situations. Furthermore, the more blood you lose, the higher your pulse will become. The higher pulse/heart rate, the more oxygen needs to be absorbed, and therefore a persons breathing will under normal conditions increase, along with the pulse.

Blood pressure: A persons blood pressure represents the pressure of the vessels from the blood flowing. Blood pressure is measured by both the systolic (maximum pressure when coming FROM the heart), and a minimum diastolic (minimum when coming TO the heart). A big difference between the systolic and the diastolic pressure, can mean that blood is flowing from the body somewhere, so blood pressure can be a good way to check of a possible internal bleeding. Blood pressure is normally measured with a sphygmomanometer, or in laymans terms a blood pressure meter. If you lose a lot of blood, your blood pressure will begin to drop. A normal blood pressure is 90-120 (systolic) / 60-80 (diastolic). If the systolic blood pressure is over 140 mmHg, you have too high blood pressure (hyper-tension). A blood pressure under 90/60 is too low (hypo-tension).

Respiratory rate Rarer used by medical professionals, but means the breathing rate per minute. Normal for adults is 12-20 breaths per minutes when resting.

How to perform CPR: Cardiopulmonary Resuscitation (CPR) is performed when a persons heart is stopped, and is performed by:
1. Making two initial ventilations, by slowly blowing air into the patients mouth, while pinching his nose to close it.
2. Place your hands on top of each other the persons sternum (between the chest).
3. Compress the sternum 30 times, hard and in a steady rhytm.
4. Check his pulse, listen over his mouth, and look at his chest, to see if his heart begins to beat. If the persons starts to breathe, his heart is also started.
5. Repeat these steps while someone else dials 911.




Vehicle accidents and falls from heights:


In most RTC's (road traffic collisions) occupants inside a crashed vehicle may suffer from many different conditions, depending on how the crashed happend, speed, vehicle type etc. The most common things to suffer from a vehicle accident (and falls from heights) are:

- Neck or back (spine) injuries Roleplayed as having pain in your neck and/or back when moving. If this occours after a crash, you should be placed on spineboard by the EMT, and avoid moving your body at all. Neck or spine injuries can easily lead to for example paralysis or a whiplash which will follow you the rest of your life

- Internal bleedings Roleplayed as having big blue marks on the area of the internal bleeding (as blood inside your body is blue and visible through the skin during a bleeding inside it, and very strong pain. Risk of coughing up blood, if the bleeding is in the tracheal (upper chest) area. The EMT will examine you for internal bleedings with a stethoscope on scene.

- Open or closed fractions (broken bones) A closed fracture (broken bone) is when a bone is broken, but not penetrating the skin. An open fracture is more serious, as it has penetrated the skin, and bones might be sticking out the skin. An open fracture needs to be closed (bandaged) before it is secured in a traction splint by the EMT. At the hospital, a doctor will perform an x-ray, to examine the bone fractures.




Gunshot wounds/knife stabs:
Internal bleedings Bulletwounds can also cause internal bleedings. Despite what many people might believe, a bullet most likely won't travel straight through your body, but cluster as soon as it penetrates the skin, and make a lot of havoc inside the body, meaning a huge risk of causing damage to vital organs, and cause internal bleedings. It's a bit more tricky to spot internal bleeding in gunshot wounds, because there will most likely not be any visible injury from the outside. A stethoscope or a CT-scanning at the hospital, can reveal this.

- Substantial blood loss RP'ing that you have lost a substantial amount of blood after a bleeding wound, will further challenge the EMS-crew. This will make your pulse rise, and increase the risk of sudden cardiac arrest, circulatory shock, or unconciousness. You need a blood transfusion if you have lost more than one litre of blood. EMT's on scene may also inject you with lactated ringers solution, for fluid resuscitation after a great blood loss.

- Bleedings in genereal An external bleeding occours, when a blood vessel is ripped apart for some reason, and the bleeding is visible on the exterior of the body. Depending on the severity and location of the bleeding, it can be more or less life threatening. Major arteries are found on the wrists, neck, thighs and chest area. A single bandage may not always be enough to stop a serious bleeding. Sometimes more compression is needed, and sometimes a bleeding can't be stopped on-scene.

Burn wounds:

A burn wound can be caused by heat, eletricity, chemicals and more, and is a condition which normally only damages the skin tissue, but with serious burns, it can also damage muscles, bone and blood vessels. You talk about about up to six degrees of burn wounds:

First degree burn: Is normally just a light redness of the affected skin area, with minor pain. This can be treated by simply applying cold water or a moisted cloth to the area. Doesn't need medical treatment. IE: Sunburns, warm water burns.

Second degree burn: Also causes redness, but also causes blistering of the skin. A second degree burn may not hurt as much, since the underlaying nerves can be temporarly paralysed or damaged by the burn. Takes much longer time to heal, and will leave a scar. Needs medical treatment, depending on the severity. IE: Chemicals, substantial heat

Third degree burn: Is a serious burn, where nerves, underlaying tissue, keratin and hair shafts is destroyed, and is creating major scars which will never heal. Therefore grafting (skin transplantation) is often needed. Most third degree burns can't be felt by the patient, because the nerves are destroyed completely. IE: Chemicals, burnwounds from fires

Fourth degree burn: Can furthermore damage the muscles behind the skin, with permanent motoric problems to follow, caused by a permanent damaged muscle.

Five degree burn: Is a very serious burn, where all overlaying tissue and skin is destroyed, along with muscles and arteties and veins, making this burn very fatal. A five-degree burn may also bleed because of this. Amputation of limbs can also be required.

Sixth degree burn: Is the most serious burn that can occour, which will completely destroy skin, tissue, nerves, muscles and everything overlaying the bone, so the bone will be exposed. If you're not already dead, an amputation is needed.




Head trauma:

Head trauma can be something as light as a normal concussion, to something very serious as a brain hemorrhage. Head traumas can be caused by everything from a vehicle accident, to a heavy bump to the head, a punch etc.

- Concussion: When you have a concussion, you will have a strong headache, become disoriented, naseous, ringing for your ears for the most. An EMT will check you at first, by lighting into your eyes with a penlight, to find out whether your pupils are dilating (contracting due to the light as they should) and to see if the pupils have the same size. If your pupils are not dilating, you could have a concussion, if the other symptoms are also showing. Depending on the seriousness of the concussion, it is treated by just observing the patient, or checking for brain swelling and/or bleeding in a CT/MRI scanner.

- Skull fracture: Is caused by a break in the skull, normally caused by a blunt force, or in a fall. Typically it will bleed violently, and can cause concussions or hemorrhages depending on the severity. A skull fracture needs to be treated immediately. Light skull fractures can be treated by stopping the bleeding, and simply observing the patient, and it will heal itself eventually. Serious skull fractures requires acute surgery.

- Brain hemorrhage: [i]Is a very serious condition which needs immediate treatment. It can be cause by many things, including hypertension (too high blood pressure), smoking, alcoholism and diabetes. A brain hemorrhage will show by defections in the body functions which is controlled by the bleeding part of the brain. Therefore it can be very difficult to spot at first. A CT-scan will reveal a brain hemorrhage i suspected. Treatment varies from daily intake of medication, to acute surgery to contract the bleeding veins inside the brain. In a severe case, a hemorrhage can cause an epileptic seizure (see under special conditions).




Special conditions to roleplay:


Heart attack Heart attacks are caused by a sudden block of the coronary artery in the heart, and must be treated immediately to save the patients life. It can be roleplayed as suddenly fainting on the street, in connection with the usage of drugs or alcohol etc. Right before a heart attack occours, you will most likely feel a very strong pain in the left side of the chest, most likely radiating out in your left arm and/or jaw. The EMT on scene will need to perform CPR to start your heart, and rush you to the hospital for further treatment.

Anaphylatic shock Anaphylactic shock or just anaphylaxis, is a very strong, sudden allergic triggered reaction. Depending where it occours, it can lead to swelling of the throat, coughing, asthmatic-like trouble breathing, chest pain, drop in bloodpressure, heart attack and/or unconciousness. The EMT should try to maintain free airways and breathing. Furthermore he should inject the patient with adrenaline from an EpiPen, which will make the veins contract, and the bronchis in the lungs to expand, so bloodpressure rises and the patients breathes easier.

Asthma attack Can occour, when an asthmatic patient is exposed to smoke, pollution, or even psycological stress, or if the person forgot to take his medication. Althogh, asthma attacks can in rare cases, be triggered in a healthy person without asthma (as first indication of the disease). The symtons are shortness of breath, wheezing and chest tightness. In case of acute attacks, the EMT will use an Albuterol-inhaler, and possibly oxygen, to calm down the patient.

Epileptic seizure A seizure can occour amongst people suffering from epilepsy, but can also rarely occour for healthy persons. It's caused by abnormal brain activity due to IE. damages in the brain from a hemorrhage. It represents as everything from slight confusion, abnormal body movents, to completely loss of body control, and falling to the ground. The EMT will roll the person over to prevent him from choking, secure his head, so the patient does not bang it, and treat him with diazepam to control the seizure. Despite wide-beief, you should NEVER but something in a seizuring persons mouth. It can be swallowed or make damage to teeth and tongue. A person can't swallow his tongue or choke in it, during a seizure.