As class heads in to our third quarter, the materials and skills shift from understanding medical emergencies and associated Nature of Illness (NOI) to traumatic injuries and their associated Mechanism of Injury (MOI).

Trauma is generally considered the gorier part of EMS, and deals with direct bleeding, fractured bones, and other physical injuries to the body that generally result from the application of an outside force on the patient. As such, there are a wide number of practical skills involved in providing interventions to our patients, including proper techniques for bandaging and tourniquet application.

But trauma isn't always obvious. Car accidents, sports injuries, slips and falls can all cause traumatic injuries to bones, muscles and internal organs, often with no visible external injuries. Some of these internal injuries are treated almost exactly the same as internal bleeding caused by medical issues, such as acute abdominal pain due to appendicitis, or altered mental status due to stroke. .

But the effects of the MOI are supposed to guide us to an index of suspicion that there may be more going on with our patients, concerns that may require more care and a deeper assessment for injuries that just simple pain or confusion would appear to warrant.

So we get a bit more touchy-feely with our fellow students, and start learning to look for DCAP-BTLS. 

Well, not quite a million, perhaps. But a lot.

If you've ever had the need for an EMT's help, you've probably experienced the barrage of questions we ask. And we consider it a really good start when you're awake, alert, and able to answer those questions.

Before our EMT classwork can start to talk about interventions for specific injuries or illnesses, it's important for us to identify what, exactly, we're dealing with. And while it's often easy to get the basics when you have a conscious and lucid patient, that isn't always the case.

EMTs are drilled to take a specific step-by-step approach, called assessments, in order to ensure we first focus on critical life-threats, and then (and only then) identify and prioritize other issues our patients may be having. These assessments break down to the Primary Assessment (done when we first arrive on the scene), the Secondary Assessment (which may be done on scene, in the ambulance), and re-assessments as needed or warranted by the specific issues and interventions being undertaken.

At this point in my EMT course work, we're starting to practice these assessment skills, linking signs and symptoms to the knowledge of anatomy we've been learning, before we move and transport patients anywhere else. And it comes with learning a bunch of mnemonics, such as AVPU, SAMPLE/OPQRST, and DCAP-BTLS (just to name a few), to ensure we don't miss any critical information.