What Do Physical Therapists Do? Installment #5: Emergency Response

REI Seattle Outdoor Space

Welcome back to the recurring segment on the blog: "What do Physical Therapists Do?"  I've previously written four other posts on this topic, all tagged with #WhatDoPTsDo so you can search the blog for those previous posts if you're interested.  I spent the last two days getting my certificate in Wilderness Emergency Response and First Aid hosted by the REI flagship store in Seattle.  (Beautiful fall weather and somehow managed to get out of there without buying anything!)

Before you get too far into this, you should know that in general, many physical therapists are not trained for emergency response care.  As trained healthcare providers who usually have training in CPR and First Aid, I would think that a physical therapist would be better in an emergency than someone without any training - but in general we're not trained for emergency response.  But we can be!  This is a key difference between physical therapists and athletic trainers where, generally, physical therapists are not present when an injury occurs and help rehabilitate the injury days or weeks (or sometimes much more time) later.  Athletic trainers are specifically trained to respond at the time of an injury or to an onset of illness to the athletes they work with. There are many ways in which PTs and Athletic Trainers With regard to urgent response, athletic trainers and educated physical therapists also differ from EMTs in many ways.  In the case of an emergency, 911 is still your best bet, but since I just attended the course, I thought I'd share why I would learn about emergency response and some of the tips and tricks I learned.

The class was structured with didactic learning intertwined with case scenarios.  We'd learn how to assess a patient and then practice in groups. Then we'd learn about various signs and symptoms of different conditions and then assess patients again.  There were numerous repetitions and they even used makeup to make bleeding/bruising so that you were looking for injuries to treat.  Conditions we discussed included musculoskeletal injuries - like I'm used to treating - and special focus on injuries to the spine, plus wounds, burns, weather-related conditions, abdominal pain, chest pain, allergic reactions.  We learned basic treatment techniques to help determine needs for evacuation/emergency care as well as splinting and wound care.

Fake Makeup Hand Injury

Why would a physical therapist get trained in emergency response?  Many physical therapists are also athletic trainers and, as such, need to keep their education current to best treat urgent cases.  There are, however, PTs who are not athletic trainers who also provide sideline coverage for sporting events (like myself with the Seattle Storm) and who can take these advanced courses in order to work towards board certification as a Sports Certified Specialist Physical Therapist.  For me, personally, I was also an EMT in my previous life and have always loved learning about urgent response.  I like knowing that I can be a helpful resource in an emergency situation.  The courses are also great reviews of basic anatomy and common illness or injury situations.

Key tips and tricks I learned in this course:

1) If you ever come across a person or group of people who are in need of emergency response, you must first make sure that the area is safe.  Otherwise you risk becoming an additional victim!  A person who fell off their bike in the middle of the street or someone who experienced a snake bite are both scenarios in which you could be putting yourself in danger and need to consider the surroundings before you can really provide adequate care.

2) Once the surroundings are determined to be safe, start with the key life threatening findings which are remembered by ABC.  Airway.  Breathing.  Circulation.  If a person is sitting up and talking to you after an injury - their airway is open and they are breathing and have a pulse - but you should still look for major bleeding that can impact circulation.  Nothing else matters if the person does not have an adequate airway, respiration, or circulatory system because those are life threatening situations.

3)  Medicine happens at the skin level.  This is something that was discussed a lot in PT school and I appreciated this reminder.  If someone says their shoulder hurts - LOOK AT THEIR SHOULDER! I remember a case we discussed in school where a patient came to PT complaining of back pain.  He went to the doctor first, was given pain medications (that weren't helping) and was sent to PT.  The physical therapist started their examination by lifting up the shirt to look at the back and see if there was any bruising - only to find a large rash.  PT wasn't going to help that condition.  Once life threatening conditions are ruled out, an injured person should be assessed from head to toe and any pain region should be exposed.

4) Failing to prepare is preparing to fail.  Take a first aid kit with you when you go hiking or backpacking in the woods.  At the very least, have the ability to splint an injury, protect injured skin, and stay hydrated and energized with enough water and food.  And always tell someone where you're going and when you should be back.  If you don't return by a certain time, they should send for help because if you're stuck in the wilderness with a major injury, you're going to need help.

5) Injuries may be easy to see, but illness may not be.  Things like heat exhaustion, altitude sickness, hypothermia, allergic reaction, diabetic emergency, or a heart attack are hard to identify if you don't know what to look for.  If you're concerned about someone feeling poorly but you can't see anything - you're better off calling for help!

I hope this is helpful if you ever find yourself in a situation where someone needs emergency care - but know that this was a 5 minute overview of a 2 day course, and that my EMT training was weeks long with ambulance calls and real life response training.  Again, you should always call 911 in an emergency situation, and only help a person in ways that you have been trained to do so.  If you're an adventurer, you should probably take a course in emergency response and/or first aid, whether or not it's specific to the wilderness, because many of the principles are similar.  I hope you go learn all this information and never need to use it!