"...a tree hit my car..."

The call is for an auto accident and, as it so happens, the ambulance (with me on board) is on the complete opposite side of our jurisdiction where the call is.

We arrive to find our engine and the rescue squad from the next area over in attendance.

"She's not complaining of anything but a headache. We're going to board and collar her as a precaution." This is delivered to me in a deferential tone by the FireFighter who just got back from Iraq and is in the middle of his EMT-Basic school.

"Let me talk to her first, OK?" I say.

"Sure. I'll get the gear." he says and heads off to get the gear.

I note a small SUV resting against a small tree in the median. The car has some damage but the airbag is not deployed and there does not appear to be much passenger compartment intrusion. The patient is sitting in a police car nearby.

As I approach, everyone is giving me information, status reports, patient statements, vitals and their opinions. They all sink in somewhere but my attention is on my patient. She's sitting with her feet out of the open door of a police car. She's looking around at everything and following all the activity. No blood and a good general impression.

I approach her left side and speak to her. Her head moves smoothly with no visible signs of pain as she looks to my voice. She knows where she is, who she is and what day it is. I move to the other side of the door and her head, again, follows me with no signs of restricted movement or pain.

"Did you hit your head?"

"No."

"Do you hurt anywhere?"

"No."

"Tell me what happened." I say.

I find that open-ended questions are great tools to assess someone's mental status. If I give them leave to say what they want, they'll tell me, through the nature of their answer, whether or not they're in their right mind. Since she has no outward signs of injury and denies any pain anywhere (including back, neck or head), I'm relying on this tool to tell me if I have a patient with a risk of spinal or brain injury. I listen for gaps in their story or bizarre events.

"I was just driving along and a tree hit my car!"

Um. OK. A tree hit your car. Right! I look to the left to see her car resting against a tree. My eyes track to the left to see the earlier FireFighter has arrived with the spinal board and C-collar. Good, I'm going to need that. Clearly, someone is not in their right mind.

I stand up to step around the patient and flashing lights catch my eye. Down the road, about 300 yards, are two police cars. They're positioned to keep traffic from hitting a huge tree that has fallen into the roadway.

I look at my patient's car again.

There's a big dent in the roof and windshield. The front of the car has only minor damage.

Wow! I guess a tree DID hit her car!

She, again, related no pain to her back, neck, or head and, no matter how hard i tried, I could find no evidence she had lost consciousness. Her story was consistent and (now) made sense to me.

She went to the hospital anyway at her own request. The only difference is she rode in a seat instead of on a backboard.

--maddog