PARAMEDIC DISPATCH
vYou have been dispatched to the home residence of a 15 year old male, Sam, who appears to have been assaulted on their return home from school.
vThere has been no loss of consciousness, but his mother is concerned regarding possible ribs injuries
vShe is a single mother with two other younger children and needs assistance to get Sam to hospital.
vThe dispatch was received at 16.45
ON ARRIVAL:
v There is no danger to the attending paramedics or others.
v The paramedics are met at the door by the single mother of three. The mother explains that she walk in on her son in the bathroom who was wiping blood from his face and upper body.
v Sam is sitting in the bathroom on a chair that has been brought in by his mother.
v Sam is supporting his right side and slowly breathing in and out and not moving freely.
INITIAL ASSESSMENT
v Sam did not lose consciousness, has sustained a blood nose which does not appear broken, and has bruising on the face and upper torso on his right side.
v His breathing is regular but he has pain on his right side when trying to breathe in deeply.
v No immediate complications or major life threatening injuries evident.
v Sam’s mother says that Sam is not forthcoming with information and does not wish to talk about what has happened, but reluctantly let her call
HJo
O
oKHRJBFOB4IOTFB5OIFN5IHFN5OIHT5OITJL5TBO5I BGL GCS Pupils Pain
Observation
HR-80
Pulse-Strong
Rhythm-regular
BP -115/70
Cap Refil-2 sec
RR-15 Shallow
Sats- 99% on air
Skin-Pale, Warm & dry
BGL- NA
GCS-15
Pupils-PEARL (pupils equal and reactive to light)
Pain-Pain – bruising on the face and torso – on deep inspiration 6/10
WHAT DO YOU KNOW AND WHAT TO DO?
•What do you know so far?
•What is your thinking at this stage?
•How would you approach Sam?
•What else would you want to know?
• What do you notice regarding:
vB – Sam’s behaviour ? (his movement, eye contact, mannerisms)
vA – his appearance; posture; facial expression and demeanour ?
History: Story from Mum!
vSam’s mother has noticed that over the last two (2) months specifically that Sam has become more withdrawn.
vShe has noticed that Sam spends far less recreational time on his computer (which is in his room for ease of access and privacy) and mobile phone and their relationship seems to have changed (less communication and not as close as previously)
vVery reluctant to talk about what is happening at school.
History: Story from Mum!
vShe realises that year 11 involves increased work and study load, but Sam’s grades have dropped in the last six (6) months from a top student to just passing subjects.
vShe has tried to talk to Sam and she believes they have generally a good relationship, but recently she gets little response.
vSam told her that everything is a bit hard at the moment but they are alright and not to worry – he is managing.
WHAT DO YOU KNOW AND WHAT TO DO?
v What does the mother’s history tell you – what have you heard?
v What is your thinking at this stage?
v How would you describe the relationship between Sam and his mother?
v What else would you want to know?
Ø How does this information relate to an assessment of ‘risk’?
Ø Consider the socioeconomic and family circumstances that may effect Sam’s wellbeing
SOCIOECONOMIC AND FAMILY FACTORS
• Explore concepts of resilience, family support and social networks, financial considerations that may effect a young person and how that relates to mental wellbeing and the assessment of ‘risk’.
Story from Sam
v Sam is sitting facing away from you as you approach.
v He is softly spoken – low volume with little to no expression in his voice, slightly hesitant and gives only brief answers.
v He only engages in eye contact and conversation when asked a direct question.
v He states that he is ‘alright and doesn’t want to worry his mum’
v He briefly describes the fight as “just a couple of guys ‘mucking around’ that got out of hand”
v He feels a bit sore on the right side of his chest “but ok”
v When he talks his facial expression remains blunted and he stares past you.
WHAT DO YOU KNOW AND WHAT TO DO?
v What do you know?
v What is your thinking at this stage?
v How would you attempt to develop a rapport with Sam?
v What else would you want to know?
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What can you add to the description of Sam’s
Behaviour and Appearance How would you describe the following: C – Sam’s speech and conversation
P – his perception, his view of the world and what is happening at the present moment ?
A – Sam’s description of his mood (how he is feeling) and his outward emotions (affect)
A bit more information from Sam
• Sam quietly tells you over the past 7 months he has been the subject to bullying via constant e-mails, Facebook and tweets which comment on his appearance, stating his is stupid and is not sexually desirable.
• The bullying has progressed to being taunted at school and physically intimidated.
• This happened after an incident where he was offered ecstasy after school and refused and tried to stick up for another student who was peer bullied into taking the ecstasy tablet.
A bit more information from Sam
• Sam tried to seek help through the appropriate school channels but has received further threats.
• The threats of physical violence have increased to the point where Sam has stayed home as much as he could to prevent further opportunities of being cornered and shoved around in the school toilets.
• Sam has tried to keep up with the workload but has been finding it harder and harder to concentrate.
Sam tells his story
• As you talk to Sam he is getting increasingly distressed and angry at himself
• He feels he is increasingly getting angry at home for no apparent reason and is taking it out on his two younger siblings (Jay, 13 and Mia, 10). He do not want to hurt his family.
• On the way home this afternoon he was assaulted by three students from their school.
• He was pushed to the ground after being punched in the face and the side of the body.
Other information
•Sam appears to be the main support for their mother who is a single parent after their father left when his sister was born.
•His mother works full time as a local librarian at the council chambers and is trying to provide a good education and home environment for her children.
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