Aaron’s scalp laceration

Time limit: 15 minutes.

Aaron’s scalp laceration

Trainer tells mock patient

Your name is Aaron. You are fully alert and oriented. Earlier tonight was the most intense action you’ve ever seen. When it calmed down you noticed you were bleeding from a cut on your forehead. You were suddenly overwhelmed and had a sudden sense of how far an El ride you are from home.

You don’t realize it, but your overwhelmed and withdrawn feelings are from low blood sugar – you were so caught up in the action you forgot to eat or drink aything but coffee this morning. You didn’t sleep much last night and it’s cold. You’ve been smoking cigarettes all day, which disguised your hunger and cold, but you only have one left.

Trainer says

After Brandy went to the hospital, the wind picked up. The protesters were hanging out and talking about the big action earlier tonight. Our gallant buddy pair noticed this guy they hadn’t met before sitting off to the side, really withdrawn. Let’s watch the medics establish consent. Pay attention: after you watch, you will get involved.

Buddy team approaches

a very withdrawn patient sitting on the ground.

Patient buddy

establishes and maintains voluntary informed consent.

Scene and comms buddy

watches the scene in a low-key way. The spotlight is on the patient buddy, not you.

Debrief

Trainer asks
Trainer explains

Voluntary informed consent is the process by which a person gives you active and continuing permission to be intimately involved in their life, in ways that may have lasting effects.

You need to provide them with accurate information about what you’re doing and why, and of any risks you are asking them to take, benefits you expect, and alternatives. If you don’t, your care becomes assault – legally and ethically.

Trainer reviews steps
  1. Inform the person who you are.
  2. Inform the person why you are concerned.
  3. Ask permission to assess.
If he consents to the assessment
  1. Ask what you can call him.
  2. Inform the person of what you’re doing, what you see, and what you want him to do.
If he refuses the assessment
  1. Inform the person that you accept his refusal (“That’s okay”).
  2. Ask what you can call him.
  3. Ask questions to explore options:
  4. Answer his questions with accurate information.

You may be able to help him in a way he makes a voluntary, informed choice to accept, even after he refuses your initial ask. Don’t use manipulative words. Treat people with respect.

The way you handle voluntary informed consent (or refusal) is one of your first opportunities to humanize a dehumanizing situation and counter the coercion of the state, racism, and the patient's previous experiences with emergency medicine. When we ask somebody “What can I call you,” we respect their right to anonymous care. This is also an opportunity to comfort, calm, and reassure.

Forum theater

Trainer says

Now we need your help to practice voluntary informed consent.

Student volunteer with a loud stage voice

reads both parts of the Aaron script from the top of this page.

Trainers replay the situation

but do everything wrong. They come from an oblique angle, touch Aaron without permission, use coercive language, both crowd him, ignore his refusal, call an ambulance without his consent, etc.

Student volunteer with a loud stage voice says

They messed that up, and need your help to fix it. Next time through, any student can call “Freeze!” when they see something they want to fix.

Then they can tell either of the medics to do something different. Let’s see how much better you can make this interaction!

Our gallant buddy pair noticed this guy they hadn’t met before sitting off to the side, really withdrawn.

Trainers replay the situation

but freeze whenever students tell them to, then act as directed by students.

Note

After Forum Theater, trainers will address refusal, implied consent, care for minors, and confidence.


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