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Everyday EMS
by Greg Friese

Hands-off! Assessment and care when you can't be there

Do you train for scenarios where you can't put hands on patient during assessment and treatment?

By Greg Friese, EMS1 Editor-in-Chief

You are hiking on a trail adjacent to a roaring whitewater river when you see a kayaker drag a limp body from the water on the far shore. The kayker yells to you for help. There is no way to swim across the river, and the nearest safe crossing is two miles upriver. Begin your assessment and treatment immediately!

I learned this scenario from another Wilderness Medical Associates instructor and have used it many times during wilderness first responder courses. The scenario challenges students to assess and treat a patient they can't speak to or touch as well as to communicate instructions to another rescuer.

I also experienced a scenario like this as a bystander at a recent distance running event. I was past the finish line watching other runners complete a half marathon on an unseasonably hot and humid day.

As I was trying to cool down and rehydrate, the emcee broke in, "Medical is needed near the porta-potties for a runner down." I jogged over to the area, assuming I would watch the race medical volunteers walk or wheel away a weak and dizzy runner.

Instead, I found an unresponsive runner supine on the pavement on the other side of an 8-foot-high fence that separated the final stretch of the run from the finishers' area.

On the opposite side of the fence, two volunteers were pouring bottles of water on the runner.

On my side in about a foot of space between the porta-potties and the fence, other runners were throwing water bottles over the fence to the volunteers.

The runner was breathing and had vomited. Like my students on the far side of the river, I needed to direct the non-medical volunteers how to move the ill runner into the recovery position, monitor his vital signs and continue to cool him until help arrived.

Getting the attention and cooperation of the volunteers was harder than I anticipated. Together, we continued care for about 10 minutes until paramedics arrived at the patient's side.

There are many scenarios where EMTs and paramedics can't put hands on a patient during assessment and treatment. Do you practice those scenarios?

Here are a few you could use for an upcoming training session:

  • Patients are in a structure that collapsed due to severe weather after a tornado. You can hear an adult shouting on the other side of a classroom wall that several children are injured and need your help.
  • A patient was shot and is barricaded in a classroom with the shooter still at large. A teacher can relay assessment findings and begin treating penetrating trauma via cell phone.
  • A patient is entrapped in a vehicle and is awaiting extrication. A medical first responder inside the vehicle can perform airway management and other treatment instructions relayed by a paramedic outside the vehicle.

How have you communicated assessment and treatment instructions in a situation where you can't be hands-on? What are other training scenarios for practicing communication to bystanders and other medical personnel who will perform actual assessment and treatment? 

About the author

Greg Friese is Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at
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