Updated August 17, 2018
By Chris Miller, MICP, MISCP
The effective management of complex emergency medical prehospital incidents can be difficult at best. Often, however, these patient driven events can be well sorted and managed by the initial implementation of a strategy which addresses needs and outcomes.
This may be accomplished by the introduction and utilization of two simple acronyms at the beginning and, then, throughout the duration of the incident. Whether the incident is trauma or medical in origin, organization from the start usually results in more efficient scene management throughout the incident and, as a result, more effective patient care.
An acronym is a kind of abbreviation. It is a word formed by taking letters from a phrase that is too long to use comfortably, e.g., laser is an acronym of Light Amplification by Stimulated Emission of Radiation. Acronyms, whether true acronyms or not, add simplification and organization to our professional EMS language. Thereby, acronyms can also act as mnemonics, or memory devices, triggering steps or tasks which should be considered or accomplished.
With acronyms, more depth of meaning is conveyed in less time and with fewer words. In the heat of battle, acronyms can be easily and quickly recalled for incident or patient size-up or assessment. In EMS, we utilize several acronyms frequently, such as CAB, LOC, OPQRST, and SAMPLE.
These are all patient centric abbreviations. Successful EMS operations begin and conclude with methodical and ongoing evaluation and treatment of not just the patient, but also the incident for the application of strategies, tactics and resources. One acronym which may be used for EMS incident size-up and management is P.E.N.M.A.N.
PENMAN is a simple acronym that may be utilized for the initial size-up of an incident with an EMS, or victim, component. The letters in PENMAN stand for:
- Personal and personnel safety.
- Environmental hazards.
- Number of victims.
- Mechanism of injury or nature of illness.
- Additional resources from within the responder’s own agency.
- Need for outside agencies.
The PENMAN acronym reminds the first arriving incident commander of the primary scene priority: safety. This acronym can be recalled while responding to an emergency and continue to be utilized upon arrival. PENMAN can also be used during the event the parameters of the incident shift.
Personal and personnel safety
Safety is a primary concern that should be addressed long before the responder actually responds. Is he or she mentally and physically ready to address another emergency incident?
Part and parcel to this first question is, “Do we have the personal protective equipment (PPE) needed to be physically safe for this incident?”, “Will we need to use body substance isolation equipment (BSI) for this event and do we have these items immediately available?” PPE should, in most cases, be on the person or immediately available to the responder.
The other role of “P”, and why “P” comes first, is to remind responders that the primary scene priority is safety. There is an unwritten golden rule among first responders, no matter which role they provide on-scene. That rule is: Everyone goes home.
Environmental hazards
An environmental hazard is anything that can reach out and hurt you; therefore, “E” also addresses safety. These hazards range from the most common killer of emergency responders — vehicular traffic — to other safety considerations like leaking fuel at a traffic collision, the possibility of a shooter still on-scene at a reported shooting, weather hazards, and airborne contaminants.
Some of these hazards can be mitigated to render the scene safe. For other hazards, the medic should stage until other qualified responders can render the scene safe so that the EMS pracitioners may proceed and perform their duties.
Number of victims
Victims are those on-scene affected by the event or illness in one way or another. Like determining the square footage of a room in order to purchase the correct amount of flooring, the first responder to arrive on-scene will want to know how many victims may require medical treatment and transportation so he/she can place an order for resources necessary to mitigate and terminate the patient component of the incident. Often, an estimate will initially work. In some cases the responder must make an estimate of the number of victims simply because there are too many to immediately count or all the victims cannot be seen. It is better to overestimate than under estimate.
Bear in mind, all people on scene are different types of victims. Even first responders are victims of a kind. These people on-scene cease being victims and become patients as soon as the responder begins assessing and treating them.
Mechanism of injury or nature of illness
What happened? How was the incident caused? Investigating how the victim(s) were injured or the circumstances leading to their illness will provide clues to the extent of the victims’ injuries or illness. Was the incident a traffic collision or was the catalyst for the incident a hazardous material release?
In a traumatic injury incident, survey the scene and its components and make an effort to determine how much force may or may not have been transferred. Was this a small car into a minivan? Was it a semi-truck into a school bus? Perhaps the older or younger residents of a particular house are very ill, and the rest present with headaches and/or general malaise such as could be found in an atmosphere charged with carbon monoxide from a faulty heater.
Determining “M” may take seconds as the responder pulls up to the scene, or may take longer if the responder needs to look deeper into the scene’s history.
Additional resources from within the responder’s own agency
That is, what does the agency have immediately available to address any needs or resources as defined by the initial incident size-up utilizing the “P”, “E”, “N”, and “M” of PENMAN.
If the responder’s agency is ambulance-based, the responder may be able to get additional ambulances, a supervisor, or a multi-casualty unit to use on-scene. Fire agencies can usually provide additional fire responders via engines, trucks, and squads, supervisors, HAZMAT, and investigative personnel. These resources should be requested as quickly as possible.
Remember, just as it is better to overestimate the number of patients, it is always better to over order than under order. Additional resources can be released or cancelled when it is determined they are not needed.
Need for outside agencies
These resources should also be requested as soon as their need is identified utilizing the “P”, “E”, “N”, “M” and “A” of PENMAN. This order is for assets which your agency cannot supply. These resources should provide the equipment and personnel necessary to complete the tactics and tasks necessary to mitigate the event.
Common outside resources requested by EMS are:
- American Red Cross.
- Coroner.
- Law enforcement.
- Fire suppression and rescue
- Air transport.
- Ground ambulance transportation
- Urban search and rescue
- A chaplain or mental health counselors.
As with additional resources from the responder’s agency, order what may be needed, and over-ordering is preferred to under-ordering.
A good rule of thumb is an ambulance for every two victims, and an engine company for every four. This rule will work when the number of patients is limited between one and eight and their injuries range from “minor” to “immediate” (based on the Simple Triage and Rapid Treatment) categories. This rule, though, will not work if there are:
- More than eight patients.
- Patients are mostly “immediate” triage category.
- Still a danger or dynamic that is generating additional patients.
In this case, the ordering becomes a little more complicated. It is a good idea to discuss the capabilities within your agency and those nearby to determine what resources are available. Then, develop internal policies accordingly addressing exactly what may be needed utilizing PENMAN for both common incidents and contingency planning.
The utilization of PENMAN begins the incident in a methodical and organized way allowing the first responder on-scene to ensure the responder and response team are safe and request more resources, as necessary, to begin to stabilize and mitigate the incident.
References
Wren, J.D., & Garner, H.R. (2002). Heuristics for identification of acronym-definition patterns within text: Towards an automated construction of comprehensive acronym-definition dictionaries. Methods of Information in Medicine, 41(5), 426-434.
Herbert, L.F., & Tsung, O.C. (2003). Acronymesis: The exploding misuse of acronyms. Texas Heart Institute Journal, 30(4), 255–257.
Stalder, D.R., (2005). Learning and motivational benefits of acronym use in introductory psychology. Teaching of Psychology, 32(4), 222-228.