Wednesday 23 May 2012

Increased level of Consciousness

"25 year old male, increased level of consciousness"

There is often criticism of how well ambulance crews measure levels of consciousness. As a rule we use a combination of common sense and the Glasgow Coma Scale (GCS). A patient is given a score based on a number of variables to determine what level of consciousness they are. A score is given out of 15 and can be as low as 3. Someone who is completely unconscious is deemed to have a GCS of 3. Someone with a GCS of less than 8 is judged to be in a coma. There is often a discrepancy between the hospitals and us as to what score the patient has. We tend to over-triage and make out a patient is worse than they are and hospitals tend to under-triage and paint a rosier picture. In a hospital it doesn't matter so much as there is constant monitoring of a patient's condition. Pre-hospitaly we have limited time and limited expertise to do anything other than be over cautious.

This is the template by which we measure a GCS:

It is a crude tool in many cases; it's hard to use on patients with dementia or any other pre-existing cognitive impairment, it's very vague on paediatrics, and if someone is blind or a mute they could easily be judged to medically in a coma!! It has its uses, especially for head injuries and strokes, so it is a valuable assessment tool at our disposal. It's most often used to determine just how much alcohol has been consumed!

When call volume is particularly high, or there are not enough ambulances running, our control will do a 'general broadcast' of the calls being held. They do this in the hope that a crew sitting at hospital, or on a "non-conveyed", who are almost ready for another job will offer up for it. We were sat at hospital when the following came over the radio:

"General broadcast, all units, ambulance required for a 25 year old male with an increased level of consciousness. I repeat, general broadcast, all units, ambulance required for a 25 year old male with an increased level of consciousness. Please press green mobile of come up RTS Priority, time of 18:56, my initials are Echo Sierra, over"

Increased level of consciousness?! That's a new one even to me! I've heart of patients calling in their own cardiac arrest but this was highly original! Obviously, it was a slip of the tongue but it made us laugh no end. I imagine most other crews who heard it also had a laugh at control's expense! It did get us talking though. What would be an increased level of consciousness?! Going by GCS you'd need more points available than 15 to accommodate what I would presume would be hyperactivity! Maybe some recreational and 'class A' drugs could cause an increased level of consciousness! Maybe excess caffeine or too many E-numbers for kids would cause a 'raise' in the GCS! To that end I have created a new GCS table to be kept in your pocket books AT ALL TIMES! 

Clinically, it probably has its flaws, but I'm bored of documenting that someone is GCS 15 when it is quite clear that whatever they have taken has put them on a completely different plain to me! Clearly, GCS should be out of 18 on the count of really big eyes!


  1. Not to be confused with "a higher level of consciousness". Symptoms include floating about in lotus position chanting and muttering about Nirvanha… way off any scale!



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