Old dog learns new trick

The adaptability of our species will never cease to amaze me. Take your average drunk for instance. As any experienced medic will tell you one of the most annoying calls to respond to is the person feigning unconsciousness. This type of assignment will generally show up anywhere between one and three am between Friday and Saturday.

The art of faking syncope (an unconscious state for you laymen out there) has evolved over my twenty plus year career. The motivations of faking unconsciousness vary but the common thread is the level of annoyance to the EMTs or Paramedics sent to an address because someone feels they need a little more attention. And it falls to these intrepid professionals to determine if life saving techniques need to be employed or if the person is full of crapola.

"Back in the day" you could obtain an accurate differential diagnosis by a brisk sternal rub or nipple twist. Those who remained unconscious were, and those that sat up violently swinging weren't. Piece of cake. Sadly, Darwinism being what it is has seen an adaptation evolve and now even the most casual faker can withstand those time honored stimuli. The same goes for ammonia inhalants and other more common alternatives.

So on a recent shift we were confronted with a frequent flyer who clearly was faking unconsciousness. What to do? That is when I was introduced to the FIN technique also known in other geographical locales at DNS. As it turns out empirical data collected in a more urban EMS area has shown that no matter how good a person is at feigning syncope and no matter their level of Zen like self control it is nearly impossible to tolerate taking THEIR finger and inserting it into THEIR nostril. If they are faking, instant consciousness and indignation result . As an added bonus, no pain or bruising to the patient. A win win situation.

Kudos to The Fisherman for teaching me this new technique. For all my fellow Paramedics let me fully endorse the Finger In Nose or Deep Nasal Stimulation maneuver. Its, quick, accurate and a real time saver. On a cautionary note, this might not work in all cases. This faker hasn't woken up yet....