Street Lessons #5 The Hand Drop Test

Anyone new to EMS is likely as amazed as I was at how many patients feign unresponsiveness.  We all likely have had a moment when a more experienced responder has demonstrated the “Hand Drop Test,” where they raise the patient’s hand over their face and release it.  If the hand smacks the face, they pass the test and truly are unresponsive.  If the hand stops or is moved to the side to avoid contact, then the patient fails the test and is a FAKER.  Or so it goes.  The best FAKERS, I was told, know our tricks and so let their hands smack their faces because they are wise to what we were trying to prove.  I was told to look out for these master fakers.*

There is a second more valuable lesson than the Hand Drop Test, a lesson that comes later and often comes painfully to your own performance as a paramedic.  And that lesson is just because a person is aware enough to move their hand to avoid their face, doesn’t mean they can’t also be really sick.

What do you mean?  They have an intracranial bleed?  They failed the hand drop test!

What do you mean?  They are in acute renal failure?  They failed the hand drop test!

I was burned by this early in my career, but never again.

All a person needs to fail the hand drop test is a smidgeon of consciousness, and a quarter ounce of remaining strength.  It merely tests for a smidgeon of consciousness and a quarter ounce of strength.  It does not provide proof that a patient is not sick or injured.

Also, if the results of all your other assessment capabilities still leave you wondering, and you just have to do the hand drop test, make certain that you protect the patient.  A paramedic caused bloody nose should not be considered collateral damage from having to do the hand drop test.

*  I no longer feel it is my job to unmask fakers.  If I suspect someone is faking, I find it easier to just pick them up, put them on the stretcher and take them out to the ambulance, than to try to prove to the surrounding crowd that the patient is conning everyone.

 

5 Comments

  • Brett says:

    It really can be amazing how many people will fake being sick to get an ambulance ride. Don’t forget the unresponsive who holds their eye lids shut, or rolls the pupils out of view when you open the eye lids.

  • Greg Friese says:

    Brett, I would call faking sick a sickness that deserves our patience and respect.

  • Matt says:

    When I was in my first few months as an EMT, I went to a call at a summer camp. The teenage girl was “unresponsive,” but even to my profoundly inexperienced eyes, she seemed to be faking it. It was the perfect environment for the test: high-drama young woman, crowd of high-drama friends, and a few adults to be properly impressed by my skill and acumen in demonstrating her malingering.

    So I got to do the hand-drop test. And she failed. As a result, we picked her up, threw her on the gurney, and I mostly ignored her for the ride to the hospital, even as she continued the act.

    The follow up turned out to be a little more complicated: she confided in one of the nurses that one of the counselors was molesting her. Then more campers came forward with the same story. I heard one of them was pregnant. Obviously, I was in a poor position to evaluate the validity or context to any of these accusations…

    But I learned to try to assess and treat my patients even when they might be faking a symptom.

  • medicscribe says:

    Great lesson there, Matt. As Greg suggests, every patient deserves our patience. Your tale clearly illustrates why. Thanks for sharing it with us. It is unforgetable.

  • Dan says:

    NPA usually tells who is faking it.

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