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 you 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.
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