First Call by Myself

[NetMatrix]

The long board does make a difference with CPR. As someone who has done compressions with and without the LSB on the gurney, you can feel the difference, mainly in smaller patients IMO.

I have a feeling this is a trauma per protocol situation. You would be amazed how many simple fall-from-standing patients get back boarded because they are a "trauma".

By simple I mean people who just fell down. No boucing off of dressers or concrete steps or whatever.

Ok I'm editing this cause it posted twice. I have no idea why. lol

 

[Aidey]

So if someone was found in cardiac arrest in bed at 6am they would be considered a trauma patient?

 

[NetMatrix]

So if someone was found in cardiac arrest in bed at 6am they would be considered a trauma patient?

Yep it's a life threatening situation. It would be documented on the paperwork as a trauma.

 

[NetMatrix]

Ok I just had to double check on what I just posted no on that one it would be a medical call. This call was documented as a trauma due to patient falling while having the seizure.

I'm still learning this stuff, but trauma depends on the situation.

 

[Aidey]

So, in short I was right. It was a trauma per protocol rather than a trauma because the patient had any actual injuries. That is assuming you didn't neglect to mention she had some sort of injury.

 

[clibb]

I can sort of understand using the long board to move an unresponsive patient out of an area if you can't get the stretcher into that area. In this situation, I don't think the collar and blocks would really be necessary.

I can sort of understand using the long board to be a hard surface for CPR, but I have to wonder what kind of stretcher mattresses they're using that are so different from standard stretcher mattresses, which in my admittedly limited experience (and always seeing, never doing), have always seemed fine for CPR. In this situation, just as the previous one, I don't see that the collar and blocks would really be necessary.

What I don't understand at all is the new claim that the patient was a trauma. I can understand that a patient, during seizures, might physically injure herself, whether from falling down or from striking something while seizing. But I don't think that kind of injury would be a significant enough mechanism to warrant a long board. Of course, I wasn't there, and perhaps there are additional details of which we have not yet been made aware.

I have had two patients that we have had to have a full trauma team activated for this week and the place we found them were in their living room. I treat the patient's symptoms and complaints, not their surroundings. One did have a seizure and had a bad fall. Another one fell down the stairs. All protocols are different for a full trauma team activation. These two patients did meet my full trauma team criteria. One had Flail Chest. Have absolutely no idea how she got it since she wasn't responsive.
My protocols state that if a patient has fallen and is bleeding from their head, I have to c-spine. If they aren't Alert and Oriented x 4 after their fall, c-spine. If they have Osteoporosis and have suffered a fall, c-spine. So I do not disagree with the decision to back board or c-spine at all.
I would have to see the patient and know her history before the decision for a trauma team to be activated or what not.

Here's a thought for you.
What if the patient went into a seizure and while falling hit her C2 or C3 and injured them. What would be one of the outcomes?
Inability to breathe using chest muscles or diaphragm. Therefore, she would not be breathing. Could this cause cardiac arrest? Yes. Would C-spine stability help this patient? Most likely.


There are so many factors that our new (almost) EMT haven't given us to really judge the situation.

2. Why was the patient put on a long board? Doesn't seem indicated to me.

Because they were doing CPR? You put the patient on a back board so that you get proficient compressions. As you're taught to do in EMT class.

 

[jjesusfreak01]

"diffubilater" This has got to be the bestest misspelling of defibrillator that I've ever seen.

My instructor always called it a defibulator. I think that is a fairly common mispronunciation.

 

[JJR512]

I have had two patients that we have had to have a full trauma team activated for this week and the place we found them were in their living room. I treat the patient's symptoms and complaints, not their surroundings. One did have a seizure and had a bad fall. Another one fell down the stairs. All protocols are different for a full trauma team activation. These two patients did meet my full trauma team criteria. One had Flail Chest. Have absolutely no idea how she got it since she wasn't responsive.
My protocols state that if a patient has fallen and is bleeding from their head, I have to c-spine. If they aren't Alert and Oriented x 4 after their fall, c-spine. If they have Osteoporosis and have suffered a fall, c-spine. So I do not disagree with the decision to back board or c-spine at all.
I would have to see the patient and know her history before the decision for a trauma team to be activated or what not.

That's nice for you and your trauma team, but I've never suggested treating a patient's surrounds instead of the patient. Nor have I ever said that you can't have a trauma in a living room.

I also never disagreed with the decision to use a long board. So I'm not sure why you're picking on me as if I have. There wasn't enough information in the original post for me to see that there was a need, that's why I questioned the need. Questioning something is not the same as disagreeing with it.

There are so many factors that our new (almost) EMT haven't given us to really judge the situation.

Exactly—that's why I was questioning, not disagreeing.

Because they were doing CPR? You put the patient on a back board so that you get proficient compressions. As you're taught to do in EMT class.

I wasn't taught to automatically put every CPR patient on a long board. I was taught that if a patient is on a couch or bed, or other soft or unstable surface, to put the patient on the floor for better CPR. I was never taught that a stretcher isn't good enough. On the other hand, in my jurisdiction, we're also supposed to get CPR patients on an AutoPulse as soon as possible, and that comes with its own CPR board, so perhaps its a moot point for me.

 

[JJR512]

I wasn't taught to automatically put every CPR patient on a long board. I was taught that if a patient is on a couch or bed, or other soft or unstable surface, to put the patient on the floor for better CPR. I was never taught that a stretcher isn't good enough. On the other hand, in my jurisdiction, we're also supposed to get CPR patients on an AutoPulse as soon as possible, and that comes with its own CPR board, so perhaps its a moot point for me.

To follow up with some new info...As I said earlier, I do not recall my primary instructor ever saying that a stretcher wasn't acceptable for CPR. I do remember that couches and beds were specifically mentioned, and I understand the problem is soft surfaces. I guess I never considered a stretcher to be a "soft surface". Now, as I mentioned earlier, my primary instructor has made a big point about getting the patient on the AutoPulse as soon as possible, so that makes whether a stretcher is too soft or not a moot point. But to get a definitive answer, I wanted to ask the question directly, but was unable to ask my primary instructor tonight due to him being out sick. So I asked the backup instructor, and she said that although it isn't specifically taught, she doesn't feel a stretcher would be acceptable for CPR.

That being said, I know I've seen CPR done on a stretcher numerous times. That doesn't mean it's right, of course, but it does illustrate the gap between classroom teachings and real-word doings.

 

[medic2be823]

I have two comments, both based on the parts of your quote that I highlighted.

1. "diffubilater" This has got to be the bestest misspelling of defibrillator that I've ever seen.

2. Why was the patient put on a long board? Doesn't seem indicated to me.

In NY, its in our protocols to put a pt on a long board so that there is a hard stable surface under the pt. It makes chest compressions more accurate and has led to more saves state wide.

 

[JJR512]

In NY, its in our protocols to put a pt on a long board so that there is a hard stable surface under the pt. It makes chest compressions more accurate and has led to more saves state wide.

Oh? It's better for chest compressions, you say? Really? Wow, I never heard that before. Certainly not five times already in this thread alone. Thanks for the amazingly new piece of information!

 

[medic2be823]

Wellll.....excuse me....but I only read the first page of this post as I got toned out....so excuse me for not being as well read as you!!!

 

[jjesusfreak01]

Lets be nice now...

 

[Fox800]

Backboards are SOP for cardiac arrests that we transport, too. Our advanced airway patients are also typically backboarded, it helps prevent the tube from becoming dislodged.

 

[clibb]

Wellll.....excuse me....but I only read the first page of this post as I got toned out....so excuse me for not being as well read as you!!!

Oh it's alright. The guy is just now figuring out that he shouldn't had skipped over the CPR chapter in his EMT book.

 

[JJR512]

Oh it's alright. The guy is just now figuring out that he shouldn't had skipped over the CPR chapter in his EMT book.

LOL—In the national curriculum, CPR is considered to be a prerequisite for the EMT-B class, not part of it. Therefore, there is no chapter for it in my EMT book. That being said, CPR is actually taught in Maryland as part of the EMT class in one of the class sessions. However, there is still no chapter for it in the EMT book. Just an appendix. You want to try to be a smartass without even knowing what you're talking about...LOL.

And I CHALLENGE you to tell me where in my protocols it says to not do CPR on a stretcher. Luckily for you, Maryland only has one set of protocols for the entire state, so you don't even need to try to figure out which local or agency-specific protocols apply to me. Here, I'll even make it easy for you by giving you a link to MD's protocols. It's the very first link on this page: http://www.miemss.org/home/EMSProviders/EMSproviderProtocols/tabid/106/Default.aspx

Finally, I think you ought to go back and review some of the things I've said and find some of the details you've missed. Details like the one that it's a local SOP to get the patient on the AutoPulse ASAP. If you don't know what that is, look it up. Part of the AutoPulse is a hard surface for the patient's upper body to rest on, which provides a firm surface for compressions. Gee, I wonder why I wasn't taught that a stretcher wasn't good enough? As I've said at LEAST twice already, it's a MOOT POINT for my jurisdiction.

So don't tell me what I'm being taught in my class. If you want to mention it at all, you may ask if that's taught in my class. And don't ever tell me, or anyone else, what's going on in my mind. Period.

 

[clibb]

LOL—In the national curriculum, CPR is considered to be a prerequisite for the EMT-B class, not part of it. Therefore, there is no chapter for it in my EMT book. That being said, CPR is actually taught in Maryland as part of the EMT class in one of the class sessions. However, there is still no chapter for it in the EMT book. Just an appendix. You want to try to be a smartass without even knowing what you're talking about...LOL.

And I CHALLENGE you to tell me where in my protocols it says to not do CPR on a stretcher. Luckily for you, Maryland only has one set of protocols for the entire state, so you don't even need to try to figure out which local or agency-specific protocols apply to me. Here, I'll even make it easy for you by giving you a link to MD's protocols. It's the very first link on this page: http://www.miemss.org/home/EMSProviders/EMSproviderProtocols/tabid/106/Default.aspx

Finally, I think you ought to go back and review some of the things I've said and find some of the details you've missed. Details like the one that it's a local SOP to get the patient on the AutoPulse ASAP. If you don't know what that is, look it up. Part of the AutoPulse is a hard surface for the patient's upper body to rest on, which provides a firm surface for compressions. Gee, I wonder why I wasn't taught that a stretcher wasn't good enough? As I've said at LEAST twice already, it's a MOOT POINT for my jurisdiction.

So don't tell me what I'm being taught in my class. If you want to mention it at all, you may ask if that's taught in my class. And don't ever tell me, or anyone else, what's going on in my mind. Period.

Trust me, I know what the AutoPulse is. I work for one of the best EMS Agencies in the nation.
I know the AutoPulse has a back board. I also know that it doesn't fit EVERYONE.
You're taught to do compressions with a firm and stable surface underneath the patient. So if you feel that a mattress on a cot is good enough, go ahead. I'm just saying that a back board will provide adequate compressions.
Oh, another question. If you don't agree with doing CPR on back boards. THEN WHY IS A BACK BOARD ATTACHED TO THE AUTOPULSE? <---- The love of your life.

 

[NetMatrix]

The AutoPulse is a great device to have, but sadly not every service has one in their ambulances. With ours (meaning the area I live in) only the ALS ambulance is equipped with one. Sadly where I live each region has their own protocols on how things are to be done.

As far as the CPR chapter in the EMT book. With the school I went to class ended on the 15th and I passed it with flying colors we are required to be certified to perform CPR before you can even think about enrolling in the class. Sadly we did have a chapter that was required to be taught that dealt with CPR. Personally I think it was dumb the book had that chapter in it and it had to be taught. Myself and 2 fellow classmates were the only 3 out of the class of 15 that were already certified to perform CPR, and that is due to us 3 being with a fire department; which at least for my department and one of the other guys department CPR certification is required encase there is someone trapped inside a burning building and you have to perform CPR.

With the use of a back board I do personally feel that it is an important piece of equipment to use if you are having to do CPR on a patient. That is because it does give a hard surface to make sure compressions are being done to their fullest. Not every ambulance service out there has the AutoPulse. Our ambulance service is a volunteer service so there isn't that much money to just go out and spend. Yes we can get a grant for equipment, but in the state of Illinois good luck getting grants. With our fire department we've been working the last 2 years to get a grant to replace some of our SCBA and we have been turned down both times.

Now I did talk with the chief who also spoke with the departments lawyer, and no we aren't at any legal issues with him having me go to the PT's house and that is because I am trained to do what I did. I felt the need to check on that information after the debates on this thread. Each state is different and according to the departments lawyer because I performed the first aid skills that we are trained to perform, and I did not step out side of my duties the department and myself can not get into any trouble for the actions that were taken. So we can get that part straightened out now and leave that part alone. I do not like the turns that this thread has taken. It started off with people disagreeing with the decision my fire chief made for me to go and try to save this woman's life because of the amount of time it takes for the department to get to this area. To now other members are getting out of line with each other. I know disagreements happen on forums, and I know this because I won a website that has a forum with over 50,000 members on it.

On another note since it was followed up with the department with the coroners office the PT's medication is what lead to her death due to a over dose which lead to the seizure and her heart failing. I did what I could to to try and bring this woman back. I did what I was trained to do...

 

[NetMatrix]

Oh' and to clear up on the text book it's Prehospital Emergency Care 9th Edition chapter 10 Airway Management, Artificial Ventilation, and oxygen. It's not a CPR titled chapter, but it does deal with CPR. It is also mentioned ina couple other chapters, but I sold my book back to the school so I don't have it for chapter reference anymore. Just the mybradykit website.

 

[JJR512]

Oh, another question. If you don't agree with doing CPR on back boards. THEN WHY IS A BACK BOARD ATTACHED TO THE AUTOPULSE? <---- The love of your life.

Time for some remedial education, it seems. I already explained this once, so to save time and energy, I'll just repeat myself...

I also never disagreed with the decision to use a long board. So I'm not sure why you're picking on me as if I have. There wasn't enough information in the original post for me to see that there was a need, that's why I questioned the need. Questioning something is not the same as disagreeing with it.

If that concept that questioning something is not the same as disagreeing with it is too complex for you to understand, please say so, and I'll try to explain it in smaller words, although frankly, I'm not sure if I can think down much further than I've already had to do so for your benefit.

Oh, and "The love of your life"...what is that in reference to? Were you signing your post as the love of my life? If that's the case, I have no comment—at least, none that can be posted without violating the rules of this website. If you were indicating the AutoPulse to be the love of my life...No. I don't care about it one way or the other. Once again, you've tried, and just as before, failed miserably, at trying to make assumptions about me.

Perhaps it's time for you to stop making snide comments, stop attacking me on something I didn't say, and either post something that's actually productive and relevant to the topic of this thread or move on.