As Rid has been saying, he should have been back boarded, not because it necessarily would have done much good, but to cover your own behind. Everyone will give the, "he could have had a spinal injury" or "this treatment works better" and there is always a possibility of that, but an even bigger reason is that if he turns out to have some neurological injury, and you didn't backboard, the court is not going to side with you unless he refused. It shouldn't take you more than 2 min to backboard even the most difficult pt except during an extrication, so if it is taking you 5 min or more you should pull out a board at the station and practice a bit.
GSW and backboard?
- Thread starter Raf
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I am new here and I enjoy the discussions, so I figured I would chime in.
I am an EMT in a tiered ALS/BLS system. Urban with a high call volume.
As far as the GSW. Why wouldnt you board him, unless he refused then he can sign AMA.
Second, You wouldnt be boarding him just to protect against possible c-spine damage, you are also immobilizing him due to the fact that he has been shot in the torso with no noted exit wound, which could mean that the jagged little piece of shrap-metal is resting nicely on one of his major arteries, or perhaps lodged in his ventrical, and any sudden movement will cause irreversible damage, up to and probably including death.
By the way LE your question about why EMTs still respond to EMS calls in the US is simple, my thoughts aside, its financial. I dont believe that every call requires a paramedic, however with what they are pumping out today in these so called educational institutions. Some who at leats slept through night medic school is probably a little more prepared to handle some calls then most EMTs.
Another thought EMTs nor paramedics save gunshot wounds surgeons do. These calls are time sensitive, I have done a few ha ha.....and sitting around on scene with these pts is completely in excusable, at the ALS or BLS level.
About the pt refusing c-spine immobilization. Usually a conversation about what it would be like to spend the rest of his life seated in a chair with his wife and children feeding him supper through a staw will usually do the trick.
I am an EMT in a tiered ALS/BLS system. Urban with a high call volume.
As far as the GSW. Why wouldnt you board him, unless he refused then he can sign AMA.
Second, You wouldnt be boarding him just to protect against possible c-spine damage, you are also immobilizing him due to the fact that he has been shot in the torso with no noted exit wound, which could mean that the jagged little piece of shrap-metal is resting nicely on one of his major arteries, or perhaps lodged in his ventrical, and any sudden movement will cause irreversible damage, up to and probably including death.
By the way LE your question about why EMTs still respond to EMS calls in the US is simple, my thoughts aside, its financial. I dont believe that every call requires a paramedic, however with what they are pumping out today in these so called educational institutions. Some who at leats slept through night medic school is probably a little more prepared to handle some calls then most EMTs.
Another thought EMTs nor paramedics save gunshot wounds surgeons do. These calls are time sensitive, I have done a few ha ha.....and sitting around on scene with these pts is completely in excusable, at the ALS or BLS level.
About the pt refusing c-spine immobilization. Usually a conversation about what it would be like to spend the rest of his life seated in a chair with his wife and children feeding him supper through a staw will usually do the trick.
mycrofft
Still crazy but elsewhere
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Hmmmm...general instructions versus clinical findings
Re the comment above from an uncited fellow poster, a BLS may be making the decision on a GSW because all you have is a BLS, or even a bystander if there is no one else there. Also, if you are ALS but your BLS-buddy can't throttle back and follow your lead; or, since the BLS is right (imagine that), you go for it. Trick is, the right decision gts made and the right course followed, whether it's Gilligan, the Skipper, or Mrs Howell.
Don't get dogmatic. Your policis and procedures are hopefully good ones, so follow them unless something doesn't make sense, then you have to act on your observations.
If the pt's gonna fight, skip it and get em in. If the pt shows clinical symptoms and will cooperate, board em and go. Just be damn sure you can manage airway and you rule out or "treat-out" a pneumothorax from that little gsw you are about to lay the pt upon. While you might paralyze them through movement, you can lose them entirely if they are bleeding or a frag is moving about doing damage. There isn't much more to be done at the entrance wound, so if it's inaccessible but covered by an occlusive dressing or Heimlich valve (am I dating myself again?), fine, press on.
Folks like to hypothesize about the physics of projectiles, but after learning the basics, medical treatment short of the O.R. (or "House, MD") is still dependent upon what you see, feel hear and smell. I'd be worrying about bleeding; bullets don't significantly "cauterize" per se (no, not even tracers), they stretch vessels so that the vessels retract and close themselves by clotting, but the large dangerous vessels don't and you can even wind up with a frag IN a major vessel. Small cal will not cavitate much unless it has a big powder charge (ala the M-16*), and then it will tumble, too; it takes energy to cavitate, and to make up for small mass you gotta accelerate, but as far as treatment, it's academic. Round and round, in and out, but defintive care demands a hospital, so didi mau.
Triage may be affected, though.
*Yes, I know, but technically speaking a M-16 round is a small caliber (diameter); it just has a pretty high mass versus a .22, plus that walloping powder charge.
Re the comment above from an uncited fellow poster, a BLS may be making the decision on a GSW because all you have is a BLS, or even a bystander if there is no one else there. Also, if you are ALS but your BLS-buddy can't throttle back and follow your lead; or, since the BLS is right (imagine that), you go for it. Trick is, the right decision gts made and the right course followed, whether it's Gilligan, the Skipper, or Mrs Howell.
Don't get dogmatic. Your policis and procedures are hopefully good ones, so follow them unless something doesn't make sense, then you have to act on your observations.
If the pt's gonna fight, skip it and get em in. If the pt shows clinical symptoms and will cooperate, board em and go. Just be damn sure you can manage airway and you rule out or "treat-out" a pneumothorax from that little gsw you are about to lay the pt upon. While you might paralyze them through movement, you can lose them entirely if they are bleeding or a frag is moving about doing damage. There isn't much more to be done at the entrance wound, so if it's inaccessible but covered by an occlusive dressing or Heimlich valve (am I dating myself again?), fine, press on.
Folks like to hypothesize about the physics of projectiles, but after learning the basics, medical treatment short of the O.R. (or "House, MD") is still dependent upon what you see, feel hear and smell. I'd be worrying about bleeding; bullets don't significantly "cauterize" per se (no, not even tracers), they stretch vessels so that the vessels retract and close themselves by clotting, but the large dangerous vessels don't and you can even wind up with a frag IN a major vessel. Small cal will not cavitate much unless it has a big powder charge (ala the M-16*), and then it will tumble, too; it takes energy to cavitate, and to make up for small mass you gotta accelerate, but as far as treatment, it's academic. Round and round, in and out, but defintive care demands a hospital, so didi mau.
Triage may be affected, though.
*Yes, I know, but technically speaking a M-16 round is a small caliber (diameter); it just has a pretty high mass versus a .22, plus that walloping powder charge.
Ridryder911
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I am concerned that some would think that it would take time to "board" someone. Seriously folks if it takes you more than a minute (non extrication), then something is wrong. Think about it, turn the patient on the side as a unit, observe the back.. look, listen and feel, then back over..if they were in a sitting position, even more simple: secure & up. How hard or time consuming? Actually, usually faster than attempting to grab ahold of someone, or lifting them..
Let's not make it any harder or difficult than it is folks...
R/r 911
Let's not make it any harder or difficult than it is folks...
R/r 911
traumateam1
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Agree with the last three posts. It really isn't that hard to board someone (unless scene isn't safe or p/t is fighting) but other than that.. you should board them and go. In all honesty, if it takes "to long" to board someone, you better practice.
I think we've beaten this to death pretty well... ^_^
I think we've beaten this to death pretty well... ^_^
Last edited by a moderator:
mycrofft
Still crazy but elsewhere
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Agreed. Scene safety is good for another thread, though.
The question of "Who shot john?" gets personal.
The question of "Who shot john?" gets personal.
Just to clarify, in my opinion a backboard should be a for gone conclusion in this instance.
Im not a big fan of monday morning quarterbacking, I wasnt there. With the information that was given I would have immobilized this gentleman.
Do I backboard all gunshot victims? No.
Have I gotten a little heat for not doing so? On occasion. Be prepared to explain your reasoning. If its logical you shouldnt have a problem.
One other thing, I dont do this job not to get sued or caught in a review board. I do whats best for my patient, if that means we deviate from the plan, then so be it. This isnt cookie cutter stuff, every situation is different and should be assessed that way.
Thats why protocols bother me some at any level, you cant conform every pt to a certain protocol it just does not work that way, as a guide sure Im fine with that, as a rule not so much.
If you dont do something that you should have done, what ever the case may be, you better have a damn good reason to back it up, as my medical director would say.
Im not a big fan of monday morning quarterbacking, I wasnt there. With the information that was given I would have immobilized this gentleman.
Do I backboard all gunshot victims? No.
Have I gotten a little heat for not doing so? On occasion. Be prepared to explain your reasoning. If its logical you shouldnt have a problem.
One other thing, I dont do this job not to get sued or caught in a review board. I do whats best for my patient, if that means we deviate from the plan, then so be it. This isnt cookie cutter stuff, every situation is different and should be assessed that way.
Thats why protocols bother me some at any level, you cant conform every pt to a certain protocol it just does not work that way, as a guide sure Im fine with that, as a rule not so much.
If you dont do something that you should have done, what ever the case may be, you better have a damn good reason to back it up, as my medical director would say.
boingo
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What if it wasn't "close to the spine?" What if it was in the abdomen, or anterior cx? If your working under the "what if" theory, then you should be boarding them too. An abdomenal GSW could very well end up in the spine, you don't know. Either board them all with the possibility it "could be" in the spine, or don't. Having a wound "near" the spine is pretty subjective. What is near, 2 cm, 10 cm, more?
No one will fault you for boarding a patient, the question is should you be faulted for not. If you are working with the assumption that a wound without exit (determining exit vs entrance in the field would be another thread) could be in the spine, then proximity to the spine should be irrelevant. Above the groin, below the head should be boarded.
Placing a patient supine on a board can make them easier to move, and it doesn't take much time. Placing a patient flat on a board can also increase anxiety and air hunger. Follow your protocols/guidelines. I wouldn't advise using the "close" arguement trying to defend why you did or didn't. Just my humble opinion.
Ridryder911
EMS Guru
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Again, no one thought of the scoop.. which could be used to lift & broke apart if need be...
R/r 911
R/r 911
traumateam1
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Scoop Stretcher? Clam Shell by Ferno? That's what I would of used...Ridryder911 said: