If you ever dropped a NOI pt, would you then package them up for trauma?

[Altered Mental Status]

I'm talking about really DROPPING them: either all the way to the ground on the stretcher or OFF the stretcher. The scenario is that the pt's head has not hit the ground (that you can tell) but they have a few minor bruises. Pt denies other injuries, pn but TECHNICALLY speaking, we're not supposed to take that chance.

You're already embarrassed and hating yourself right about now. You know you're gonna have to report it and document like crazy. The nurses at the ED are already going to give you hell.

Packaging her up will take time. You will now have to apply a c-collar in front of her family and about 2 or 3 chuckling firemen or witnesses who are already on-scene. The family is already a little annoyed but not LIVID. Applying a c-collar may give the family the idea that somethings really wrong and to sue while acting casual about it MIGHT abate some concern but might also look "cavalier" and bite you in the behind later on.

You're a fairly new EMT or medic...not quite green but you still haven't gained the clout of a seasoned "master." What do you do?

1. "Shoot. Partner, get the backboard and a no-neck. I **'d the pooch."
2. Head-to-toe palp. "Ma'am, you're okay to go? I don't need to immobilize you, do I?"
3. "Depends on ___ factor." (please explain)

We all make mistakes but sharing ideas BEFORE the unthinkable happens makes us better providers if or when it does.

 

[Aidey]

WTF is NOI?

 

[DesertMedic66]

Any head, neck, back pain? Any pain on palp of the spine. If neuro is still ok then nope no backboard or collar.

 

[rescue1]

If the patient does not complain of neck or back pain, does not have an AMS, and has no extremity numbness/tingling, then why would they need to be immobilized?

 

[DesertMedic66]

WTF is NOI?

I'm assuming nature of illness? I'm thinking the OP just wants to make it clear the original call was medical.

 

[Altered Mental Status]

Yes, sorry. Nature of Illness.

 

[Aidey]

I'm assuming nature of illness? I'm thinking the OP just wants to make it clear the original call was medical.

That was the only think I could think of too, but "dropped a nature of illness pt" didn't make much sense.

 

[Tigger]

Treat them like every other patient, assess them and provide treatments and interventions as necessary. If spinal motion restriction is indicated, do so. If not, do not do so. Document the circumstances and report it.

 

[Altered Mental Status]

Right. But the assumption here is that TECHNICALLY, we ARE supposed to package them up for ANY trauma where unknown spinal injury is possible. From a legal standpoint, we're already in a bit of hot water for droppin 'em so just from a CYA standpoint, doesn't it look bad if we don't and later they start having neck pain?

Not to even MENTION the sense of personal guilt/responsibility we'd feel for taking a risk in making a bad pt worse...I mean what IF? I know it's a longshot but...well is it really? A ground level fall that the patient experiences on his own, he's usually prepared for: he can put his hands out or make split-second muscle contractions that may avert some sustained trauma but if WE dropped 'em? No warning. That's straight shock to the spine if we drop the stretcher, even without head trauma. Shouldn't we always maintain an index of suspicion for spinal injury in all instances?

I'd LIKE to think that if the fall was significant enough and I was unable to break it with my body, that I'd be able to put my embarassment aside, suck it up and immobilize. I may feel like a retard doing it but I'd feel good about the fact that I responded to even my own mistake with apropriate care: you can never rule out the wcs...even if it's your own, dang fault.

Do I have anyone who backs me on this?

 

[rescue1]

Right. But the assumption here is that TECHNICALLY, we ARE supposed to package them up for ANY trauma where unknown spinal injury is possible. From a legal standpoint, we're already in a bit of hot water for droppin 'em so just from a CYA standpoint, doesn't it look bad if we don't and later they start having neck pain?

Not to even MENTION the sense of personal guilt/responsibility we'd feel for taking a risk in making a bad pt worse...I mean what IF? I know it's a longshot but...well is it really? A ground level fall that the patient experiences on his own, he's usually prepared for: he can put his hands out or make split-second muscle contractions that may avert some sustained trauma but if WE dropped 'em? No warning. That's straight shock to the spine if we drop the stretcher, even without head trauma. Shouldn't we always maintain an index of suspicion for spinal injury in all instances?

I'd LIKE to think that if the fall was significant enough and I was unable to break it with my body, that I'd be able to put my embarassment aside, suck it up and immobilize. I may feel like a retard doing it but I'd feel good about the fact that I responded to even my own mistake with apropriate care: you can never rule out the wcs...even if it's your own, dang fault.

Do I have anyone who backs me on this?

If your protocols state you must immobilize all traumas, then you should do so. However, the lack of evidence supporting spinal immobilization as a valid treatment for spinal trauma, coupled with the high patient discomfort that accompanies lsb immobilization makes me reluctant to board patients based on mechanism alone. Can you not clear cspine in the field?
In any case, my decision whether to board the patient would be unrelated to whether I dropped them or not. The fact that you may be at fault should not effect your patient care. That being said, I'd be extra sure to follow your protocols closely, just in case it goes to court.

 

[Medic Tim]

I hate boarding people. Not because I am lazy but because I know it doesn't help and in most cases causes discomfort/more discomfort. If there is no indication for it there is no need to do it. It is not uncommon for me to take a pt off the board or take a c collar off a pt that a first responder /emt has put on. Some people think we need to board every trauma pt just in case which is absolutely ridiculous. Most cases it is not their fault as that was the mis information they were taught in school.
With your pt I would treat them as any other pt. From the Sounds of it boarding the pt is/was not needed for reasons others have hit on.

Would you give a pt a medication just to make the family think you were doing something?
or start a line just to say you did something?

 

[mycrofft]

NO-brainer. Pt was dropped in addition to prior complaint, eval and treat appropriately and record. You have the benefit of having a recent baseline eval and history.

A more-pointed question would be why you would NOT treat a potential fresh injury which occurred before your very eyes? In a related thread generically about dropping pt's, a few responders described a potentially injurious incident, but then included the phrase "but he wasn't hurt" without evidence of an eval.

If a nurse did that and it was discovered they could be reprimanded, if they covered it up they could be fired and their license challenged. It would go badly in a civil suit too. And it's just wrong

 

[Tigger]

Right. But the assumption here is that TECHNICALLY, we ARE supposed to package them up for ANY trauma where unknown spinal injury is possible. From a legal standpoint, we're already in a bit of hot water for droppin 'em so just from a CYA standpoint, doesn't it look bad if we don't and later they start having neck pain?

Not to even MENTION the sense of personal guilt/responsibility we'd feel for taking a risk in making a bad pt worse...I mean what IF? I know it's a longshot but...well is it really? A ground level fall that the patient experiences on his own, he's usually prepared for: he can put his hands out or make split-second muscle contractions that may avert some sustained trauma but if WE dropped 'em? No warning. That's straight shock to the spine if we drop the stretcher, even without head trauma. Shouldn't we always maintain an index of suspicion for spinal injury in all instances?

I'd LIKE to think that if the fall was significant enough and I was unable to break it with my body, that I'd be able to put my embarassment aside, suck it up and immobilize. I may feel like a retard doing it but I'd feel good about the fact that I responded to even my own mistake with apropriate care: you can never rule out the wcs...even if it's your own, dang fault.

Do I have anyone who backs me on this?

CYA is not an appropriate reason to provide a treatment in any realm of medicine. It certainly happens, but that doesn't make it right.

 

[Melclin]

OP:

You ask shouldn't this pt technically be immobilised, like there is some universally accepted criteria for immobilising patients.

There isn't.

Firstly I would consider the mechanism and its potential for causing spinal injury. If I felt the mechanism couldn't cause an injury to this pt, then of course, the game stops there. The pt doesn't get immobilised. When a person stubs their toe, I don't even consider immobilisation.

If I am considering the posibility of injury or the pt has pain/symptoms consistent with verbral/ligamentous injury, then I move onto spinal clearance. If this is not something you're allowed to do then I suppose you stop there and immobilise. If you can clear, then run through you process and immobilise or not based on the outcome.

The next question then is what kind of mechanism has the potential to cause spinal injury? I'm not aware of any good literature on this and I'm reasonably sure that there is plenty of literature to suggest that mechanism is very hard to link with occult injuries with any great consistency. There is some guidance that I won't go on about too much, but its pretty seat of your pants sort of stuff. Thats fine if you're using mechanism simply as an entry point to spinal clearance. No harm comes from considering mechanism, accepting that injury is possible, then running through clearance criteria and finding that you don't need to be immobilised. However, if you're using mechanism simply as an indication for spinal immobilisation then you'll find its wildly inaccurate and that is why clearance criteria exist in the first place.

 

[WuLabsWuTecH]

We have a C-spine clearance protocol. I would run through that!