- 11,040
- 1,483
- 113
Strictly for discussion purposes only (we promise not to tell you medical control director ).
What would you change about your current protocols and why if it was up to you?
As for me, I would change two things immediately. First of all, our protocols only allow us to give oxygen at 15 lpm via NRB or 6 lpm via nasal canula. I would change this to allow us to titrate the O2 to maintain sats above 95%, consistent with national guidelines on flow rates for the various masks.
Secondly, our protocols state that we are NOT to board and collar a patient based upon mechanism of injury alone. I would change this to allow c-spine precautions based upon mechanism of injury or medic gut-feeling. Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:
1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury
I had a call a couple of months ago, for a female that had been thrown from a moving vehicle. Upon our arrival, PT was CAOx4, not under the influence, no complaints of neck pain or arm/leg numbness. PT was non-tender, and there were absolutely NO signs of injury what so ever. I mean, her jeans didn't even appear to have scraped on the concrete. Privately, I thought she was just claiming this to get a free ride, especially when she couldn't repeat the details of the incident consistently. I went ahead and placed her on a board and collar based upon mechanism alone, and initiated transport. While in route, I asked all of the routine SAMPLE History questions. The PT stated that she had some surgery a couple of years ago, so I asked her what type of surgery. She replied that she had broken her neck, and had three bones fused together!!! I then called for an ALS rendevous, and they completed the transport. A few days later, I was asked by a member of my department (who was at the call but not there during the transport), why I placed the patient in C-spine precautions and called for ALS when she did not appeared to be injured. I explained her history and added that after learning it, I was very glad that I did what I did (just to cover my own butt).
What would you change about your current protocols and why if it was up to you?
As for me, I would change two things immediately. First of all, our protocols only allow us to give oxygen at 15 lpm via NRB or 6 lpm via nasal canula. I would change this to allow us to titrate the O2 to maintain sats above 95%, consistent with national guidelines on flow rates for the various masks.
Secondly, our protocols state that we are NOT to board and collar a patient based upon mechanism of injury alone. I would change this to allow c-spine precautions based upon mechanism of injury or medic gut-feeling. Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:
1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury
I had a call a couple of months ago, for a female that had been thrown from a moving vehicle. Upon our arrival, PT was CAOx4, not under the influence, no complaints of neck pain or arm/leg numbness. PT was non-tender, and there were absolutely NO signs of injury what so ever. I mean, her jeans didn't even appear to have scraped on the concrete. Privately, I thought she was just claiming this to get a free ride, especially when she couldn't repeat the details of the incident consistently. I went ahead and placed her on a board and collar based upon mechanism alone, and initiated transport. While in route, I asked all of the routine SAMPLE History questions. The PT stated that she had some surgery a couple of years ago, so I asked her what type of surgery. She replied that she had broken her neck, and had three bones fused together!!! I then called for an ALS rendevous, and they completed the transport. A few days later, I was asked by a member of my department (who was at the call but not there during the transport), why I placed the patient in C-spine precautions and called for ALS when she did not appeared to be injured. I explained her history and added that after learning it, I was very glad that I did what I did (just to cover my own butt).