# LSB or Scoop Strecher??



## MedicPrincess (Aug 20, 2006)

One of our units had this "disagreement" with ALS Fire.  Keep in mind, per our protocols, we can clear C-Spine in the field.  ALS Fire has the same Medical Director and same protocols as we do.

LOLFDGB in her bathroom.  Its a very small hallway bathroom.  Definantly one of those 1-butt bathrooms.  Its a toilet and a sink.  94 y/o Pt c/o of excruciating pain in the hip region.  Doesn't really isolate, just kind of says "here" and waves her hand over.  Patient has rotation/shortening.  At this time the patient denies neck or back pain.  Denies LOC.  Family onscene confirms no LOC.

Fire onscene for approximately 6 minutes prior to EMS arrival.  FD Medic has been a Medic since I was in diapers, has been instructing EMT and Paramedic programs for 10 years, was a medic with our service until he crossed over to the darkside and got his firestandards too, the entire alphabet after his name, bedside manor with patients tends to be way above and beyone, but is a but rough around the edges with his EMTs. (he has this silly notion that if you passed your state exam you should be able to perform the BLS skills of an EMT)

So, they have the patient sheet splinted, vitals being monitored, assessment done.  They have not spinal immobilized her.  The FD Medic has cleared her C-Spine. 

As the ambulance is pulling up, dispatch advised them the FD needs them to bring in their scoop stretcher.  Medic for EMS says hold on before getting the scoop stretcher and let him go in and assess.  This is the same Medic that I worked with before that scared me so bad with his driving.  Theres a thread somewhere....

They get inside, FD's Medic says Crap, he'd advised Fires dispatch to advise the EMS unit to bring their scoop stretcher.  The EMS Medic says, yea we got that, but I'm not going to use it and sends his EMT for a LSB.

And suddenly there wasn't enough room for anybody in that room because the Egos began to swell and feelings were hurt and FD called their Chief and EMS called our Shift Commander and suddenly there weren't 2 professional Paramedics with that patient, there was a brand new FF/EMT who is still trying to feel out his Medic partner, the EMS EMT who had the LSB and a couple of preschoolers fighting over who was right.  Pathetic, I know.

So....*which would you guys have used, LSB or Scoop, and why?*


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## DT4EMS (Aug 20, 2006)

Sounds to me like a pi$$in match that didn't need to be going on. Either LSB or Scoop will work for Hip FX. 

The scoop works well to keep the movement down to a minimum though.


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## ffemt8978 (Aug 20, 2006)

I would have used the scoop stretcher, and here's why:

The scoop is designed for the LOLFDGB scenario.  She's already in extreme pain, and placing her on a hard surface isn't going to help her any.  With the scoop, you can gently place her on the cot and then remove the scoop stretcher during transport to keep her more comfortable.

Kip's right, though.  Either will work.


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## DT4EMS (Aug 20, 2006)

You are right. I should have been more specific of the "movement" I was speaking of. 

By all means the Scoop could be used to reduce the amount of "movement" of the patient's hip/femur preparing for transport.

If I know it is a hip, I call and get orders for pain meds prior to movement anyway AND I treat ALS. Hip Fx's are ALS in my opinion.


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## MedicPrincess (Aug 20, 2006)

> Sounds to me like a pi$$in match that didn't need to be going on.


 
Yep.  Sure was.



> Hip Fx's are ALS in my opinion.


 
Yet I put this in the BLS forum....

I thought so too, until I had a patient with one.  I figured with the amount of potential blood loss and possibility of pt deterioration, ALS package should be warranted.

Hip FX are routinely BLS'd in our service.  And I have yet to see anybody give pain meds for them prior to or after moving.


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## Flight-LP (Aug 20, 2006)

EMTPrincess said:
			
		

> Yep.  Sure was.
> 
> 
> 
> ...



It is so sad to think that your FD medics don't care enough about their patients and fail to address their pain management needs. I can't really relate, but thats gotta hurt!!!!! Give 'em drugs!


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## doc5242 (Aug 20, 2006)

Flight-LP said:
			
		

> It is so sad to think that your FD medics don't care enough about their patients and fail to address their pain management needs. I can't really relate, but thats gotta hurt!!!!! Give 'em drugs!



i wouldent have given drugs either, Shes 94, once you get past a certain age, pain meds cause more problems than good. I wouldent have put her on a board, once again shes 94, and shortining and rotation are indications of femur fx not hip fx, she needed a hair traction if anything, you need to look at the age of pt's sometime, old people are like glass, the more crap you  pile on them the eaiser they break


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## MedicPrincess (Aug 21, 2006)

Flight-LP said:
			
		

> It is so sad to think that your FD medics don't care enough about their patients and fail to address their pain management needs. I can't really relate, but thats gotta hurt!!!!! Give 'em drugs!


 
Not just the FD Medics, but the EMS Medics too.  Its not to often pain meds are given in the field here.


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## Jon (Aug 21, 2006)

ffemt8978 said:
			
		

> I would have used the scoop stretcher, and here's why:
> 
> The scoop is designed for the LOLFDGB scenario.  She's already in extreme pain, and placing her on a hard surface isn't going to help her any.  With the scoop, you can gently place her on the cot and then remove the scoop stretcher during transport to keep her more comfortable.
> 
> Kip's right, though.  Either will work.


Second the motion!


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## Flight-LP (Aug 21, 2006)

doc5242 said:
			
		

> i wouldent have given drugs either, Shes 94, once you get past a certain age, pain meds cause more problems than good. I wouldent have put her on a board, once again shes 94, and shortining and rotation are indications of femur fx not hip fx, she needed a hair traction if anything, you need to look at the age of pt's sometime, old people are like glass, the more crap you  pile on them the eaiser they break



And you would have been negligent in your care. I don't care if she is 194, she is a human being in pain and that pain needs to be addressed, period. You show me one verifiable source that lists age as a contraindication to analgesics and I'll shut up.......

BTW - You are incorrect, shortening and rotation are very much indicators of a hip fracture. So in addition to you not treating your patient and addressing their pain needs, you are now going to apply traction???????? OUCH!!!!


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## Flight-LP (Aug 21, 2006)

EMTPrincess said:
			
		

> Not just the FD Medics, but the EMS Medics too.  Its not to often pain meds are given in the field here.



I'm very sorry to hear that Princess, your patients deserve better!


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## DT4EMS (Aug 21, 2006)

Flight-LP said:
			
		

> I'm very sorry to hear that Princess, your patients deserve better!




WHen I first became a medic, I wasn't to in on giving patients pain meds for hip fx's. But then again I never used to pad the LSB before I put them on it either.

When I moved from an urban to a rural setting I really began to treat people different.

IN the city a ground transport time was usually less than 10 minutes. In the rural setting we may have a ground transport time of more than 45 minutes.

One of our bases 45 minutes was the norm. If the pillow splint and cravats didn't help with the pain of the hip fx, pain meds were on the way.

Pain management is HUGE in the pre-hospital and in-hospital setting. 

I have never used a traction splint of any kind on a hip fx.


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## MedicPrincess (Aug 21, 2006)

I was wondering about that.  I had been taught rotation/shortening was indicitive of a hip fx and seems most of the hip fx's we've had had it, but I thought maybe i'd been wrong.  Happens from time to time....

I wonder how my medic would respond if I bent down and started pulling traction on a hip fx....

As far as pain meds go, MOST of the transport times for my truck are under 10 minutes.  Theres that call or few each shift where we are outside our district covering other trucks and it may be longer.  We tend to try to alleve pain with pillows/sheet splints/positioning/O2 before breaking out the narcs.


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## gradygirl (Aug 21, 2006)

The only thing with pain meds and the elderly is that you have to be so, so careful with the dosage, because a normal dose of meds for your average pt. could be an overdose for your elderly one.


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## doc5242 (Aug 21, 2006)

Flight-LP said:
			
		

> And you would have been negligent in your care. I don't care if she is 194, she is a human being in pain and that pain needs to be addressed, period. You show me one verifiable source that lists age as a contraindication to analgesics and I'll shut up.......
> 
> BTW - You are incorrect, shortening and rotation are very much indicators of a hip fracture. So in addition to you not treating your patient and addressing their pain needs, you are now going to apply traction???????? OUCH!!!!




ok, first off, read here about hip/femur
http://www.orthoassociates.com/hipfx.htm

 and re-educate yourself on orthopaedic medicine. and second, the issue with the drugs is that once they hit a certain age, you either have to cut the doses in half or cant give them, remember, like phenergren, you cant give over the age of 75, why?? because the liver has trouble metabolizing it in the elderly past that age. Narcotic analgesics, cause respiratory depression, everyone hould know that, you push  MSO4 on a 94 year old woman, who has already fallen down, and after laying on a cold kitchen floor is already bradycardic, which means her respiratory effort is low, or say she has other complications, like a closed head injury, and you just gave morphine, you just killed your PT, now whos negligent.

oh and ..BTW back... withholding pain meds IS NOT a cause for NEGLIGENCE, it is an ethical dilema, but i will always stabd by LIFE OVER LIMB,  maybe in texas its negligence but not up in the north. 

there my rant is done. next time you plan on critizing somone, know there polices and procedures from where they operate and know what your talking about.


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## divinewind_007 (Aug 21, 2006)

ffemt8978 said:
			
		

> I would have used the scoop stretcher, and here's why:
> 
> The scoop is designed for the LOLFDGB scenario.  She's already in extreme pain, and placing her on a hard surface isn't going to help her any.  With the scoop, you can gently place her on the cot and then remove the scoop stretcher during transport to keep her more comfortable.
> 
> Kip's right, though.  Either will work.



diddo...however i see the LSB get used more around here. you mention a scoop and  they just look at you strange.


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## Hightoweruk (Aug 21, 2006)

Hi

I'm guessing what you call a LSB is what we call a Long Board??

Personally i would have used the scoop in that situation, if it was that small a room then even to use a board i may have used scoop to get her there rather than a log roll due to space constraints.

By the way, do you guys carry the vehicle extracation jackets (K.E.D, T.E.D etc) on your trucks, have found that they can be handy in immobalising some ?#N.O.Fs 

Just a thought.

Either way there was no need for debates to kick off in the pt's presence

ade


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## DT4EMS (Aug 21, 2006)

Hightoweruk said:
			
		

> Hi
> 
> I'm guessing what you call a LSB is what we call a Long Board??
> 
> ...



Yes the KED tunrned upside down can be a great tool for a hip fx.


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## fm_emt (Aug 21, 2006)

DT4EMS said:
			
		

> Yes the KED tunrned upside down can be a great tool for a hip fx.



And it's also quite amusing to everyone that hasn't used one in a while. "Dude! WTF is that thing?!"


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## Flight-LP (Aug 21, 2006)

doc5242 said:
			
		

> ok, first off, read here about hip/femur
> http://www.orthoassociates.com/hipfx.htm



Interesting article. Well written and very informative. But it still doesn't change the fact that shortening and external / internal rotation is indicitive of a hip fracture.



			
				doc5242 said:
			
		

> and re-educate yourself on orthopaedic medicine. and second, the issue with the drugs is that once they hit a certain age, you either have to cut the doses in half or cant give them, remember, like phenergren, you cant give over the age of 75, why?? because the liver has trouble metabolizing it in the elderly past that age. Narcotic analgesics, cause respiratory depression, everyone hould know that, you push  MSO4 on a 94 year old woman, who has already fallen down, and after laying on a cold kitchen floor is already bradycardic, which means her respiratory effort is low, or say she has other complications, like a closed head injury, and you just gave morphine, you just killed your PT, now whos negligent.



Never said anything about giving Morphine specifically, personally Fentanyl is my agent of choice due to its lesser risk of hemodynamic instability. Also, no one ever said the patient was bradycardic. That obviously would be a contraindication. I am interested in knowing how you can ascertain her bradycardia causing a low respiratory drive, perhaps grandma is on a beta blocker, her resps could be just fine. Either way, a thorough assessment would reveal these findings.



			
				doc5242 said:
			
		

> oh and ..BTW back... withholding pain meds IS NOT a cause for NEGLIGENCE, it is an ethical dilema, but i will always stabd by LIFE OVER LIMB,  maybe in texas its negligence but not up in the north.



Try explaining that one to a trial lawyer. Pain is what the patient tells you it is and needs to be addressed.



			
				doc5242 said:
			
		

> there my rant is done. next time you plan on critizing somone, know there polices and procedures from where they operate and know what your talking about.



I think you are taking things a little too personal................

Lighten up, its just a forum!


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## MedicPrincess (Aug 21, 2006)

doc5242 said:
			
		

> she needed a hair traction if anything


 
I guess I am still confused by this.  I read the article.  Even though it is technically the "femur" that is fx, the entire article still refers to it as a hip fx.  But it did say some traction would be ok



> To help with the discomfort of a displaced fracture, 5 lb of longitudinal (Buck’s) skin traction can be used, although pillow support alone has been shown to be just as effective


.

So my question to you is, in your system, does your protocols have you you pulling traction on a hip fx w/ rotation and shortening, just in case its the femur involved?  And do you do it with all patients who have r/s?

Our system is sheet splinting and pillow support, "consider" pain meds.  Often the sheet splint and pillows make it tolerable.


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## Ridryder911 (Aug 22, 2006)

Interesting article and maybe you should read it sometime. I do not see anywhere on placement of a longitudinal traction device for surgical neck fractures or commonly called 'garden fractures". If you want to get technical, please refer to the manufactures guidelines of use for "mid-shaft femur fractures" for the use of traction. Furthermore, placing pressure on the ischium, will cause induce and needless pain, since that is near the site of the fracture. This is not to be confused with traction devices such as "bucks" etc...

Furthermore, phenergran is usually withheld from patients > 70 not so much of "breakdown" in the liver (which all meds should be considered, in that age group) as much as it causes delirium and temporary psychoses. Other, anti-emetics, should be considered. 

Yes, pain is real and should be treated as much as the fracture would be. I suggest reading AMA's and FACEP, NEMSP viewpoints and suggestions of such. If one is worried about respiratory depression with use of opioid analgesics, then one should not be given authority to administer medications. Especially paramedic level, knowing narcan can reverse, as well as one should have the knowledge and capability of managing the airway. 

In recent years, not addressing and managing pain properly is one of the popular areas of litigation and loss of health care providers, this includes physicians, nurses and yes even EMS personnel.

Personally, both are good immobilizers.. however; the scoop can be removed more easily. If this is an isolated injury, one should not have to remain on a LSB for a long period of time, as research has shown, LSB can produce as many injuries as they prevent.

R/r 911


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## micsaver (Oct 10, 2008)

doc5242 said:


> ...she needed a hair traction if anything, you need to look at the age of pt's sometime, old people are like glass, the more crap you  pile on them the eaiser they break




Um I do believe that traction splits are contraindicated for Hip injury, knee injury or tib/fib injury. As far a I know Traction Splits are made purely for Femur fx.


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## KEVD18 (Oct 10, 2008)

*8.22.2006* yep, thats when the last post on this one was, over two years ago.....


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## mikie (Oct 10, 2008)

KEVD to the rescue!


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## knxemt1983 (Oct 16, 2008)

MedicPrincess said:


> One of our units had this "disagreement" with ALS Fire.  Keep in mind, per our protocols, we can clear C-Spine in the field.  ALS Fire has the same Medical Director and same protocols as we do.
> 
> LOLFDGB in her bathroom.  Its a very small hallway bathroom.  Definantly one of those 1-butt bathrooms.  Its a toilet and a sink.  94 y/o Pt c/o of excruciating pain in the hip region.  Doesn't really isolate, just kind of says "here" and waves her hand over.  Patient has rotation/shortening.  At this time the patient denies neck or back pain.  Denies LOC.  Family onscene confirms no LOC.
> 
> ...



sounds to me like some people need to learn what the work TEAMWORK means. I always try and work with fire, ultimately my rear is the one that gets chewed at the ER, but really in this scenario I would prefer the scoop also unless I missed something in the post. Then again it's just personal preference, reason being if she doesn't need full immobil, then I can remove the scoop once in the rig for patient comfort. hip immobilizers are nice to because you can lay them out on the cot, then move pt on with scoop and remove scoop then apply it. 

just my 2 cents


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## KEVD18 (Oct 16, 2008)

KEVD18 said:


> *8.22.2006* yep, thats when the last post on this one was, over two years ago.....



seem appropriate to bring this up again!!!!


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## Jon (Oct 16, 2008)

OK... Post is over 2 years old... and EMTPrincess is now MedicPrincess.
Protocols might have changed, etc.


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