# Intoxicated 20 year old falls



## nymedic9999 (Dec 29, 2013)

Ok, I had a call the other day that involved a 20 year old that fell from a standing height with an arm injury.  I arrived on-scene to find a highly intoxicated 20 year old male seated on the ground cradling his arm.  Patients friends stated that he tripped and fell resulting in the arm injury.  Patient did not hit his head and no trauma was noted to his head.  I ended up transporting him BLS to the hospital without spinal precautions.  The thing is when I got to the ED, the nurse chewed me out for not immobilizing the patient due to him being intoxicated and his mechanism of falling from standing.  Should I have boarded the patient?


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## Wheel (Dec 29, 2013)

nymedic9999 said:


> Ok, I had a call the other day that involved a 20 year old that fell from a standing height with an arm injury.  I arrived on-scene to find a highly intoxicated 20 year old male seated on the ground cradling his arm.  Patients friends stated that he tripped and fell resulting in the arm injury.  Patient did not hit his head and no trauma was noted to his head.  I ended up transporting him BLS to the hospital without spinal precautions.  The thing is when I got to the ED, the nurse chewed me out for not immobilizing the patient due to him being intoxicated and his mechanism of falling from standing.  Should I have boarded the patient?



I probably wouldn't have, unless he was drunk to the point of having altered mental status. If he's A&Ox4, no significant injury above the clavicle, no midline neck or back pain, etc, then no board.


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## NomadicMedic (Dec 29, 2013)

No. No board. 

Uhhhhh... 

Unless your protocols specifically call for boarding intoxicated patients. 

Then yes, board.


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## Handsome Robb (Dec 29, 2013)

DEmedic said:


> No. No board.
> 
> Uhhhhh...
> 
> ...



This.


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## LACoGurneyjockey (Dec 29, 2013)

DEmedic said:


> No. No board.
> 
> Uhhhhh...
> 
> ...



Exactly what my protocol says, if they had a ground level fall and are at all intoxicated, they can't accurately report pain resulting from a possible c spine injury. Do I agree with it, no, but would I board this patient, absolutely.


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## teedubbyaw (Dec 29, 2013)

Wheel said:


> I probably wouldn't have, unless he was drunk to the point of having altered mental status. If he's A&Ox4, no significant injury above the clavicle, no midline neck or back pain, etc, then no board.




Agreed


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## mycrofft (Dec 30, 2013)

We get a lot of scenarios about why a nurse chewed out someone at an ER.


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## Medic Tim (Dec 30, 2013)

no board for this pt.


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## NomadicMedic (Dec 30, 2013)

UNLESS the protocols specifically call for a board. 

This is the kind if thing that gets new EMTs in trouble. If the protocols require it, you need to do it, until you're in a position to change the protocols or move to a new service.


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## TransportJockey (Dec 30, 2013)

With my protocols I wouldn't board this pt. I generally try to find any reason at all to not board them if I can help it


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## epipusher (Dec 30, 2013)

C-collar, no lsb.


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## ZombieEMT (Dec 31, 2013)

TransportJockey said:


> With my protocols I wouldn't board this pt. I generally try to find any reason at all to not board them if I can help it



I am a big support of not backboarding if not needed but this is the mentality that irritates me, and I am sorry if I offend you. Some people should be longboarded and there are some people that find what ever excuse not to. Same applied to KED. 

Like I said, I am a supporter of no longboard when not indicated and have done much research on the topic. This is not limited to alternated to longoards, such as scoops.


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## TransportJockey (Dec 31, 2013)

ZombieEMT said:


> I am a big support of not backboarding if not needed but this is the mentality that irritates me, and I am sorry if I offend you. Some people should be longboarded and there are some people that find what ever excuse not to. Same applied to KED.
> 
> Like I said, I am a supporter of no longboard when not indicated and have done much research on the topic. This is not limited to alternated to longoards, such as scoops.



Name one person who absolutely needs one. Most people can do just fine with a collar and sitting on the gurney. Studies show that backboards cause more harm than good. My protocols let me use my judgement to avoid performing potentially uncalled for and harmful procedures. Honestly I don't care, and couldn't care less, what your opinion of me is. I am truly behind EBM and wish EMS would actually start to change faster in that direction.


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## ZombieEMT (Dec 31, 2013)

Not every patient does need one, I agree with you. I am just saying, I personally do not look for reasons to not do something. If I do, I document why not (if you have a protocol for doing something). Like I said, big supporter of no longboards, but getting everyone in the field on the same page is going to take a long time.

I understand, you do not care what my opinion on you is. You do not know me nor do I know you. I do not judge, I am just saying, that some people have this attitude and their reason is normally laziness not patient care. I am not trying to offend anyone, and I hope that I don't.


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## mycrofft (Dec 31, 2013)

DEmedic said:


> UNLESS the protocols specifically call for a board.
> 
> This is the kind if thing that gets new EMTs in trouble. If the protocols require it, you need to do it, until you're in a position to change the protocols or move to a new service.



The reason being the protocols reflect a standard of care and "best practices" experience.

Not, as some here would say, "Do it or they'll get mad at you".


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## NomadicMedic (Dec 31, 2013)

Correct, but in many cases EMTs are not granted the latitude to use any critical thinking skills*. They're told to "follow the protocols. Period"

Which is why I see patients, who were ambulatory after a car wreck and talking on the cell phone, being secured to a board when they want to be checked out at the ED for neck or back discomfort.  

*And not all EMTs do this, but many do.


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## TheLocalMedic (Jan 2, 2014)

If I saw someone trying to board this patient they'd suddenly find themselves in a time out.  I have no tolerance for this kind of ignorance.  And just because someone is intoxicated doesn't mean they get a board, whatever your protocols say.


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