# ALS Head injury criteria



## chri1017 (Oct 12, 2013)

When to call ALS for a head injury?  Would mild dizziness require ALS?


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## NomadicMedic (Oct 12, 2013)

It depends. 

Ask a vague question, get a vague answer.


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## Medic Tim (Oct 12, 2013)

chri1017 said:


> When to call ALS for a head injury?  Would mild dizziness require ALS?



It depends. We would need more information.


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## chri1017 (Oct 12, 2013)

Say it was a fall from standing in a 18 yom who hit his head with a minor head lac, who is also dizzy.  No loc or AMS


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## Clipper1 (Oct 12, 2013)

chri1017 said:


> Say it was a fall from standing in a 18 yom who hit his head with a minor head lac, who is also dizzy.  No loc or AMS



Why did an 18 y/o male fall while standing?


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## NomadicMedic (Oct 12, 2013)

This is the same as asking, "I cut my finger. Should I get it seen by a doctor?"

Tell us the story. Events leading up to the fall. Medical history. Medications. Full assessment. Vital signs. 

Ya know, make us see what's going on...


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## Anjel (Oct 12, 2013)

Did he fall because he was dizzy?


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## chri1017 (Oct 12, 2013)

So the kid feel and hit is head.  He complained of feeling dizzy from striking his head and presented with signs of a minor concussion as in he was nauesous and dizzy.  No loc and everything else was normal.


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## Medic Tim (Oct 12, 2013)

chri1017 said:


> So the kid feel and hit is head.  He complained of feeling dizzy from striking his head and presented with signs of a minor concussion as in he was nauesous and dizzy.  No loc and everything else was normal.



fall from standing height? stairs, a step? walking? running? any others forces involved? where did he hit his head? etc

from what you are describing....if the pt decided he wanted transport I would have taken him in a position of comfort and most likely no interventions. With the limited info it is hard to get a sense of the scene and the pt.


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## Akulahawk (Oct 12, 2013)

chri1017 said:


> So the kid feel and hit is head.  He complained of feeling dizzy from striking his head and presented with signs of a minor concussion as in he was nauesous and dizzy.  No loc and everything else was normal.


Are you qualified to evaluate concussions?


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## DesertMedic66 (Oct 12, 2013)

Medic Tim said:


> fall from standing height? stairs, a step? walking? running? any others forces involved? where did he hit his head? etc
> 
> from what you are describing....if the pt decided he wanted transport I would have taken him in a position of comfort and most likely no interventions. With the limited info it is hard to get a sense of the scene and the pt.



Pretty much this. 

Why did the 18 YOM fall? People always have a reason for falling, they don't just fall.


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## Akulahawk (Oct 12, 2013)

Medic Tim said:


> fall from standing height? stairs, a step? walking? running? any others forces involved? where did he hit his head? etc
> 
> from what you are describing....if the pt decided he wanted transport I would have taken him in a position of comfort and most likely no interventions. With the limited info it is hard to get a sense of the scene and the pt.


Particularly because of the limited info, it's very difficult to get a sense of the patient and if there were other contributing factors involved. I would hope that most of us would _easily_ be able to evaluate whether or not this guy should be evaluated and/or transported by ALS. 

Of course, another question that must be raised is whether ALS is qualified to evaluate this kind of patient either...

What would _I_ have done? It totally depends on the circumstances, things that I _know_ haven't been discussed in this thread. As an ALS provider, I might or might not have transported this guy to the ED for further evaluation. That's about as definite as I can get under the described circumstances.

Given my own educational background, as a BLS provider, I may or may not have transported this guy...but I'd certainly be able to articulate _why_ I made whatever decision I made.


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## medicsb (Oct 12, 2013)

Unless there is an airway or breathing issue, there is, realistically, almost no need for "ALS".  If there is a problem with mentation, then about the only thing that is useful from ALS is a BGL if BLS is unable to measure it.  And if it's normal, the patient almost assuredly should go via BLS (assuming no breathing or airway problem).


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## mycrofft (Oct 13, 2013)

I don't give medical advice except see your doctor.:nosoupfortroll:


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## DrankTheKoolaid (Oct 13, 2013)

medicsb said:


> Unless there is an airway or breathing issue, there is, realistically, almost no need for "ALS".  If there is a problem with mentation, then about the only thing that is useful from ALS is a BGL if BLS is unable to measure it.  And if it's normal, the patient almost assuredly should go via BLS (assuming no breathing or airway problem).



Ugh what? There area many other correctable reasons for an Altered mental status besides BGL. Cardiac dysrhythmias, hypotension, etc etc. and yes those are ALS..


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## Carlos Danger (Oct 13, 2013)

medicsb said:


> *Unless there is an airway or breathing issue, there is, realistically, almost no need for "ALS".*  If there is a problem with mentation, then about the only thing that is useful from ALS is a BGL if BLS is unable to measure it.  And if it's normal, the patient almost assuredly should go via BLS (assuming no breathing or airway problem).



This.

However, that said, every system I've worked in, pretty much every "head injury" is an automatic ALS dispatch, with the helicopter on standby even, if it "sounds bad". 




Corky said:


> Ugh what? There area many other correctable reasons for an Altered mental status besides BGL. Cardiac dysrhythmias, hypotension, etc etc. and yes those are ALS..



But an EMT can assess BP, skin temp/color, pulse regularity/quality, and mental status, which taken together, generally tells you all you need to know about cerebral and systemic perfusion. 

EMT's should, IMO, be using their assessment skills and calling for help only when they need it, not routinely every time there is any chance that someone "might get worse".


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## nymedic9999 (Oct 13, 2013)

As a basic if a patient presented with vomiting and or dizziness following a head injury I would defiantly call for ALS.  My reasoning behind this is that, if a patient presents with the above issues they most likely have a closed head injury and could possible deteriorate during transport.  That being said someone who states they were light headed or dizzy directly after the fall and for only a matter of seconds does not require ALS.  Obviously LOC, AMS, and all the other big ones would be ALS criteria.


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## Akulahawk (Oct 13, 2013)

nymedic9999 said:


> As a basic if a patient presented with vomiting and or dizziness following a head injury I would defiantly call for ALS.  My reasoning behind this is that, if a patient presents with the above issues they most likely have a closed head injury and could possible deteriorate during transport.  That being said someone who states they were light headed or dizzy directly after the fall and for only a matter of seconds does not require ALS.  Obviously LOC, AMS, and all the other big ones would be ALS criteria.


Another part of the puzzle is knowing how long it'll take ALS to get there vs you taking the patient to an ALS provider (aka the ED). Oh, and it's "definitely" not "defiantly" as those are two different words that can really change what your sentence means...


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## Handsome Robb (Oct 14, 2013)

nymedic9999 said:


> As a basic if a patient presented with vomiting and or dizziness following a head injury I would defiantly call for ALS.  My reasoning behind this is that, if a patient presents with the above issues they most likely have a closed head injury and could possible deteriorate during transport.  That being said someone who states they were light headed or dizzy directly after the fall and for only a matter of seconds does not require ALS.  Obviously LOC, AMS, and all the other big ones would be ALS criteria.



I'm not really all that concerned about a CHI in an 18 year old GLF unless they take anticoagulants/platelet meds.

What'd he hit his head on? 18 year olds don't just randomly fall while standing still, you've yet to answer this question and it's been asked multiple times.

If I can explain the dizziness and it's not an etiology that warrants an ALS attendant I've got no problem with a B/ILS attendant. 

With how vague you're being and the fact that you haven't provided any information that's been requested multiple times I'm going to say, yes, this patient should have an ALS attendant because I'm not very confident on your medicine. Probably gonna get some points for that one.


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## mycrofft (Oct 15, 2013)

"Take two tylenol and wake up dead", as I tell my first-aid classes.


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## Aidey (Oct 15, 2013)

Robb said:


> I'm not really all that concerned about a CHI in an 18 year old GLF unless they take anticoagulants/platelet meds.
> 
> What'd he hit his head on? 18 year olds don't just randomly fall while standing still, you've yet to answer this question and it's been asked multiple times.
> 
> ...



Yeah, you should probably reconsider since the person you posted wasn't the OP.


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