# Inappropriate extrication



## Sassafras (Oct 10, 2017)

Hi guys. It's been a LONG time. Quite a few years. I allowed my EMT-B to lapse after getting employed in a hospital working with spinal cord rehabilitation. I currently work on a neuro trauma unit...so more spine, add brains and they are barely out of the ED. I may have left the truck, but I never walked very far away. 

Anywho...I witnessed an accident yesterday and pulled over to see if I could help until EMS arrived. I held c-spine, and started a history, but his orientation started fading and he wasn't a good history teller after a few minutes. 

Fastfoward, fire arrived on scene, collared him, placed the board under his butt, a firefighter climed in the passenger side to help position him onto the long board, and suddenly my hands are shoved off and they are pulling the passenger toward the driver's side door ignoring their colleague in the passenger seat. I told them to stop, that his head wouldn't clear the door. They ignored me every time I spoke up and proceeded to repeatedly bend his head to his shoulder to pull him out of the door as the patient kept telling them they were hurting his neck. If he did have cord damage, they just assured he would have a transectioned complete cord injury.

My question is, does fire fall under the same governing body as EMS? Who would I contact about this? I was dressed for work, so in scrubs and when I spoke up I was told I didn't know what I was talking about because the hospital is not the real world on the field. A co-worker suggested I call the hospital the patient was transported to, but I wouldn't know who to ask to speak with. Is there someone, like a certifying agency or governing body who could insist on skills review? 

Thanks in advance.


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## Chris07 (Oct 10, 2017)

Sounds like the responding crew was either complacent and "went through the motions" or they were rough around the edges. Either way it's obviously not right. You've been out of the field for a while, so it may be surprising to hear that what you witnessed isn't an extremely rare occurrence by any stretch of the imagination, unfortunately. I encountered this sort of "half-assed" extrication more than a couple of times.

If you really want to pursue this you would be best off contacting their department. An FD that provides EMS service has someone in-charge of overseeing that and you can file a complaint. Here's the question though...do you really want to go through the trouble of doing that? What do you expect will come out of this?

If you make a phone call, talk to their EMS captain and insist that they have a skills review, I'm sure you'll get a "I'm, sorry, we'll look into it" and that's it. Really the only person who can actually make a meaningful complaint imo is the patient himself, not a random bystander.


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## DesertMedic66 (Oct 10, 2017)

I doubt that they “just assured he would have a transectioned complete cord injury”. Is it possible they may have made it worse? Yes. Is it possible they didn’t make it worse? Also yes. 

I am very cautious about other “people” on scene trying to direct me around. On TCs I have had CNA say they are a nurse and try to direct me around. Unless you are a physician who is willing to take over all control of this patient I try not to involve civilians and would rather have them leave the scene. 

You should know that trying to contact the hospital and asking about a patient will not give you any information due to HIPAA. 

If you want to file a complaint usually you could go to the management of the fire department or the local EMS agency or the state EMS agency. However don’t be surprised if nothing happens as a result being it’s a he said, she said story.


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## VFlutter (Oct 10, 2017)

Sassafras said:


> I was dressed for work, so in scrubs and when I spoke up I was told I didn't know what I was talking about .



Somewhat relevant side story. When I first started working in the hospital I always saw a distinguished looking older gentleman in surgical scrubs with 2 beepers on his belt in the cafeteria and thought “Wow, he must be an important surgeon or something”. Turns out he was the OR janitor....

So I’m not sure you wearing scrubs gives you more credibility and regardless if you have experience or knowledge in that situation you are still not a licensed medical provider so why do you expect them to listen to you on a scene? 

Are you more upset about the actual care they provided or that they did not acknowledge your opinion?


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## Sassafras (Oct 10, 2017)

Chase said:


> So I’m not sure you wearing scrubs gives you more credibility and regardless if you have experience or knowledge in that situation you are still not a licensed medical provider so why do you expect them to listen to you on a scene?
> 
> Are you more upset about the actual care they provided or that they did not acknowledge your opinion?


 You are correct and multiple bystanders kept saying I was a doctor and I kept correcting them, no. I am not. I do not get special treatment for simply wearing scrubs. However, do not simply assume I don't know what I'm talking about either when I ask you to debrief your team on proper extrication. I'm not upset about my opinion. I'm upset that they could have REALLY hurt this patient. And if this is normal for them, then there are serious issues that need addressed, because then it becomes a matter of when they hurt someone, not if. 



Chris07 said:


> If you really want to pursue this you would be best off contacting their department. An FD that provides EMS service has someone in-charge of overseeing that and you can file a complaint. Here's the question though...do you really want to go through the trouble of doing that? What do you expect will come out of this?
> 
> If you make a phone call, talk to their EMS captain and insist that they have a skills review, I'm sure you'll get a "I'm, sorry, we'll look into it" and that's it. Really the only person who can actually make a meaningful complaint imo is the patient himself, not a random bystander.


 I expect training. The problem is I suspect you  are right and I will be brushed off. However, the patient cannot speak for himself if he has amnesia from the event (which is very common with traumatic head injuries) has crashed further and is intubated, or worse, dead. Who speaks for them when they cannot speak for themselves and they have no family close enough to speak for them? I know this patient did not have anyone local to speak for him. He was very far from home. 



DesertMedic66 said:


> I doubt that they “just assured he would have a transectioned complete cord injury”. Is it possible they may have made it worse? Yes. Is it possible they didn’t make it worse? Also yes.
> 
> I am very cautious about other “people” on scene trying to direct me around. On TCs I have had CNA say they are a nurse and try to direct me around. Unless you are a physician who is willing to take over all control of this patient I try not to involve civilians and would rather have them leave the scene.
> 
> ...


To your first point, yes, you could be correct. But there is a real possibility and plausibility of that happening as well. That is my issue. I've seen it happen, more than once. As for being cautious of other people, I understand that too. It is sort of tattooed on the EMT's brain in training that bystanders are not to be trusted. I get it, but this time, they were clearly in the wrong and were not even communicating with their colleague who was in the car with the patient. Even she was rolling her eyes and told them to watch his spine. Even she was ignored. 
I also know inquiring about the patient is not permitted. Stopping in to check on him and say, "Hello, I hope you're feeling better", since I do have his name and birth date, is a sticky gray area, I'm not willing to risk my job over. I just want to know if there is an overseeing agency that can look into this and/or insist on a skills review. It's all about better outcomes. It is all about the patients. It is not about personal egos, my own or theirs.


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## NomadicMedic (Oct 10, 2017)

This is why I usually remove bystanders from my scenes as soon as I arrive.


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## DrParasite (Oct 10, 2017)

1) you are a civilian.... they are professionals in the AHJ.  Its their scene, not yours.

2) once they show up, it's their party, best bet for you to do is step back and let them to their job.

3) studies have shown that spinal immobilization is over rated. Many places are taking backboards off their ambulances altogether.

4) if you do want to make a big deal about it, why don't you just contact the chief of the department?  if you know the fire department in question, just call up their administrative number, and let their Chief direct you to the proper person.

5) don't be surprised if you are given the brush off.  you are a civilian complaining about how a patient was treated.  They might ask questions, but if that's how the AHJ operates, that's how they are going to operate.

6) assuming their actions lead to a negative patient outcome, do you really want to get dragged into that?  you can be added as a defendant, because they will blame you for the negative outcomes, since you were there first.  Do you really want to get involved in it?


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## epipusher (Oct 11, 2017)

A former EMT bystander wearing scrubs who stopped at a vehicle accident. Halloween costume idea!


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## SMC (Nov 26, 2017)

Was the patient awake and able to follow commands ?  Was a C-Collar On ?    If both are answers are yes.   

Mam/Sir  could you please come toward me and stand and sit on my stretcher ?  I can assist you if needed.   

If not awake or unable to follow commands how was the airway ?  Was rapid extrication needed ?  #armchairquarterback

There are way to many variables here.  I'm with Dr Parasite.  

John Martin  EMT-P


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