# Sternum Rub



## AZEMSPRO (Jan 19, 2018)

So I just re-new'd my CPR Certification and the instructor told me that we no longer do sternum rubs due to the fact that its a lawsuit waiting to happen. 

Is this just a layperson thing or does it apply to EMS as well?

My EMT Instructor works for FIRE here in Arizona still and he said he has heard no such thing.


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## drumlemorace (Jan 19, 2018)

Tyler Pruitt said:


> So I just re-new'd my CPR Certification and the instructor told me that we no longer do sternum rubs due to the fact that its a lawsuit waiting to happen.
> 
> Is this just a layperson thing or does it apply to EMS as well?
> 
> My EMT Instructor works for FIRE here in Arizona still and he said he has heard no such thing.


My teacher here in Los Angeles co. Where i complered my EMT course told us not to do it for that reason as well. 

In Oregon though where I was a medication's aide. I did it under the supervision of an RN in the ALF i worked in. 
So........I assume it depends where you are licensed and working. As fsr as a lay person i can imagine under good Samaritan laws ot shouldnt be too bad of a problem. I personally wouldn't attempt it, but im just one person, and new to EMS.


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## DrParasite (Jan 19, 2018)

Please explain why or how they are a lawsuit waiting to happen.  Especially during a cardiac arrest, when you are likely to break ribs doing compression.  Unless you have a reasonable suspicion that the patient might have sustained trauma or a fracture to their sternum....

I would refer you to https://emtlife.com/threads/no-more-sternal-rubs.43429/, http://allnurses.com/general-nursing-student/sternal-rub-794714.html, https://ems-law.net/page/2/, https://www.ems1.com/ems-products/p...Misinterpreting-the-results-of-a-sternum-rub/, http://theemtspot.com/2009/11/17/test-for-unconsciousness-the-sternal-rub/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987201/

Also remember, you can be sued for anything.  You can sue your instructor for providing incorrect information.  Whether or not you actually have a case that can be won is a much different story.

Just because something is out of favor in a particular area doesn't mean you are great risk for losing a lawsuit.  Unless he can actually provide a case where a person was sued successfully for appropriately doing a sternal rub to a patient (in which case, please let the rest of the world know), than I think he's full of crap and spreading misinformation based on what he thinks is the best advise to give.


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## Jim37F (Jan 19, 2018)

When I was in LA Co as an EMT, I was told in class that there were only 2 authorized painful stimuli...the nail bed press, and the pen-between-the-knuckles squeeze. I do remember being told in class specifically not to do sternum rubs...I also remember someone saying that was at least partially due people doing it wrong, that the running was more likely to cause skin damage and that the real 'proper' way was more of a roll, pressing your knuckles into the sternum vs a rub.

That all being said, as best I can tell, that's all pure anecdote. I don't think I've ever seen any official "this is a proper way to do a sternum rub; this is the improper way" nor do I remember an actual specific protocol in LA Co specifically saying which specific painful stimuli were and were not authorized (though it is LA Co....I wouldn't be that surprised if there was one buried in there that I had missed....not being in LA Co anymore, I can't be assed to look that up right now lol). In real world practice I felt like I was the only one who ever did the nail bed pinch, most every one else did a trap squeeze or the sternum rub anyway, never heard of anyone getting in trouble for that, or that they shouldn't do that.

In my current National Registry EMT class (part of my fire academy) I will say our instructors specifically said trap squeeze was the preferred method, though that just may be the local preference...and FWIW they also showed the sternum rub and made no mention on it not being allowed, and I personally used the sternum rub on the mannequins for skills testing and had no problems with that.


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## EpiEMS (Jan 19, 2018)

Jim37F said:


> I personally used the sternum rub on the mannequins for skills testing and had no problems with that.


Same here - for NREMT in NH, CT state exam, and NYS state exam.


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## drumlemorace (Jan 19, 2018)

DrParasite said:


> Please explain why or how they are a lawsuit waiting to happen.  Especially during a cardiac arrest, when you are likely to break ribs doing compression.  Unless you have a reasonable suspicion that the patient might have sustained trauma or a fracture to their sternum....
> 
> I would refer you to https://emtlife.com/threads/no-more-sternal-rubs.43429/, http://allnurses.com/general-nursing-student/sternal-rub-794714.html, https://ems-law.net/page/2/, https://www.ems1.com/ems-products/p...Misinterpreting-the-results-of-a-sternum-rub/, http://theemtspot.com/2009/11/17/test-for-unconsciousness-the-sternal-rub/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987201/
> 
> ...


I want to clarify that in my case, it's like Jim34f's case. My instructor had used the argument that too many people we're doing it wrong. I'm always learning, and wondered why sternum rubs were frowned upon too.


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## DrParasite (Jan 19, 2018)

drumlemorace said:


> My instructor had used the argument that too many people we're doing it wrong.


So the procedure isn't the problem, the fact the people are doing it incorrectly is.  Do I understand you?

Lets use another misused item: narcan.  most places say that you should use only enough to get the patient breathing, and not wake them up.  but there are countless reports of medics slamming narcan, cops giving narcan to every unconscious person, and people giving a full dose to wake the person up.  Following your instructor's logic, we should ban the use of narcan....

As others have said, there is nothing wrong with the procedure; the issue is people don't do it right.  sounds like if you do it right, there is no issue.  If anything, there is an education issue, and those doing it incorrectly should be retrained by the appropriate people.

i'm still waiting to hear doing an accepted practice that is taught in EMT class is a lawsuit waiting to happen.

BTW incorrectly doing any procedure can result in an increased potential liability.  just throwing that out there.


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## VFlutter (Jan 19, 2018)

A Sternal Rub is still an accepted technique however it is commonly done incorrectly and is probably not the best choice for painful stimuli. Trap squeeze, supraorbital pressure, and nail bed pressure are probably better and less likey to cause injury.  I personally have seen some pretty ugly skin tears from sternal rubs which may happen even if done correctly.


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## Lo2w (Jan 22, 2018)

By policy my division only allows the pen between the finger and I believe the nail bed. During my ride time I had FTOs that would use an NPA to check responsiveness. Amazing how responsive someone becomes when that tube starts going in.


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## MSDeltaFlt (Jan 30, 2018)

Bare in mind that if your assessment reveals that you need to assess your patient's pain response, then without causing any injury, you must cause actual pain.  You have to hurt them.  Just don't injure them.

Me personally I just try to piss them off before I attempt any pain.  I do that by gently tapping the lids of their closed eyes or tickle their nose.  There are those who can tolerate a sternal rub.  But you start @#$%ing around with their eyes and you'll usually get a response.


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