# Two Car MVC



## Sasha (Jul 4, 2009)

You are called to an MVC on the interstate. The offending car was travelling 50 mph, approximately, and hit a stopped car from a backed up exit. The offending car tried to swerve away, hit the rear passenger side with damage to the bumper and the tire of the parked car. The offending car's driver door is caved in just enough where it wont open, the headlights broken, bumper's hanging off, hood bent up. No airbag deployment.

Crasher has self extricated through passenger door, is walking around upset and crying. The state trooper tells you that originally both the crasher and the crashee claimed to be fine, but now that the crashee's friend  has arrived, the crashee is complaining of neck pain.

Ready, set, go.


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## Shishkabob (Jul 4, 2009)

/me thinks crasher is you.


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## Sasha (Jul 4, 2009)

It is, I thought what the medics did was...interesting, nothing I've ever read or heard or seen before. Would like to see the direction other people take it.


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## Shishkabob (Jul 4, 2009)

Without a more detailed physical exam, can't decide much.  C-spine and hx, and tx for xray. 








On a personal note-
The usual bystander would go "Faking it", but we all know that adrenaline can mask pain when something first happens, soo.... get a lawyer.


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## Sasha (Jul 4, 2009)

Uhm.. ask what you want and I will tell you. I saw everything the medics did, I was standing right there and was infact a "patient" myself.


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## Shishkabob (Jul 4, 2009)

Well, what was the other driver complaining of?

Any specific area or general?

1/10?

Provocation?


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## Sasha (Jul 4, 2009)

"My neck hurts and my brain feels like it's swelling"
"My whole neck"
"10"
Negative.


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## Mountain Res-Q (Jul 4, 2009)

Sasha said:


> "My neck hurts and my brain feels like it's swelling"
> "My whole neck"
> "10"
> Negative.



What does "my brain feels like its swelling" feel like?  And how would you know?

My response... tell the crashee that, "It probably ain't anything of concern rolleyes, but if you want to make their lawsuit more realistic we should probably put a tight restraining device around your neck, strap you to a really hard and uncomfortable backboard, and leave you on that board for hours on end while the ER staff finds the time to clear your neck... hopefully you won't have to pee, eat, or drink anything for 6-12 hours... oh and while we are at it we should strip you naked just to make sure that you don't have something more serious, start 2 12 gauge IVs just to be cautious, and probably take a rectal temp because... well just becasue...  or would you like to sign out AMA and not waste our time."  J/K  Mountain would never say that!!!  ^_^

On the other hand... sounds like you are screwed Sasha...  :sad:


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## Sasha (Jul 4, 2009)

Listen. I'm not looking for legal advice, "you're screwed" or "sucks you were in an accident".

I am looking to play out the scenario. I'll post what actually happened. Anything more with your assesment? How the patients were sitting or standing, physical findings, vital signs?


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## Shishkabob (Jul 4, 2009)

Were they ambulating?

How did they opt to get on the backboard *if one was used*, IE standing takedown, or did they sit?

Did they sit, twist, turn, or bend at all either during the EMS crews presence, or the police presence?

Prior hx of back/neck pain?  

BGC?

AOx4?

Accept or reject cspine precautions?


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## Sasha (Jul 4, 2009)

Here's what happened:

The medics went to put a C-Collar on her and she was texting, looking down at her phone. It was established she still had full range of motion and no neural defict. They put a C-Collar on her, stood her up and walked her from the driver's side to the passenger side to sit her down, ( I presume so their backs weren't to traffic, it was very busy and there were accidents all up and down the interstate due to a really big 4th of july event. ) They took orthostatics, her intial vitals were 127/something with a pulse in the high 80s pulse ox 98 on RA with no significant change when standing. She said she hit her head on the "door pole". 

After some talking, they decided to let her go by friend's POV to the ER, still wearing C-Collar.

Patient was released from the ER with no injury.

That's what I was a little befundled about. They let her go with a C-Collar. What if it had become too tight and she had trouble breathing? Or it slipped? Though I doubt she wouldn't be able to figure out how to pull it off, you never do know!


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## atropine (Jul 4, 2009)

sign the pt.out AMA as soon as I can.


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## Shishkabob (Jul 5, 2009)

Well, as far as the c-collar is concerned, maybe they don't have clearing c-spine in their protocols?


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## HotelCo (Jul 5, 2009)

Linuss said:


> Well, as far as the c-collar is concerned, maybe they don't have clearing c-spine in their protocols?



Then transport the patient.

I'm not a fan of the idea of releasing a patient while they're still wearing a C-Collar.


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## Shishkabob (Jul 5, 2009)

No choice if they are AMA...


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## Mountain Res-Q (Jul 5, 2009)

Well, you all will like this one then... today, while responding to the SAR Cache to pick up vehicles and gear for a rescue... an 18 y/o girl ran a stop sign and drove right into my lane of traffic.  I swerved to avoid killing her and ended up snapping my axel.  Non-injury... and I took all the appropriate steps for legal reasons.  The Highway Patrol agreed it was her fault even if I was doing 60 mph, like she claimed after admitting guilt to me with a, "I'm so sorry."  BTW, I was not doing 60, something that is impossible on this road.  I was doing the speed limit (25) and was in fact riding the brakes to avoid another car that ran the same sign only 5 seconds before.  What a great weekend for me!!!  :sad:

As far as Sasha goes... I would never place a collar on someone unless we were going to transport; you don't start medical treatment like that and then just let them drive to an ED.  What's next... traction, IVs, intubating and then leting them drive themselves in?  No transport... no c-spine... sign AMA... and let's get clear this call.


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## Aidey (Jul 5, 2009)

Where I work the pt can refuse transport at any time. Doesn't matter what interventions or treatment you've started. You could have them in full spinal precautions, with an IV running and if they say "Stop, let me go, I don't want you to touch me" they are within their right to do it (as long as they meet the LOC requirements).


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## CAOX3 (Jul 5, 2009)

Aidey said:


> Where I work the pt can refuse transport at any time. Doesn't matter what interventions or treatment you've started. You could have them in full spinal precautions, with an IV running and if they say "Stop, let me go, I don't want you to touch me" they are within their right to do it (as long as they meet the LOC requirements).



Yes they have the right but you wouldnt leave the IV in or the collar on would you?


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## Sasha (Jul 5, 2009)

She hadn't refused, they told her she would be okay to go by POV. If they couldn't clear C-Spine they should not have released her to go by POV, nor should they have stood her up and walked her anywhere. Personally I feel the medics handled it wrong. If she was going by POV, I think that they should had taken off the C-Collar. Not doing so opens them up to liability should she run into complications during her ride to the hospital.


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## HotelCo (Jul 5, 2009)

Linuss said:


> No choice if they are AMA...



Then they don't get the C-Collar.


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## Flight-LP (Jul 5, 2009)

Linuss said:


> Well, as far as the c-collar is concerned, maybe they don't have clearing c-spine in their protocols?



Doesn't matter............

Neck pain = C-collar until radiologically or M.D.ogically cleared.


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## Flight-LP (Jul 5, 2009)

Sasha said:


> Here's what happened:
> 
> The medics went to put a C-Collar on her and she was texting, looking down at her phone. It was established she still had full range of motion and no neural defict. They put a C-Collar on her, stood her up and walked her from the driver's side to the passenger side to sit her down, ( I presume so their backs weren't to traffic, it was very busy and there were accidents all up and down the interstate due to a really big 4th of july event. ) They took orthostatics, her intial vitals were 127/something with a pulse in the high 80s pulse ox 98 on RA with no significant change when standing. She said she hit her head on the "door pole".
> 
> ...



Hope your week gets better my friend!

Honestly, I wouldn't worry about litigation as the EMS crew has provided more than enough good times for an ambulance chasing lawyer.

1. Never release a pt. with medical equipment in place, thats already been covered. Next thing you know an intubated pt. will come in POV with their friends bagging them!

2. NEVER, NEVER, NEVER walk a pt. when you are applying spinal motion restriction. It is never acceptable. I have testified at many civil trials and have seen every single EMS provider lose this argument. If safety is a concern, get the fire department or law enforcement to secure your scene safety. Thought that was one of the first steps of every single assessment???????

3. Having a pt. AMA is one thing, to tell a pt. that they will be "allright, o.k., nothing to worry about, probably be just fine etc." is words that should never come out of a providers mouth if the pt. voices a complaint secondary to witnessed trauma (no matter how minor or trivial). That is just plain stupidity!

Hey, accidents happen (so my dad constantly tells me!). Thats life and why we have insurance. But it sounds like stupidity was added to the equation by some half a$$ed medics.

Again, I hope your week turns brighter!


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## emtfarva (Jul 5, 2009)

Lets see...

First of all, in my personal opinion, the medics handled the call wrong. If you look at the instructions on the package of the C-collar states: *To be used by Trained Medical Personal. *It is fine that the Pt wanted to AMA herself, but I would have never left the C-collar on the Pt. As someone pointed out, what if the Pt had an airway issue, and the person with her had no clue what to do, or worse, told not to take the collar off. at least in the back of the ambulance we could assist the Pt with her airway.

Was this Pt ambulatory prior to EMS arrival?

How was the Pt found when EMS arrived?


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## Ridryder911 (Jul 5, 2009)

I would had informed the patient of the risks (death, paralysis, etc) and the alternatives, then if the patient was able to repeat and converse she understood the risks (of me removing the device as well), then I would have her sign the AMA (hopefully with witnesses) and then removed the cervical collar. 

Cervical collars solely do not prevent injuries, as mere a reminder. Would you leave a KED on someone or a Hare traction? 

They (patient) made an informed and reasonable choice. Then document my arse off. 

R/r 911


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## Aidey (Jul 6, 2009)

CAOX3 said:


> Yes they have the right but you wouldnt leave the IV in or the collar on would you?



Yes I would if the pt said "don't freakin' touch me again!" 

I can explain what I want to do, and explain why I want to do it, but if the pt says "don't touch me" I'm not touching them.


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## redcrossemt (Jul 6, 2009)

Flight-LP said:


> Doesn't matter............
> 
> Neck pain = C-collar until radiologically or M.D.ogically cleared.



does anyone have protocols to 'clear' someone with neck pain in the field??


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## WuLabsWuTecH (Jul 7, 2009)

redcrossemt said:


> does anyone have protocols to 'clear' someone with neck pain in the field??


i doubt it unless they have a protable xray and a film processing truck.  Hmmm, I kinda want to drive a truck now with the call sign of "x-ray 1"

Flight-LP
Never is a harsh term to use.  If the scene becomes unsafe, then you might have to emergency move someone...


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## Flight-LP (Jul 7, 2009)

WuLabsWuTecH said:


> i doubt it unless they have a protable xray and a film processing truck.  Hmmm, I kinda want to drive a truck now with the call sign of "x-ray 1"
> 
> Flight-LP
> Never is a harsh term to use.  If the scene becomes unsafe, then you might have to emergency move someone...



So is being found guilty of negligence because you did not provide an appropriate standard of care. 

If your scene is no longer safe, you make it safe or leave. Remember, your personal safety comes before any aspect of pt. care and can be easily justified. In this scenerio, the safety issue was traffic. Again, have the FD or PD block traffic. There is NO need or appropriate situation to ambulate a pt. while applying SMR.


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## daughertyemta (Jul 7, 2009)

MEDICAL CONTROL...PUT it back on them plus they can usually talk them into going.  Or Im gonna try my damndest because I DO NOT feel comfortable taking someone out of full c spine that they allowed me to put them in in the first place!  But then again we have protocols for clearing c spine.   But if all fails in the end..you dont wanna be charged with kidnapping or assult!



Aidey said:


> Where I work the pt can refuse transport at any time. Doesn't matter what interventions or treatment you've started. You could have them in full spinal precautions, with an IV running and if they say "Stop, let me go, I don't want you to touch me" they are within their right to do it (as long as they meet the LOC requirements).


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## MendoEMT (Jul 8, 2009)

Mountain Res-Q said:


> My response... tell the crashee that, "It probably ain't anything of concern rolleyes, but if you want to make their lawsuit more realistic we should probably put a tight restraining device around your neck, strap you to a really hard and uncomfortable backboard, and leave you on that board for hours on end while the ER staff finds the time to clear your neck... hopefully you won't have to pee, eat, or drink anything for 6-12 hours... oh and while we are at it we should strip you naked just to make sure that you don't have something more serious, start 2 12 gauge IVs just to be cautious, and probably take a rectal temp because... well just becasue...  or would you like to sign out AMA and not waste our time."  J/K  Mountain would never say that!!!



I am so with you on this one!  Sudden neck pain upon arrival of lawyer or friend = me doing my "utmost to provide the maximum level of care I can possibly give", preferably in a manner that makes the idiot completely aware of all the other better things they could be spending their time on!


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