# How Did I Do?



## miperry (Sep 13, 2011)

Today during a soccer game a friend of mine went up for a header and collided heads with another player resulting in approx. 2 1/2 inch gash that was bleeding a lot. I immediately went over to him to see if he was alright, once i saw all the blood i yelled for someone to grab me a clean sock, or shirt to control the bleeding. I had some people assist me in rolling him over, my coach and the athletic trainer, keeping in mind he could have a neck injury. After controlling the bleeding, i checked his mouth, nose and ears for fluid as well as bruising behind the ears and everything checked out good. I moved to his neck he said he had no neck pain, I did an examination and ruled out the possibility of a neck injury and allowed him to sit up. By this time his mental status seemed to be dropping slightly, and i also had a doctor from the side line helping me. We were brought a med kit and switched from a sock to gauze and a tight bandage for pressure. We laid him back down and assessed pulse and breathes, which were higher than normal, but then again we were playing soccer. He began to come around again, and the doctor transported my friend in her car.

My question is should we have called an ambulance or was I okay leaving him in the care of the doctor? Any other comments?


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## Katy (Sep 13, 2011)

You handled it the best anyone could with what little resources you had. Now, with a Doctor and a Athletic Trainer present, I would think they would catch a neck injury, or if they suspected something far more serious, I'm sure they would have called. After all, this is the specialty of the Athletic Trainer, they are the experts in these type of injuries. I would have consulted with the Doctor and AT to see what they thought, and if they didn't think an ambulance was needed, I wouldn't have called for one. However, don't get too cocky in this situation as far as doing an assessment and thinking yours is better, because there's will be better and far more in depth. Good job though.


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## Anjel (Sep 13, 2011)

It was the doctor and athletic trainers call to make. 

He definitely needs to go to a hospital for altered mental status. So as long as he gets there one way or another. 

I probably would of collared and boarded him if I was transporting him. Just because of a traumatic head injury with AMS. You never know what happened in the spine area.


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## miperry (Sep 13, 2011)

If i was transporting him I probably would have collared and boarded him too. Also he is doing good, i just talked to him.


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## silver (Sep 13, 2011)

If an athletic trainer is there, he/she should be in charge of patient care until he/she asks for help and/or defers care to you. They have much more training and education with sports injuries/trauma.


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## sdennislee (Sep 13, 2011)

Withut any input my call would be c-collar and board. IF the Dr or the AT ruled out c-spine, I would defer to them. I agree this should been the AT case.


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## truetiger (Sep 13, 2011)

I wouldn't of done any of that. With a doctor and trainer on scene, its safe to say they have it covered. You were wrong to omit c spine. You were not on duty, making that not your call. Let's say there was no doctor on scene. I show up to transport and do my own assessment. The patient has a head injury with an altered mental status, per my employer's protocols, this patient will be boarded. Now I have to put you, your "assessment", and your B number in my report.


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## Akulahawk (Sep 14, 2011)

You did fine for your level of training. However, the AT is most "at home" in this setting and was likely well ahead of you in their evaluation of the player. Please, do not feel bad at all. The AT has a highly specialized education that goes well beyond what an EMT _ever _gets for evaluating these situations. While the open wound is quite the attractive thing, I'd be more concerned with the strong possibility of concussion... or worse.


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## WoodyPN (Sep 14, 2011)

C Spine.

Never shoulda moved without c spine. After that, I would called 911, and assisted the crew get.him boarded and transported.


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## Akulahawk (Sep 14, 2011)

WoodyPN said:


> C Spine.
> 
> Never shoulda moved without c spine. After that, I would called 911, and assisted the crew get.him boarded and transported.


Consider it... but it could very well not have been needed. Player wiggling all fingers & toes and no c-spine step-offs or tenderness?


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## Tigger (Sep 14, 2011)

WoodyPN said:


> C Spine.
> 
> Never shoulda moved without c spine. After that, I would called 911, and assisted the crew get.him boarded and transported.



Ever notice how many big hits there are in a football or hockey game? Even when the ATC does make it the ice, how often does the player end up in C-Spine Precautions? Not very often...

MOI cannot be the only reason that C-Spine precautions are implemented. An appropriate and thorough assessment of the athlete by an ATC (who, as stated has far and above more education than a basic and some medics for that matter). If the athlete shows signs or symptoms of a cervical spine injury than by all means c-spine, but not because he collided with someone and there was a cut. 

Also if some joe shmoe called 911 while an ATC or doctor was on the field without being directed to do so, I think I would lose it (oh wait that happened and I did).


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## truetiger (Sep 14, 2011)

Why bring liability to yourself if you have no duty to act? There were already two trained professionals on scene.


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## miperry (Sep 16, 2011)

To all the people saying i should have probably called 9-11, i think his mom, who also happened to be the doctor, would have flipped. There was no need to call EMTs just so they could keep him in cspine when the trainer and i ruled it out, and the doctor agreed. Also next time i will pay more attention to letting the people with more training take the lead instead of jumping in, i guess it was just a rookie/foolish mistake. Thanks for the advice though.


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## bigdogems (Sep 16, 2011)

Im not sure of the laws in every state but I'm pretty sure no matter where you are if your not under medical direction by a doc you are technically not allowed to do anything other than basic first aid. ariway and bleeding controll. 

If I understand correctly you were just there as a friend watching. You werent working. Its fine if you want to help a friend. Probably not going to get into any kind of trouble if you know them. As mentioned by one person prior. Everyone wants to bring up c-spine. If you werent on the job there is no reason for this. I was involved in boxing and MMA for years. People get knocked out all the time. Take a while to get their head right and go about their day. Same with sports like motorcross. Ive seen crashes that on the streets people would be calling for air transport and they get their arm splinted and have a friend drive them to the hospital. There is a reason that over the last few years there is alot of talk about not immobilizing as much as we do


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## firetender (Sep 16, 2011)

*His Mom was the Doc?*

What more need be said; you were an appendage at best!


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## Tigger (Sep 16, 2011)

bigdogems said:


> Im not sure of the laws in every state but I'm pretty sure no matter where you are if your not under medical direction by a doc you are technically not allowed to do anything other than basic first aid. ariway and bleeding controll.
> 
> If I understand correctly you were just there as a friend watching. You werent working. Its fine if you want to help a friend. Probably not going to get into any kind of trouble if you know them. As mentioned by one person prior. Everyone wants to bring up c-spine. If you werent on the job there is no reason for this. I was involved in boxing and MMA for years. People get knocked out all the time. Take a while to get their head right and go about their day. Same with sports like motorcross. Ive seen crashes that on the streets people would be calling for air transport and they get their arm splinted and have a friend drive them to the hospital. There is a reason that over the last few years there is alot of talk about not immobilizing as much as we do



I see no issues with holding c-spine when not on the clock, that is of course assuming that the patient actually needs it. It's hard to argue that holding someone in-line is much more than advance-first aid.


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## epipusher (Sep 17, 2011)

Agreed with the full c-spine. The head injury would be considered a distracting injury making me unable to clear the c-spine.


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## Akulahawk (Sep 17, 2011)

epipusher said:


> Agreed with the full c-spine. The head injury would be considered a distracting injury making me unable to clear the c-spine.


Each situation is different. One injury may not actually be as much of a distraction to one player as it would be to another. You also have someone who likely has much more training/education than most of us specifically for this kind of event, they function from whole different set of rules than we do. It's not implausible that they were able to clear the c-spine on the field with a reasonable degree of certainty that nothing untoward occurred from the collision.


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## Tigger (Sep 18, 2011)

epipusher said:


> Agreed with the full c-spine. The head injury would be considered a distracting injury making me unable to clear the c-spine.



Even if the patient is not point-tender on any aspect of their c-spine, shows no deformity anywhere near the spinal area, is not guarding their neck, and does not complain of any cervical spine pain? And there are no abnormalities in the neuro exam?

I guess that's kind of the difference between EMS and Sports Medicine. We have no protocols to determine a spinal injury. If the ATC or doc says there is one, then we get the c-spine stuff and medic crew. If they think there is no c-spine injury, we don't.


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## zmedic (Sep 22, 2011)

Also I don't have data on this, but my gestalt is that the mechanism is relatively low risk for C-spine injury. Most of the spinal fractures I've seen or heard about (in young people) involve high energy transfers. Ie motorcyclist ejected, diving injury, tackling someone with your head in football where there is an axial load etc. Head to head in soccer with an awake patient who denies neck tenderness and has no extremity neuro signs is pretty low risk in my book. 

Not wrong to board if you are concerned. But in trauma to the head is not automatically the same as significant mechanism of injury for the spine.


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## Akulahawk (Sep 22, 2011)

zmedic said:


> Also I don't have data on this, but my gestalt is that the mechanism is relatively low risk for C-spine injury. Most of the spinal fractures I've seen or heard about (in young people) involve high energy transfers. Ie motorcyclist ejected, diving injury, tackling someone with your head in football where there is an axial load etc. Head to head in soccer with an awake patient who denies neck tenderness and has no extremity neuro signs is pretty low risk in my book.
> 
> Not wrong to board if you are concerned. But in trauma to the head is not automatically the same as significant mechanism of injury for the spine.


I certainly wasn't there and didn't see the MOI that caused the head lac. I have seen a couple cervical injuries during football games and I've studied it some... most occur from either axial loading (likely didn't happen here) or from a very significant force applied that very violently snaps the head back or to the side. Both C3-4 injuries I've seen took a falling head on a rising knee to cause enough energy transfer to injure the C-Spine. It doesn't take much force, comparatively speaking, to cause a good-sized scalp or facial lac. 

In events where both are standing, I doubt that much displacement occurs to the C-Spine, where the upper body also contacts the other object after the initial contact with the head and other object.

Think about it like this: would you put yourself into C-Spine precautions if you walked into the corner of a wall and gave yourself a similar laceration? The energy transferred isn't much, yet is often of sufficient shear forces to tear skin. Now transfer that concept to the soccer players... the transferred forces may be higher, but you might see concussion symptoms in addition to the highly distracting (to you) laceration.


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## BlakeFabian (Oct 16, 2011)

When in doubt; call.

However, I think you did well with the situation at hand.


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