# Transport scenario - may be pretty easy



## emt281101 (Jun 6, 2008)

Hello all,

I am an EMT-B in Maryland. My LT. asked me this question a few months ago and I'm curious as to what your answers will be.

Single vehicle MVC, with vehicle into guardrail on left shoulder. Not a high speed crash, but hit hard enough for airbags to deploy. Driver was belted.

Upon ambulance arrival, patient (driver) was sitting on curb on right side of road, in handcuffs. Patient also had taser probes in his back, from an apparent struggle. Pt. complains of neck pain. 

How do you package and transport the patient?

In my jurisdiction, protocol dictates that all trauma patients complaining of neck and/or back pain are boarded and collared.

Protocol also dictates that taser probes are not to be pulled out of a patient in the field: It MUST be done in the hospital.

So, how do you package and transport the patient?


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## emt281101 (Jun 6, 2008)

I guess I should have said that driver was involved in a low speed chase by police. I forget what the charge was, but it's irrelevant. Theft or something. No obvious sign of ETOH use.


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## Ops Paramedic (Jun 6, 2008)

One should opt for full spinal immobilisation, for 3 reasons:  The MVC itself, the patient complaining of neck pain, as well as the fact that he was tasered. 
 I have never been on the recieving end of a taser (fortunatly), but from seeing some video on the use of the taser, i would immobilise.  It looks like a miniature electricution, and seeing that person shake, i would have to think cervical spine trauma has a srong posibility of occuring (Although the device is classed as non-lethal).


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## Firemedic515 (Jun 6, 2008)

This patient needs full spinal immobilization.  Consult with the recieving facility and TELL them that your are removing a couple taser barbs from this guys back.  Have the cops uncuff him and throw him on a long board.


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## mikeylikesit (Jun 6, 2008)

cuff him to the side of the board, don't worry about the probe they will bend to conture to his body...or whats left sticking out of him. Full spinal cause whats worse, pain from the little probe poking you, or paralysis? tough one though cause where i'm from Basics are allowed to pull them out...most of the basics get thier training from working at the police academy and pulling the probes out during training.


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## Firemedic515 (Jun 6, 2008)

Pulling taser barbs is not rocket science and I'm not sure why the State of Maryland tries to make it such.  Unless the barb is lodged in an eye, mouth, or genitals just pull the damn thing out!


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## Jon (Jun 6, 2008)

Good question. I'd put a C-Collar on the patient, have an EMT hold manual c-spine... then consult with medical command and PD. If PD are allowed to remove barbs from "non delicate areas" have the PD remove the barbs. If PD aren't... have PD check with their supervisor while you talk with command. If PD has been trained in barb removal, and Sergent/Shift Supervisor is able to OK barb removal... then have PD remove it. Otherwise, discuss the situation with command.

I wouldn't be comfortable with pinning the barbs under the patient... too many risks. Around here, protocols state that if barbs aren't pulled by the LEO's that we need to immobilize them as impaled objects with bulky dressings... this wouldn't work well with a backboard.

The other option is either some form of bass-akwards prone c-spine (not going to work well), or discussing it with command and transporting with just a collar.

Next point... He's in custody, likely for fleeing/eluding PD, as well as theft (or something else). Additionally, he was non-compliant after the MVC, and ended up getting the PD's version of electrical therapy. This guy will probably end up with 1 arm cuffed to the stretcher, and a LEO, with a key, in the rig WITH ME. Anything else don't fly in a case like this.


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## Alexakat (Jun 6, 2008)

We pull taser barbs out in the field.  Hold skin taut with one hand & pull straight out with the other (tell the patient you are taking them out).  Control bleed with pressure/pressure dressing.


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## Firemedic515 (Jun 6, 2008)

Alexakat said:


> We pull taser barbs out in the field.  Hold skin taut with one hand & pull straight out with the other (tell the patient you are taking them out).  Control bleed with pressure/pressure dressing.



Yep, that's the same thing they'll do in the ER.  That's why I don't understand why some jurisdictions have a problem with us removing these things in the field.  Granted, there are some situations where these people will need transported to the ER for barb removal (ie. barb in the eye).  Heck, most people who get tasered remove the dang barbs themselves in an effort to avoid more electricity!


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## mikeylikesit (Jun 6, 2008)

Smoe situations the LEO will leave the barbs in to deliver further shock for non compliance. i had a LEO shock the guy in the back of the bus one time...thank god he didn't ruin any of my equipment...or shock me for that matter.


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## Jon (Jun 6, 2008)

mikeylikesit said:


> Smoe situations the LEO will leave the barbs in to deliver further shock for non compliance. i had a LEO shock the guy in the back of the bus one time...thank god he didn't ruin any of my equipment...or shock me for that matter.


Umm... yeah... that patient doesn't really belong in my ambulance until they decide to play nice with me and the PD.


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## mikeylikesit (Jun 6, 2008)

Jon said:


> Umm... yeah... that patient doesn't really belong in my ambulance until they decide to play nice with me and the PD.


yeah he was cooperative...until about half way to the hospital then the last few shot hit him and it was all down hill from there.


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## emt281101 (Jun 7, 2008)

Jon said:


> ...The other option is either some form of bass-akwards prone c-spine (not going to work well), or discussing it with command and transporting with just a collar.




Jon, I like your thinking, but what about positional asphyxiation...I wouldnt agree with this course of action.

Not to be funny, but she did the next best thing: called HER supervisor and had him deal with it. They ended up calling the hospital and asking to remove the tasers; with hospital permission they did it in the field, boarded and collared, and transported.


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## KEVD18 (Jun 7, 2008)

"it was the funniest thing. i was immobilizing the barbs in place and thgey just came out. weird....."


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## Jon (Jun 7, 2008)

emt281101 said:


> Jon, I like your thinking, but what about positional asphyxiation...I wouldnt agree with this course of action.
> 
> Not to be funny, but she did the next best thing: called HER supervisor and had him deal with it. They ended up calling the hospital and asking to remove the tasers; with hospital permission they did it in the field, boarded and collared, and transported.


Positional asphyxia was one of my concerns with prone c-spine, that was why I said it that way.... even without considering positional asphyxia: it makes airway management difficult, and communicating with the patient is hard. The Pt. is probably also going to be uncomfortable


Although, if this genius needed to be tased, that is a factor for an increased risk of Excited Delirium.. so he needs to be monitored closely.


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## Bosco578 (Jun 7, 2008)

Firemedic515 said:


> Pulling taser barbs is not rocket science and I'm not sure why the State of Maryland tries to make it such.  Unless the barb is lodged in an eye, mouth, or genitals just pull the damn thing out!



We have a barb removal policy here. Aside from what is listed above.
After removal they get polysporin and a band-aid.


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## Jon (Jun 7, 2008)

Is there an evaluation requirement afterwards for Excited Delirium?


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## traumateam1 (Jun 9, 2008)

I would do full spinal immobilization for the three reasons: 1. MVC 2. Complaining of neck pains and 3. Being tasered, other than that leave the barbs in and transport to the hospital.


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## BLSBoy (Jul 13, 2008)

Guys, you would backboard this guy JUST because he was in an MVC, or JUST because he was Tased?
Treat your patient, not the cookbook. 
Now, since he is c/o neck pn, you then ask, "would you like to go to the hospital to get checked out?"
To quote George Carlin, "not every orgasm deserves a name", not every person who has pain or is sick wants to go to the hospital. 
Many times, they say, "ow", and PD will call for a bus. Evaluate your patient, and determine what they want.


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