# Log Roll Pelvic Injury



## Bulldog Medic Student (Oct 25, 2010)

Arrived on scene to find a 30ish female. She had a fall from a veichle in another town. Family attempted to drive her home. Got as far as our district. Partner and I find her lying on the grass on the side of the road screaming in pain. Chief cmplaint a 20 on 1-10 pain scale for right hip area. Cant touch it , no visible signs of fracture, dislocation, bruising, bleeding or swelling.
We acess her, manual c-spine, collar and backboard her.
Now for the question half of ems on scene wants to roll her to her good hip, the other half says the bad hip. Which way would you go? I'll tell you what we did and why. But need to know what you think.We did eventually palpate it and felt no movement.


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## Shishkabob (Oct 25, 2010)

Id use a scoop stretcher.


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## SanDiegoEmt7 (Oct 25, 2010)

Linuss said:


> Id use a scoop stretcher.



well played sir!  +1


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## Aidey (Oct 25, 2010)

Um, don't log roll her? 

1. How did she get out of the car?
2. Why did you put a c-collar on her? 
3. Is the back board being used as a splint of her hip or because you think she needs to be back boarded? 

If you insist on putting her on the back board there is a scoop stretcher or sliding the board under her via any number of methods. Alternatively you could let her lie there until the pain medications take effect and then move her.


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## Aidey (Oct 25, 2010)

Linuss said:


> Id use a scoop stretcher.



Damn you and your fast replying!


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## Bulldog Medic Student (Oct 25, 2010)

Used a c-collar because we had no idea of what had happened to her. Her injury happened 3 towns away. No idea of how she got out of the veichle she was laying on the ground. Yes we probably should have used the scoop but we didnt. Except for driver they were all exhibiting signs of intoxication strong alcohol odor on pt and others.


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## firetender (Oct 25, 2010)

*No scoop on board...now what??*

Do tell, gang


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## Bulldog Medic Student (Oct 25, 2010)

She was also bending her knee on bad side. Legs completly in line no rotation.


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## Bulldog Medic Student (Oct 25, 2010)

Where did I say we didnt have scoop on board?


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## TransportJockey (Oct 25, 2010)

Bulldog Medic Student said:


> Where did I say we didnt have scoop on board?



He's changing up the scenario to see how they would change treatment. 

As for me, if I didn't have a scoop, I'd wait for opioids to kick in, then see if we can get a people mover under her and transfer her to a board that way if we absolutely wanted to torture her with useless spinal immobilization.


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## Akulahawk (Oct 25, 2010)

firetender said:


> Do tell, gang


Lots of people? Just lift her straight up... about 3" and slide the backboard under her, lower to board. 

Not a lot of people? Log roll to good side. Much mass on injured area may cause additional injury. It's going to hurt anyway.


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## firetender (Oct 25, 2010)

*Let's just say...*

No scoop. Now what?


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## firetender (Oct 25, 2010)

*Damn, I thought YOU re-stocked the drug box?*



jtpaintball70 said:


> if I didn't have a scoop, I'd wait for opioids to kick in, .


 
No opiods on board, but don't let me forget your idea! In fact, just you and your partner and a backboard with all your whatever spinal immobilization gear, just no scoop..

Maybe, what first?


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## TransportJockey (Oct 25, 2010)

firetender said:


> No opiods on board, but don't let me forget your idea!


Even without opioids, getting a people mover under her, while it might take longer, probably would hurt less than a log roll to either side. I won't let ya forget it 

EDIT: No fair editing your post!

Hmm... Lets see, standard immob equip... straps, board, blocks, collar... towels... I'm drawing a blank. But then again, I hate immobilizing patients


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## Akulahawk (Oct 25, 2010)

jtpaintball70 said:


> Even without opioids, *getting a people mover under her*, while it might take longer, probably would hurt less than a log roll to either side. I won't let ya forget it


If you can easily slide or lift inline... it'll do nicely and not hurt as much as a log roll.


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## Aidey (Oct 25, 2010)

Bulldog Medic Student said:


> Used a c-collar because we had no idea of what had happened to her. Her injury happened 3 towns away. No idea of how she got out of the veichle she was laying on the ground. Yes we probably should have used the scoop but we didnt. Except for driver they were all exhibiting signs of intoxication strong alcohol odor on pt and others.



What do you think the chances of her having a c-spine injury were if she managed to get back into a car, and then out of it and onto the ground? No offense, but if you had a scoop and didn't use it that unjustifiable.


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## Bulldog Medic Student (Oct 25, 2010)

Nope just responding to the post above mine . It said they didnt have a scoop.


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## Aidey (Oct 25, 2010)

Bulldog Medic Student said:


> Used a c-collar because we had no idea of what had happened to her. Her injury happened 3 towns away. No idea of how she got out of the veichle she was laying on the ground. _*Yes we probably should have used the scoop but we didnt*_. Except for driver they were all exhibiting signs of intoxication strong alcohol odor on pt and others.



You said you didn't use it.


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## CAO (Oct 25, 2010)

No drugs, but do we have an extra LSB?


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## LucidResq (Oct 25, 2010)

I'm pretty much with Akula - lift her if you've got the hands. If she's made it this far and doesn't have any tenderness/deformity along the spine, and all that good stuff, checks out on neuros in extremities and such... move her the least painful way possible. If she's not complaining of any midline tenderness/pain etc etc... aside from the whole thought process that says MVA = automatic spinal immobilization, the only benefit to an LSB in my opinion is to make it somewhat easier to splint her pelvis. Of course this is under the assumption we don't have a scoop... which we should.


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## firetender (Oct 25, 2010)

Bulldog Medic Student said:


> 30ish female. fall from a veichle in another town. Family attempted to drive her home...lying on the grass ...screaming...20 on 1-10 ... Cant touch it , no visible signs ...
> 
> Now for the question half of ems on scene wants to roll her to her good hip, the other half says the bad hip. eventually palpate it and felt no movement.


 
This is all about your relationship with the patient.

Once she knows you're NOT going to get her loaded on pain killers, she'll either cooperate or refuse. If she thinks she's going to get pain killers, then she'll go to the hospital but she'll still be a 20! and you'll get nowhere.

(If you should encounter me while I'm drunk, sure, I'd love a little morphine to go with that!)

Her cooperation is key, and if she gave you a 20 when you asked on a 1-10, shame on you for missing a scammer -- especially in the absence of any injuries!

In answer to your question, in the absence of her guidance, log roll on to the unaffected side. If she screams, splint her legs together and tell her this is the last option and she's going to be moved and it'll take a second. Then, do it fast.

Watch how she plays you.

If she's legit, then you will be able to get her to help you move her. I didn't hear anything about a head-to-toe exam, either; a totally inadequate response, primarily because this is the time when you establish rapport with your patient and can enlist their aid to determine just how bad they REALLY are. This is also the time when you establish yourself as the expert.


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## reaper (Oct 25, 2010)

So she a drug scammer, just off that little bit of info? Nice way to play god over people!


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## CAO (Oct 25, 2010)

Drat.  I thought this was a chance to rig something up and test our ingenuity.

I could already hear the MacGyver theme in my head.


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## firetender (Oct 25, 2010)

*Aloha, Reaper, long time no scuffle!*



reaper said:


> So she a drug scammer, just off that little bit of info? Nice way to play god over people!


 
I presented a process of elimination with focus on the patient first. Her cooperation would help me ascertain if my initial "hit" was correct or not. 

If I smell poop on entry to the scene I'm going to glove up and then do my work. Since textbooks don't talk about putting telltale signs together to recognize the POTENTIAL for abuse, then we need to cover it here.

And, as usual, key components of the narrative were missing, like "Um, how did you get here on the ground, Ma'am?" Once again, a scenario lacking in details adequate to make a determination.

...and actually, if you look at my approach, I give her the first nod by enlisting her aid. Were I God, I would just act like she was a junkie. I proposed acting like she was a real human being.

Outside of all that, howzit?


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## Shishkabob (Oct 26, 2010)

I'm not of the "wait for drugs on board before moving" crowd.  I'm of the move the move them quickly and hopefully that relieves some, if not most of the pain, than go from there.

If you leave them on the ground without trying to reposition them, they're in that pain that much longer just waiting on the drugs to kick in...which won't have their full effect for a while.


I had a relatively similar scenario a few months ago and we quickly moved the guy to the cot, and it helped immensley with the pain.  When we got him to the rig I gave him all the opiods he coukd handle to help with the rest of the pain.





But to answer the ops question, you roll to the good side, baring any extenuating factors.  The hip is obviously unstable as is, so putting a ton of weight on it isn't really that good.


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## Aidey (Oct 26, 2010)

I have to admit that the thought of drug seekign definitely crossed my mind too, sorry if that makes me a horrible person, oh well.

As for the wait for opiates thing, I'm not saying don't do anything else in the meantime. I'm thinking more of the cases where the situation won't allow for a quick move.


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## TransportJockey (Oct 26, 2010)

I changed my mind on how to deal with this patient. Scoop, vec, roc, tube, vent, call Brown in his orange 'DOCTOR' jumpsuit


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## LonghornMedic (Oct 26, 2010)

Linuss said:


> Id use a scoop stretcher.



Bingo!


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## the_negro_puppy (Oct 26, 2010)

jtpaintball70 said:


> I changed my mind on how to deal with this patient. Scoop, vec, roc, tube, vent, call Brown in his orange 'DOCTOR' jumpsuit



x2 on Brown backup


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## MrBrown (Oct 26, 2010)

*Brown and Oz swan down out the sky in thier "DOCTOR" jumpsuits and look around wondering if Puppy has called Dr Rashford (the QAS Medical Director) and prepare to either treat the patient or fight to the death with Dr Rashford for the job

Put in a line, bit of morph and if that don't work top her off with some ketamine, off to hospital, nice and easy .... can probably be taken by road.

Gah Oz, the things they are calling us for these days! ... oh and JT you have to anaesthetise the patient first before you give them vec and roc, no "DOCTOR" jumpsuit for you


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## usalsfyre (Oct 26, 2010)

firetender said:


> I presented a process of elimination with focus on the patient first. Her cooperation would help me ascertain if my initial "hit" was correct or not.
> 
> If I smell poop on entry to the scene I'm going to glove up and then do my work. Since textbooks don't talk about putting telltale signs together to recognize the POTENTIAL for abuse, then we need to cover it here.
> 
> ...



And if the patient is seeking, you've harmed them by giving meds how? As opposed to the patient who really is in pain that you've withheld from and now has to lay there in pain because her paramedic thinks he's "Narcoman: Defender of the Opiates"...

Why are people more concerned with being fooled than pain itself?


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## usalsfyre (Oct 26, 2010)

First choice, c-spine clearance, second choice scoop, third choice, straight lift to a board and finally log roll on the good side to a board. Don't aggravate the injury by making the patient lay on it, no matter how brief a time period.


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## LonghornMedic (Oct 26, 2010)

usalsfyre said:


> And if the patient is seeking, you've harmed them by giving meds how? As opposed to the patient who really is in pain that you've withheld from and now has to lay there in pain because her paramedic thinks he's "Narcoman: Defender of the Opiates"...
> 
> Why are people more concerned with being fooled than pain itself?



Exactly. Give them meds. That's what you are there for. I'd rather give pain meds to 100 drug seekers than end up missing one legitimate patient in pain.


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## Veneficus (Oct 26, 2010)

Bulldog Medic Student said:


> Arrived on scene to find a 30ish female. She had a fall from a veichle in another town.



As in car surfing, riding in a truck bed? Suspicious circumstances you are not being told? 




Bulldog Medic Student said:


> Family attempted to drive her home. Got as far as our district.



The home boy ambulance service, gotta love 'em.




Bulldog Medic Student said:


> Partner and I find her lying on the grass on the side of the road screaming in pain. Chief cmplaint a 20 on 1-10 pain scale for right hip area. Cant touch it , no visible signs of fracture, dislocation, bruising, bleeding or swelling.



So call ALS or if you are, give her some drugs, splint her, scoop or slide her vertically on a board, load her up and transport. A rather straight forward case.




Bulldog Medic Student said:


> We acess her, manual c-spine, collar and backboard her..



Why did you decide to do this? (can't offer an opinion with what is listed here)



Bulldog Medic Student said:


> Now for the question half of ems on scene wants to roll her to her good hip, the other half says the bad hip. Which way would you go? I'll tell you what we did and why. But need to know what you think.We did eventually palpate it and felt no movement.



Textbook says to roll on the good hip. But there is more than one way not to roll her at all. (clearly covered in the responses already)

I would suggest reducing the pelvis before moving. You know, splinting helps reduce secondary injury and often reduces pain.

From your very meager description, if ALS is available, call them.

Before we start to decide who should receive pain medication and who shouldn't, we need to consider the injury. Bad people get hurt too, that incldes addicts. 

From a personal standpoint, since EMS isn't prepared to offer an addict the level of help they need, they shouldn't be deciding a seeker shouldn't get meds. If all you do is withold pain meds for a one time event, what good are you doing the patient? In healthcare try not to let social bias influence medical decision making. It is not your job, duty, or whatever to administer what you decide as justice. All patients are worthy of your best and the best you can offer. (granted depending on the level of fatigue, etc, your best is always relative, but it should never include a holier than thou attitude.)

US EMS education doesn't include any depth of knowledge, adding social implication to that may be a little much.

"Man up" is not good medicine. Always bear in mind the standard of care. You are always responsible to it.


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## firetender (Oct 26, 2010)

Veneficus said:


> you are not being told?
> 
> (can't offer an opinion with what is listed here)
> 
> ...


 
Based on the OPost and follow up; I'm skeptical that there's any injury whatsoever. There was really only one question (Logroll on which side first) when there should have been many.

Once again, a process of elimination with the nod ultimately going to the patient and ALL based on the circumstances. Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.


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## Pittma (Oct 26, 2010)

Well here's my best shot- like it was already said if she's seeking, well, she's seeking. But who am I to decide what's too much pain for the girl? I probably would have done what someone already said, though. I would have told her we were going to roll her on her good hip- and prepared to do it quick. If she wouldn't tolerate any movement, we could lift her up about 3in and get the LSB in, but obviously I would rather get the scoop (scenario says we don't have one though). As a newbie, I would assume C-Spine based on the MOI, I mean, doesn't it take a good amount of force to break a hip? If she was intoxicated, she probably wouldn't have known if she had a broken neck or anything (although slim chance if she got back in the car and drove for a bit), but what's wrong with the extra precaution? Would it be wrong to assume C-Spine? Other than that, I'd try to make her as comfortable as possible on a board, splint it on the way to the hospital, and treat her like any other patient- drug seeker or not.


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## Veneficus (Oct 26, 2010)

firetender said:


> Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.



Maybe I am jumping to an unfair conclusion, but from the description here, I am suspect of the quality of the exam and efforts.

In all fairness to the OP and collegues, Basics are specifically told not to perform a specific test that yields results. (specifics witheld so nobody takes it upon themselves to deviate)  Based also on the question, it sounds like they are too inexperienced to press hard enough even when it hurts in order to find what is there. Just my thoughts.


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## usalsfyre (Oct 26, 2010)

firetender said:


> Based on the OPost and follow up; I'm skeptical that there's any injury whatsoever. There was really only one question (Logroll on which side first) when there should have been many.
> 
> Once again, a process of elimination with the nod ultimately going to the patient and ALL based on the circumstances. Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.



Why are you so skeptical? What is considered a "valid" (I read "worthy") injury? And I ask again, what are you out if they are seeking?


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## usalsfyre (Oct 26, 2010)

Pittma said:


> As a newbie, I would assume C-Spine based on the MOI, I mean, doesn't it take a good amount of force to break a hip? If she was intoxicated, she probably wouldn't have known if she had a broken neck or anything (although slim chance if she got back in the car and drove for a bit), but what's wrong with the extra precaution? Would it be wrong to assume C-Spine?



Never assume anything based on "mechanisim". MOI was meant to help determine what injuries might be present, not to BE the assesment. If I apply an massive amount of force solely to your femoral neck and break your hip, do you think it would damage your spine? 

Everyone, intoxicated or not I have ever seen with a spinal injury has been soley concerned with their back and/or neck. Granted, this is not scientific, YMMV ect, ect.


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## Pittma (Oct 26, 2010)

usalsfyre said:


> Never assume anything based on "mechanisim". MOI was meant to help determine what injuries might be present, not to BE the assesment. If I apply an massive amount of force solely to your femoral neck and break your hip, do you think it would damage your spine?
> 
> Everyone, intoxicated or not I have ever seen with a spinal injury has been soley concerned with their back and/or neck. Granted, this is not scientific, YMMV ect, ect.



Right, but we don't know that the force was applied solely to the hip, and I guess I'm just using the MOI to state not the assessment (which, I would still do anyway), but to show that a large amount of force has been applied to the patient regardless, and though my assessment may find no broken spine or neck, I am not an x-ray machine, and if someone fell out of a car and broke their hip couldn't I assume that (even if my assessment didn't physically feel it upon palpation) enough force was applied that there is still a risk, and precautions can be taken? I'd rather take the precaution than have to explain why I didn't take precautions, right?


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## usalsfyre (Oct 26, 2010)

Pittma said:


> Right, but we don't know that the force was applied solely to the hip, and I guess I'm just using the MOI to state not the assessment (which, I would still do anyway), but to show that a large amount of force has been applied to the patient regardless, and though my assessment may find no broken spine or neck, I am not an x-ray machine, and if someone fell out of a car and broke their hip couldn't I assume that (even if my assessment didn't physically feel it upon palpation) enough force was applied that there is still a risk, and precautions can be taken? I'd rather take the precaution than have to explain why I didn't take precautions, right?



You might want to review the NEXUS study and look at radiography accuracy vs physical exam accuracy for C-Spine injuries (hint, the  X-ray machine doesn't win). The "not an x-ray" excuse doesn't work when you look at the data. 

I'd rather not put the patient through an uncomfortable, painful, needless and potentially harmful procedure "just in case". I could intubate everyone "just in case" but it's not called for, harmful and would get my card pulled. If more medical directors would start looking at spinal immobilization as an intervention that needs to be justified (which it is) rather than a something we do "just in case" I'm betting the number of times a spine board is used pointlessly (most of the time) would go down drasticly.


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## Pittma (Oct 26, 2010)

usalsfyre said:


> You might want to review the NEXUS study and look at radiography accuracy vs physical exam accuracy for C-Spine injuries (hint, the  X-ray machine doesn't win). The "not an x-ray" excuse doesn't work when you look at the data.
> 
> I'd rather not put the patient through an uncomfortable, painful, needless and potentially harmful procedure "just in case". I could intubate everyone "just in case" but it's not called for, harmful and would get my card pulled. If more medical directors would start looking at spinal immobilization as an intervention that needs to be justified (which it is) rather than a something we do "just in case" I'm betting the number of times a spine board is used pointlessly (most of the time) would go down drasticly.



Well, I understand your point then, and I also agree that it seems a little overboard to immobilize every time. 

However, the nexus criteria state:

C-spine imaging is recommended for patients with trauma unless they meet all of the following criteria: 
Absence of posterior midline cervical-spine tenderness 
No evidence of intoxication 
Normal level of alertness
Absence of focal neurological deficit 
No clinically apparent painful injuries that might distract from pain of a cervical spine injury


The patient was supposedly intoxicated and there was apparently a strong suspicion of alcohol, so C-Spine imaging using nexus would be recommended, and therefore I would take c-spine precautions. I wouldn't say the procedure is needless, and comparing C-Spine to intubation is a bit of a hyperbole.


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## usalsfyre (Oct 26, 2010)

I appologize, it is hyperboyle, which I can be prone to at times. But it can be useful to get the point across. 

However, if the patient is able to actively participate in the exam, and is alert to person, place, time and event, does the fact they have consumed alcohol really make a difference? I'm not saying we should clear the really sloshed (but then, in the absence of good history I probably should suspect something besides alcohol) but a few drinks does not make you incompetent to participate in an exam.


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## VirginiaEMT (Oct 26, 2010)

Linuss said:


> Id use a scoop stretcher.



THANK YOU, THANK YOU, THANK YOU!!!!!  Now please help with this:

I took a elderly lady in from a nursing home that had an obvious deformity of the hip. She was in a bad position, on the bathroom floor, and I used a scoop to get her up and to the cot. I packaged her on the scoop with pillows, straps, blankets, etc. to make her as immobile as possible during the 5-6 minute ride to the E.D. No medic on the call, only BLS, so no pain meds. were administered.

The charge nurse said " I hate those things, they are cold and uncomfortable, and she she have been removed from the scoop and simply placed on the cot for transport(which means we would have had to move her again from the cot to the bed). This patient was in tremendous pain.

It appears that many in our EMS hates the scoop.

What is your opinion on the patient transport?


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## Aidey (Oct 26, 2010)

We have break away stretchers, so when we use the scoop we put that on the gurney, put the pt on that, and then remove the scoop. That way they can be moved on the break away stretcher without having to stay on the scoop. 

My opinion is why the heck wasn't ALS called for pain control?


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## TransportJockey (Oct 26, 2010)

Just ran a call today where I made the basics use a scoop  They'd never taken the thing out of the truck except to mark that it's there and intact. Worked great


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## MrBrown (Oct 26, 2010)

We have not carried longboards in ages and now only carry the scoop although we are replacing them on a new vehicle basis with something called the CombiCarrier II.

Also no headblocks here.


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## Shishkabob (Oct 26, 2010)

jtpaintball70 said:


> I made the basics use a scoop



You Intermed-god.  Jeez, that blue patch with red lettering really got to your head


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## TransportJockey (Oct 26, 2010)

Linuss said:


> You Intermed-god.  Jeez, that blue patch with red lettering really got to your head



Nah, being third on a truck with two Basics for the first part of my shift did  Although I wish at least one of the basics had been younger than me  I'm still the baby of a service.


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## jrm818 (Oct 26, 2010)

MrBrown said:


> We have not carried longboards in ages and now only carry the scoop although we are replacing them on a new vehicle basis with something called the CombiCarrier II.
> 
> Also no headblocks here.



Your patients should thank you...both choices much more comfortable than LSB, at least to me.

Do you do ever do anything to secure the head?  I'm on-board with the criticism of the current system of rampaging backboards that storm through scenes strapping themselves on the backs of every patient they find.  Still, there really are patients with unstable spines who may even end up in a halo...do you do anything to try to restrict movement in high-risk cohorts?


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## MrBrown (Oct 26, 2010)

jrm818 said:


> Your patients should thank you...both choices much more comfortable than LSB, at least to me.
> 
> Do you do ever do anything to secure the head?  I'm on-board with the criticism of the current system of rampaging backboards that storm through scenes strapping themselves on the backs of every patient they find.  Still, there really are patients with unstable spines who may even end up in a halo...do you do anything to try to restrict movement in high-risk cohorts?



The only thing I can think of is rolled up towels and tape or letting the patient rest in POC so they dont move around ... last pair of blocks I saw was in the lego bucket, seriously we haven't had them in a few years.


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## jrm818 (Oct 26, 2010)

It's always interesting to me to learn about how things are done in other systems.  I'd love to see a outcome comparison between your system and a high performing US system.  Could give some more specific data about the benefit/lack of benefit of immobilization techniques than comparing with Malaysian pickup trucks (or wherever the comparision was in the "homeboy ambulance" c-spine study).

Do you tend to do any assessment of the spine?  NEXUS/Canadian C-spine criteria or the like?  Is there any change in your treatment of trauma/fall/whatever patients if you suspect a spinal injury?

It might be the remnants of our c-spine brainwashing over here, but I would be a little hesitant about completely abandoning any attempt to keep high risk patients from moving their head.


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## MrBrown (Oct 26, 2010)

Consider the possibility of cervical spine injury in all patients suffering from trauma. Patients with injury secondary to road crash or significant fall (especially head first fall), and patients with preexisting cervical spine abnormalities (e.g. ankylosing spondylitis or rheumatoid arthritis) are particularly at risk.  Life threatening abnormalities within the primary survey take priority over the cervical spine.

Patients who meet all of the following criteria (regardless of mechanism of injury) do not need cervical spine immobilisation:
• GCS 15, alert, cooperative and
• No neck or upper back tenderness on palpation or active movement and
• Normal peripheral sensation and movement and
• No significant painful or emotional distractions.

These criteria may be used for children provided the child is old enough to understand and cooperate with taking a history and performing an examination. If all of the above criteria are not met then the patient must have their cervical spine immobilised.

*Immobilising the cervical spine*
• Life threatening abnormalities within the primary survey take priority over the cervical spine and immobilisation must never impair maintaining adequate airway, breathing and circulation.

• Place the patient supine in a well-fitted hard collar with the head and neck in an anatomically neutral position (3-4 cm of flat pillow or folded towel behind the head). If the patient is placed on their side then maintain this anatomically neutral position if possible.There is usually no role for the ‘recovery position’ in this group of patients.

• Lateral padding (or head blocks) at the side of the head is not required as a routine for all immobilised patients. Lateral padding should be considered if significant movement is anticipated (e.g. over rough terrain), or the patient is unconscious but has normal airway and breathing, or if there are clinical signs of cervical spine injury. Lateral padding must not be used if it interferes with the ability to look after the airway.

• The head and shoulders must not be independently immobilised unless the entire body is also immobilised.This is to avoid creating
a fulcrum effect on the spine. Entire body immobilisation is not required as a routine for all immobilised patients, but should be considered when significant movement is anticipated (e.g. over rough terrain).

• Spine boards and other rigid flat boards are to be used as sliding or extrication devices only. Patients must not be transported on such boards. Scoop stretchers are preferred as they allow stretcher removal at hospital without having to roll or lift the patient.Devices such as the KED should not be used as a spinal immobilisation device in their own right. The primary function of the KED is to keep alignment of the spine during extrication. Once in place, a KED should remain on until the patient is in hospital, but with the strap tension released to enable the patient to be in a supine position.

• Clinical judgement must be used for uncooperative patients.  If cervical spine immobilisation results in the patient ‘fighting’ to remove it, then it is appropriate not to formally provide immobilisation if this approach minimises cervical spine movement. All patients with suspected spinal injury should be transported supine, but if forcing the patient to lie supine results in them ‘fighting’ to sit up, then it is appropriate to allow them to adopt a position that minimises cervical spine movement.

• If significant respiratory distress is present it is appropriate to gently sit the patient to 45 degrees, with a cervical collar in place and the spine in alignment.

• Patients requiring intubation should have the front of their hard collar undone during intubation. In line stabilisation (not traction) of the cervical spine should be performed during intubation if there is a spare trained person to perform this.


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## jrm818 (Oct 27, 2010)

Got it (and like it).

I hope you didn't type that all out on my account


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## Aidey (Oct 27, 2010)

MrBrown said:


> We have not carried longboards in ages and now only carry the scoop although we are replacing them on a new vehicle basis with something called the CombiCarrier II.
> 
> Also no headblocks here.



That's it, I'm moving. I can get used to the weather.


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## LucidResq (Oct 27, 2010)

Really had to dig to find this ol' post of mine 

EMS Responder article about the Cochrane Review



> The readership is referred to the brief evidence-based emergency medicine report by Baez and Schiebel entitled, "Is Routine Spinal Immobilization an Effective Intervention for Trauma Patients?" which appeared in the Annals of Emergency Medicine in January 2006. The objective of this study was to quantify the effect of different methods of spinal immobilization (including immobilization versus no immobilization) on mortality, neurologic disability, spinal stability and adverse effects in trauma patients





> The authors searched all databases where peer-reviewed medical journal articles would be found, along with the Cochrane Controlled Trial Register for evidence of scientific trials. Then they contacted experts in the field and eight manufacturers of spinal immobilization devices to determine whether they were aware of any sound evidence for use of these devices that would not otherwise appear in the on-line search. The authors were unable to find a single randomized controlled trial of actual injured patients to support the efficacy and effectiveness of spinal immobilization strategies and spinal immobilization techniques. *In other words, there has never been a study in the medical literature that proves that any form of spinal immobilization or any technique or device used during such immobilization actually prevents spinal cord injury or lessens morbidity from spinal column injury.*


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## LucidResq (Oct 27, 2010)

And I'm too busy making dinner to dig up the articles right now, but there is also a significant body of evidence that points to the often ignored complications of immobilization via LSB, such as decubitus ulcers, pain and even neuro deficits.


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## firetender (Oct 27, 2010)

*Pardon, please, need to catch up!*



usalsfyre said:


> Why are you so skeptical? What is considered a "valid" (I read "worthy") injury? And I ask again, what are you out if they are seeking?


 
I can't answer you in terms of the OP's post. Too little info to go on. Let me tell you my truth.

In an overtaxed service, with limited resources and almost non-existent back up you learn to be extremely discerning. In an atmosphere where everybody in ALL allied agencies are having MI's at the THOUGHT that these "kids" are carrying NARCOTICS! you get a little cautious on who you shoot up. At the same time as EMS was getting off the ground, so were scammers attaining a greater level of sophistication. 

You do the job. Everyone deserves the best you have. *AND* don't be made a fool of because of your dilligence more than once by the same person. If you notice patterns, pay attention to them and share what you've learned. You have the right to conserve your own life-force and provide support for your peers in doing so as well.

Once again, this is not about prejudice, this is not about attitude, this is wholly about discernment and the appropriate application of scant, available resources; and that includes good will and your own self-respect. 

It took me a good 9 years in the field before I started to recognize that maybe I was overtreating. I began paying more attention to my patients, guaging them for a true sense of urgency and specifificity to determine the DETAILS of what I was really treating. Let's figure out what's the *real* emergency  and then focus on that and that alone. 

So when someone talks to me about a call, even on this forum, I guess I kind of expect that the basics will be covered and DETAILS communicated so I can respond adequately. 

Please don't distract all of us from what's REALLY going on and don't rag on me when I call you on it!

Fondly,

your local firetender


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## Aidey (Oct 27, 2010)

LucidResq said:


> And I'm too busy making dinner to dig up the articles right now, but there is also a significant body of evidence that points to the often ignored complications of immobilization via LSB, such as decubitus ulcers, pain and even neuro deficits.



What is also interesting are the number of potentially serious injuries that manage to walk themselves into the ER. I've heard of one case of something similar here. 

http://swns.com/horse-rider-who-suf...des-again-thanks-to-f1-technology-261212.html


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## usalsfyre (Oct 27, 2010)

firetender said:


> I can't answer you in terms of the OP's post. Too little info to go on. Let me tell you my truth.
> 
> In an overtaxed service, with limited resources and almost non-existent back up you learn to be extremely discerning. In an atmosphere where everybody in ALL allied agencies are having MI's at the THOUGHT that these "kids" are carrying NARCOTICS! you get a little cautious on who you shoot up. At the same time as EMS was getting off the ground, so were scammers attaining a greater level of sophistication.
> 
> ...



I apologize for calling you out, it was wrong of me. That said, I see "drug seeking" used more as an excuse for people NOT to do their jobs more often than not.


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## firetender (Oct 27, 2010)

usalsfyre said:


> I apologize for calling you out, it was wrong of me. That said, I see "drug seeking" used more as an excuse for people NOT to do their jobs more often than not.


 
I have no problem being called out, and there was no "wrong" to it. I can learn from you, too, you know and sometimes I need a kick in the ***.

And you ARE right. I know what it's like to _want to_ withhold pain meds from a junkie because "Hey, all those times you scammed me over nothing? Here's what pain really feels like!" That's worse than laziness but it goes on.


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## Ravemtech (Jan 6, 2011)

Getting back to the alternatives to a log roll, here is a link to a photographic guide to the side straddle lift http://www.neann.com/lsb4a.htm  - video http://www.youtube.com/watch?v=jLGhi_7D31Q ( taken from a free downloadable manual on spinal care at http://www.neann.com/psc.pdf ). This technique is an excellent alternative to the log roll especially if no Scoop is available.  A number of recent studies have shown less movement with this than a log roll, and it places very little pressure on the pelvis (ref 1-2).  

Just remember, you must pad the Board to resolve discomfort and pressure sore development .... http://www.neann.com/Board Confort Studies.pdf    Althought the document is put out by a company selling a Board pad,  the studies are all independent.  Once a Board is padded,  the need to remove the Board are resolved and it can be used as a transport / splinting device without pain and pressure sores so often quoted by studies undertaken on unpadded Boards.


Ref

1. J Athl Train. 2008 Jan-Mar;43(1):6-13. The 6-plus-person lift transfer technique compared with other methods of spine boarding. Del Rossi G, Horodyski MH, Conrad BP, Di Paola CP, Di Paola MJ, Rechtine GR

2. Spine (Phila Pa 1976). 2008 Jun 15;33(14):1611-5. Transferring patients with thoracolumbar spinal instability: are there alternatives to the log roll maneuver?  Del Rossi G, Horodyski M, Conrad BP, Dipaola CP, Dipaola MJ, Rechtine GR


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## Melclin (Jan 6, 2011)

Ravemtech said:


> Getting back to the alternatives to a log roll, here is a link to a photographic guide to the side straddle lift http://www.neann.com/lsb4a.htm  - video http://www.youtube.com/watch?v=jLGhi_7D31Q ( taken from a free downloadable manual on spinal care at http://www.neann.com/psc.pdf ). This technique is an excellent alternative to the log roll especially if no Scoop is available.  A number of recent studies have shown less movement with this than a log roll, and it places very little pressure on the pelvis (ref 1-2).
> 
> Just remember, you must pad the Board to resolve discomfort and pressure sore development .... http://www.neann.com/Board Confort Studies.pdf    Althought the document is put out by a company selling a Board pad,  the studies are all independent.  Once a Board is padded,  the need to remove the Board are resolved and it can be used as a transport / splinting device without pain and pressure sores so often quoted by studies undertaken on unpadded Boards.
> 
> ...



I've never heard of or seen the side straddle lift. It look fantastic and makes good, intuitive sense too. Thanks for that link. Log rolls have always bothered me a little. I'm certainly going to put more thought into it and have a good read of some of that immobilisation literature from John Till.


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## clibb (Jan 6, 2011)

Towel tie pelvic area since she's complaining of hip pain. C-spine and scoop.


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## Ravemtech (Jan 6, 2011)

Melclin said:


> I've never heard of or seen the side straddle lift. It look fantastic and makes good, intuitive sense too. Thanks for that link. Log rolls have always bothered me a little. I'm certainly going to put more thought into it and have a good read of some of that immobilisation literature from John Till.



Hi Melclin, 

No worries.

Who did your spinal training during your course.  The Straddle lift is part of Ambulance Victoria spinal teaching and was introduced in 1995 as part of the Spinal program.  The manual "A photographic Guide To Prehospital Spinal Care"  http://www.neann.com/psc.pdf was issued to all Ambulance students from 1995 until 2006 at the AOTC and then MUCAPS.  The straddle lift was taught as part of the course.


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