# Walking out a broken leg



## Desette (Dec 18, 2011)

Hey Everyone

What are your opinions on a pt walking on a splinted suspected broken tib/fib, no obvious deformities, just point tenderness.  Pt said he heard a crack when he put his foot in a hole. Pain 5/10.Walk is 400 yards along a cut line to the road or bring an quad with a rescue sled in.


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## usafmedic45 (Dec 18, 2011)

Please tell you're not serious because if you are, I'm going to ask the moderators for permission to smack the crap out of you.


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## DesertMedic66 (Dec 18, 2011)

I wouldn't have him walk. A flat or stokes basket would be my first choice. Do you have access to a wheelchair of any kind? 

If you have to walk the patient out have the patient put one arm around one persons neck and the same for the other arm. That will allow the patient to "walk" while only using one leg (the un-injured one)


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## usafmedic45 (Dec 18, 2011)

I think this is more just the "We're lazy and don't want to work" sort of question.  Making a suggestion that would require effort isn't going to be the advice the OP is seeking most likely.


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## Desette (Dec 18, 2011)

Sorry I'm new did I do something wrong?


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## Medic Tim (Dec 18, 2011)

If you walked the pt to the truck . Yes


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## mycrofft (Dec 18, 2011)

*Do you mean was it advisable, possible, or what?*

Adviseable? Nope.
Possible? I was in on a case where a young NEbraska football player, out breaking curfew, was struck by a car, ran two blocks, went to bed, and discovered he couldn't get up to go to the bathroom a little while later. Xray showed he had a cracked femur.


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## bigdogems (Dec 18, 2011)

usafmedic45 said:


> Please tell you're not serious because if you are, I'm going to ask the moderators for permission to smack the crap out of you.



Pretty much my first thought


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## DesertMedic66 (Dec 18, 2011)

Having the patient walk could possibly make the patients leg worse. When you splint something you are trying to prevent any movement. Having the patient walk is only going to make the injury move. 

I messed up my knee and leg pretty good motorcycle riding and I walked back to my bike and kept riding. It didn't make my injury any better. 

If you brought a patient to the hospital and told the nursing staff and the doctor you had the patient walk, you should get ready for a verbal lashing.


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## Desette (Dec 18, 2011)

By something wrong I meant rules or being rude.

No I didn't walk him out, he wanted to walk out.


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## mycrofft (Dec 18, 2011)

*OP doesn't say he decided to have the subject walk out.*

Might want to clarify, or change monikers...

If it was the subject's idea, was he high on something, very well-developed, wearing logging boots, or what? (The step in a hole variety is usually distal and could be "auto-splinted" for a while by an already tight high boot).


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## DesertMedic66 (Dec 18, 2011)

Desette said:


> By something wrong I meant rules or being rude.
> 
> No I didn't walk him out, he wanted to walk out.



You weren't rude and didn't break any rules. It was a question that, don't take me the wrong way, common sence should answer. Once again I'm not trying to be rude.


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## Remeber343 (Dec 18, 2011)

Heck. Have him drive himself to the ER.


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## DesertMedic66 (Dec 18, 2011)

Remeber343 said:


> Heck. Have him drive himself to the ER.



Yeah haha. I've had patients refuse to sit on the gurney and be wheeled to the ambulance, they will just start walking straight to the ambulance. If they are worried about people seeing them on a gurney then they are good enough to drive/have some drive them to the ER and sit in triage.


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## Meursault (Dec 18, 2011)

firefite said:


> . If they are worried about people seeing them on a gurney then they are good enough to drive/have some drive them to the ER and sit in triage.



Not necessarily true. The other day, I was the second crew in for a mentally disabled 50-something SNF resident who had recent chest pain with a cardiac history, worsening CHF, and visibly cyanotic lips and lower extremities. He was, however, generally anxious and absolutely terrified at the idea of going in the back of the ambulance or even sitting on the stretcher. It took a lot of convincing to transport him. (and then it turned out to be indigestion + pushy SNF nurses + poor history)


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## DesertMedic66 (Dec 18, 2011)

MrConspiracy said:


> Not necessarily true. The other day, I was the second crew in for a mentally disabled 50-something SNF resident who had recent chest pain with a cardiac history, worsening CHF, and visibly cyanotic lips and lower extremities. He was, however, generally anxious and absolutely terrified at the idea of going in the back of the ambulance or even sitting on the stretcher. It took a lot of convincing to transport him. (and then it turned out to be indigestion + pushy SNF nurses + poor history)



However there is a difference between being terrified and just not wanting to sit on the gurney.


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## Always BSI (Dec 18, 2011)

usafmedic45 said:


> Please tell you're not serious because if you are, I'm going to ask the moderators for permission to smack the crap out of you.



i lol'd.


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## mycrofft (Dec 18, 2011)

*The OP didn't make himself clear.*

I think he was asking if it was physically possible, not if it was advisable. (My first impression from the title was telling someone to "walk it off" regarding a leg fx....funnier, but wrong). Geez, stop meeting raw meat.


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## DesertMedic66 (Dec 18, 2011)

mycrofft said:


> I think he was asking if it was physically possible, not if it was advisable. (My first impression from the title was telling someone to "walk it off" regarding a leg fx....funnier, but wrong). Geez, stop meeting raw meat.



That was my first impression also. "hey guys we splinted his leg, he is good. Sir can you please walk to the ambulance?".


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## FourLoko (Dec 18, 2011)

mycrofft said:


> I think he was asking if it was physically possible, not if it was advisable. (My first impression from the title was telling someone to "walk it off" regarding a leg fx....funnier, but wrong). Geez, stop meeting raw meat.



Even funner when you know it's a song/dance (or was):
http://www.youtube.com/watch?v=pxjZM-d_ShI


And I "walked" with a minor fracture to my acetabellum, not without crutches though.


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## Thriceknight (Dec 18, 2011)

usafmedic45 said:


> Please tell you're not serious because if you are, I'm going to ask the moderators for permission to smack the crap out of you.



:rofl:


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## mycrofft (Dec 18, 2011)

*I typed  for "eating raw meat" but my spell check...*

aw never mind.


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## medichopeful (Dec 18, 2011)

Desette said:


> Hey Everyone
> 
> What are your opinions on a pt walking on a splinted suspected broken tib/fib, no obvious deformities, just point tenderness.  Pt said he heard a crack when he put his foot in a hole. Pain 5/10.Walk is 400 yards along a cut line to the road or bring an quad with a rescue sled in.



I'd say go for it.  Just hope he doesn't step in another hole! :unsure:*

*End sarcasm.

Seriously, think about what you just asked...


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## Desette (Dec 18, 2011)

What I should have just asked is if there was any situation where you would walk someone out with a possible broken leg. I didn't put in a lot of details here but I was originally told that there was no way we could get the quad with the trailer so I was thinking of alternatives and considered walking him out with an improvised crutch.  Then they said they lied and the quad and trailer could fit so I brought it in and got him out. 

But if it couldn't fit next time what would I do?  Was walking out ever an option as a last resort?

I appreciate all the advice and insults.


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## FourLoko (Dec 18, 2011)

you scoop his *** up and carry him out:

BAM


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## Desette (Dec 18, 2011)

FourLoko said:


> you scoop his *** up and carry him out





No scoop there, only a stokes basket with no wheel. My other thoughts were grabbing as many people as needed and picking him up and carrying him out.


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## DesertMedic66 (Dec 18, 2011)

Best picture I could find. It allows for the patient to only use one leg to walk.


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## usalsfyre (Dec 18, 2011)

400 yards and you need a quad?!? 

I once hand carried a stokes 3 miles out of a hiking trail. Uphill both ways. In the snow.

Ok not really uphill both ways in the snow (It was back up to the road from a waterfall). But the point stands, four people should be reasonably able to stokes carry an average sized adult 400 yards without too much difficulty.


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## exodus (Dec 18, 2011)

Why not just use the stokes? Or drive the ambulance onto the football field?


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## Handsome Robb (Dec 18, 2011)

With the utmost respect intended, you are one lazy human being. What possibly makes walking a pt with a suspected fractured leg sound remotely like a good idea?  

4 point him in a stokes basket. 400 yds is not far.


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## medic417 (Dec 18, 2011)

Seems that there is a rule on this site about being rude and attacking people.  Many that have replied deserve to receive contact concerning those rules.  

OP in general you would not allow a person in your care to walk on a broken leg.  That being said is the patient alert and oriented?  If yes they can refuse any and all treatments.  So if patient states no you can not carry me then they have that right and just document to protect yourself.  

I apologize for the rude replies many have given you.  It is obvious that many have the pack mentality and may need to be rounded up and sent to the pound for a while.


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## Remeber343 (Dec 18, 2011)

medic417 said:


> Seems that there is a rule on this site about being rude and attacking people.  Many that have replied deserve to receive contact concerning those rules.
> 
> OP in general you would not allow a person in your care to walk on a broken leg.  That being said is the patient alert and oriented?  If yes they can refuse any and all treatments.  So if patient states no you can not carry me then they have that right and just document to protect yourself.
> 
> I apologize for the rude replies many have given you.  It is obvious that many have the pack mentality and may need to be rounded up and sent to the pound for a while.



I've seen your fair share of witty to rude replies....


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## medic417 (Dec 18, 2011)

Remeber343 said:


> I've seen your fair share of witty to rude replies....



Yes you have so you can be sure I have had the rules shown to me. 

Mom used to say 2 wrongs don't make a right.  So learn from my mistakes rather than making the same.


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## Fish (Dec 18, 2011)

ummmmmmmmmm, walk? Never

Carry? Yes

I know your knew so lets talk about this, if you were concerned enough about the leg that you splinted. Then why would you ever walk a patient on that leg and possibly make the injury you are concerned about worse?

Not to mention the legal implications


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## firetender (Dec 18, 2011)

*Living and learning.*



usafmedic45 said:


> Please tell you're not serious because if you are, I'm going to ask the moderators for permission to smack the crap out of you.


 
In re-going over this thread, I had to chuckle to myself. I didn't respond at first because my take on usaf's comment was he was being incredibly polite to consider asking us first for permission to pounce. For him, that's a huge improvement!:beerchug:

The chances of us granting usaf such license are about as absurd as the idea that the OP would actually walk the patient off the scene!

The "IT" in "walking it out" was obviously the wounded patient and not the act of "walk it out, it'll feel better soon."

Yet, it did take the OP a bit to clarify that the pt. wanted to walk off the field on his own. 



> No I didn't walk him out, he wanted to walk out.


 
Have you ever covered a Rodeo? Some of those guys would rather (literally!) die than not get off the field under their own power. So I see the OP reflecting on a dilemma he had to face and I'll gamble there are still aspects of the call he hasn't mentioned.



> My other thoughts were grabbing as many people as needed and picking him up and carrying him out.


 
Underneath it all, perhaps the OP had a concern with liability.

So, once again, a new poster stepped into a den of wolves who make strong judgments in the absence of pertinent information. That goes on here sometimes. 

Yet, I don't want to neglect my kudos to those who were the voices of reason and tolerance!

So if I have anything to say it's take in a breath before you pounce, and be aware, when a new person walks in the door, it's usually to learn something and sometimes they need a little guidance as to how to present their scenarios.


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## 18G (Dec 18, 2011)

NO. This patient would never be walked or allowed to walk on a fractured leg. 

Yes, they are able to decide for themselves since they are alert and oriented, but if they want any treatment from me and still decide to walk, then they are signing a refusal form indicating they refused extremity immobilization and extrication.


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## usafmedic45 (Dec 18, 2011)

usalsfyre said:


> 400 yards and you need a quad?!?




That's what I was thinking.


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## usafmedic45 (Dec 18, 2011)

> In re-going over this thread, I had to chuckle to myself. I didn't respond at first because my take on usaf's comment was he was being incredibly polite to consider asking us first for permission to pounce. For him, that's a huge improvement!


Thank you....I think.  LOL



> The chances of us granting usaf such license are about as absurd as the idea that the OP would actually walk the patient off the scene!



As far as people being of sufficiently questionable judgment to walk someone with a broken leg to the ambulance, I would not put it past the lazier in our ranks. 



> So, once again, a new poster stepped into a den of wolves who make strong judgments in the absence of pertinent information.



I asked for clarification before tearing out his heart and taking a bite out of it Aztec style.  What more could you ask for? LOL


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## Veneficus (Dec 18, 2011)

*I call your attention to:*

something that may help in your future.


http://www.gp-training.net/rheum/ottawa.htm


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## Handsome Robb (Dec 18, 2011)

I'll admit I wasn't very tactful in my response although I did state "with the utmost respect"

Along with firetender's post referring to rodeos: this is a very valid example. I have never worked a rodeo but I have a few friends that compete and like he said, they will die before medics take them away unless they "know"/can feel that something is really wrong.

Also what 18g said is very relevant. Just because a PT signs an AMA doesn't mean they are refusing transport. If the PT wants to walk out it is a reasonable request to ask them to sign an AMA relating to ambulating on the presumed fractured leg. 

With that said, I stand by my statement of being lazy. 400 yds is not far, I would stress the importance and ramifications of walking on a possible fractured leg. If he still refuses being carried  I would insist that he signs an AMA and acknowledges the risks associated with ambulating on it and document the hell out of it.

I don't think I have ever seen/heard USAF ask for permission. h34r:


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## DrParasite (Dec 19, 2011)

*wait what???*

he only has one broken leg.

why not just let him hop the 400 yards on his non-broken leg?

problem solved, now what's for dinner?


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## d0nk3yk0n9 (Dec 19, 2011)

If I was in the woods camping with just me and a buddy and someone broke a leg, I'd seriously consider doing an assisted walk out after splinting it. In this case, the only reason I'd want to make that decision is that I'm weighing the risk of further injury to the leg versus the risk of calling out an entire rescue team to carry him out (which, depending on the situation and terrain, could put quite a few people at risk). If I can get him out myself in a reasonable amount of time with relatively low risk of further injury to him or me, I'm going to just do it.

Of course, in the situation where I get called to deal with the injury in an EMS capacity, no way in hell I'm walking that patient out.


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## RocketMedic (Dec 19, 2011)

Depending on the injury, environment, manpower and resources, walking or assisting a walk may be the best option.


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## Tigger (Dec 19, 2011)

Never carried any of my athletes off the ice or field, their teammates and I helped them walk, but there was no way that we would get a stretcher out for a lower extremity injury unless they were unable to stand...they have too much pride.

On the ambulance if I splint someone's lower extremity they are getting carried from wherever they are to the stretcher. Wouldn't want to put the patient in more pain/make the injury worse/get accused of making the injury worse. I'd seat carry them with two people if it came to them, or possible even resort to a backboard (no c-spine obviously) if no other options were available.


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## EMSLaw (Dec 19, 2011)

Distance matters.  And we're talking tib/fib here, right, not a femur?

If you were 400 yards from the ambulance, you should have put him on a Reeves or something like that and carried him out.

If they're 4 feet from the gurney, I will expect the assisted spin-and-sit.  Just hop on the unbroken leg while my partner and I hold you up.


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## 18G (Dec 19, 2011)

The standard of care for a fracture is to stabilize it in the position found unless there is a need to augment it in case of angulation and impaired circulation.

How does having a patient with a suspected or obvious fracture hop around, parallel the standard of care? Is it not possible for further damage to be done by permitting this? 

Why not immobilize like your supposed to, apply some ice, treat pain and nausea as indicated, and carry your patient to the ambulance? This seem's like the better treatment plan.

It's kinda like some providers who have patient's involved in an MVC lay down on the backboard which was placed on the stretcher. What's really the point of immobilizing?


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## the_negro_puppy (Dec 20, 2011)

Shouldnt you have 2 fire trucks and 8 firefighters with you at every call lulz? get them to help carry him out on a scoop stretcher or the likes :rofl:


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## RocketMedic (Dec 20, 2011)

Once again, depends on situation. If at all possible, carry out. If that's not workable,  reckon something up. For example,  wilderness rescue.


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## Handsome Robb (Dec 20, 2011)

the_negro_puppy said:


> Shouldnt you have 2 fire trucks and 8 firefighters with you at every call lulz? get them to help carry him out on a scoop stretcher or the likes :rofl:



:rofl:

Umm no, we only get one engine thank you very much! and depending on which of the two cities we are in it's either 3 or 4 firefighters. 

You still should be able to carry this guy out with the help of his teammates. Honestly I'd be willing to bet his teammates or training staff would end up carrying him and I wouldn't have to do much of anything 

With that said, most if not all of the fields here have access points for emergency vehicles to drive right onto the playing field.


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## mycrofft (Dec 21, 2011)

*Improvisation!*

This is my new mantra besides "5=4" and "Parse!":
"Can you improvise some sort of primitive lathe?". (Sam Rockwell, "Galaxy Quest")


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## Commonsavage (Dec 23, 2011)

Desette said:


> Sorry I'm new did I do something wrong?



Des, we like to say "There's no such thing as a stupid question."  As such, we need to respect the fact that you asked and hope that we can provide a teaching/learning moment.
If you have splinted a patient, you have already declared a high suspicion of injury.  So, no, you do not walk the patient out.  Additionally, attempting to 'walk' with a splint properly placed is a hazard in itself.  Either way, at the very least, it would be considered neglegent.


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## katgrl2003 (Dec 23, 2011)

mycrofft said:


> "Can you improvise some sort of primitive lathe?". (Sam Rockwell, "Galaxy Quest")



Is it sad I recognized that quote before I read where it was from? :wacko:


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## mycrofft (Dec 23, 2011)

*Question: where does necessity require something like walking on a broken limb?*

"Karolyi replied, "Kerri, we need you to go one more time. We need you one more time for the gold. You can do it, you better do it."

(Olympic coach Bela Karolyl coaching gymnast Keri Strug in Barcelona after she had injured her ankle; the result was she experienced a third degree lateral ankle sprain and tendon damage).

Imminent danger, unavailability of transport or assistance from site, or helping your team make the gold medal.

PS part of her subsequent career was with the Ice Capades, so she recovered to some greater degree. She was lauded as a hero, Karolyl subsequently went through a period of not being welcome, but has since resumed a leading role in gymnastics and has gyms for young aspirants.


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## Lozenger19 (Jan 20, 2012)

I managed to complete A marathon with a broken ankle. 

I was 3 miles from the end and had raised £6500 for charity


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## epipusher (Jan 20, 2012)

I would not let him walk unless he absolutely insisted on it.


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## NYMedic828 (Jan 20, 2012)

A broken arm? Sure. But, a leg? What are you thinking...

My first thought that comes to mind is YOU CAN BE SUED.

Unless the patient signs that they WANTED to walk and that you adamently offered to wait for a rescue vehicle due to their stable condition, you are totally liable.

Our major concerns with fractures are ensuring the patency of distal perfusion, and stopping a simple fracture from becoming a compound fracture. Both of which are achieved via splinting, and limiting mobility. Walking, completely defies the entire purpose of our care.

What I WOULD have done, is called for a stokes or the quad you spoke of with the rescue sled as well as an ALS unit capable of pain management. The pain management because quads aren't exactly built for comfort, and due to the extended removal time.

NEVER would i walk a lower extremity fracture. NEVER EVER.  

If he started to walk on his own, I would sooner let him go and document it as him fleeing the scene on his own merit than me allowing him to do so.


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## mycrofft (Jan 20, 2012)

I want to see a thread for "Walking Out On A Broken Arm".
This little guy did. Or was it a leg?


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## Tigger (Jan 20, 2012)

NYMedic828 said:


> A broken arm? Sure. But, a leg? What are you thinking...
> 
> *My first thought that comes to mind is YOU CAN BE SUED.*
> 
> ...



Well yea, of course. You can be sued for anything provided an injury (of any sort) occurred, that a causal connection exists between the injury and the defendant, and that the the possibility for redress exists. Don't think of specific examples in which you can be sued, you can be sued for anything you do on the job with your patient. 
(http://www.justice.gov/usao/eousa/foia_reading_room/usam/title4/civ00035.htm)

The reasons why you shouldn't walk a lower extremity fx out of the woods are in the second part of your post.


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## Remeber343 (Jan 20, 2012)

Splint the broken arm and if he wants to walk to the rig let him.


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## mycrofft (Jan 20, 2012)

Hahah I tried to get a photo of someone hand walking with a cast, but didn't happen.


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## Jon (Feb 2, 2012)

Coming at this from a Wilderness First Aid perspective, if you can splint the extremity and assist them without too much discomfort - I say go for it, if there is no other quick way to get them out. If getting a Quad to you is do-able, then go that route.

This is a textbook case for a Boy Scout First Aid meet. And guess what - 2-person assist would probably work here.


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## DPM (Feb 2, 2012)

If it's not a femur you could even take turns piggy-backing him. I would feel right letting him walk though. I walked back to camp with a broken ankle after a night out on the piss, just because I managed doesn't mean it was a good idea!


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## Hellsbells (Feb 7, 2012)

> My first thought that comes to mind is YOU CAN BE SUED.



For the love of god, you Americans are so paralyzed by fear of litigation. 

The salient point in this query is that its a wilderness type situation (more or less) not an urban or rural situation. Clearly, its not ideal to have this pt walk out, but the situation may dictate some form of assisted ambulation on the pts part, where no weight is put on the injured leg. 

As the OP states, this happened 400 yards into a cut line, so obviously this is a industry job of some sort (pipeline or logging operation likely). Typically, this means there is one responder and a truck camper used as an ambulance which may or may not be equiped with the proper equipment for this type of rescue. 

So, no a pt with a leg fracture should not, under normal circumstances be "walked" out, but sometimes the circumstances dictate a modified response. Additionally, it sounds like the OP did in fact find a safe solution, although apparently, using a quad is the "lazy" way to do things. However, one should pause to consider the wisdom of four men hauling a heavy cot the length of 4 footballs fields over rough terrian thats lousy with tree roots, and other debris.


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## Veneficus (Feb 7, 2012)

Hellsbells said:


> although apparently, using a quad is the "lazy" way to do things. However, one should pause to consider the wisdom of four men hauling a heavy cot the length of 4 footballs fields over rough terrian thats lousy with tree roots, and other debris.



But think of the comraderie it would build when they all had to crawl out with broken legs together. :unsure:


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## Maine iac (Feb 7, 2012)

If he called for help that means he can't walk out.

Pony up and crawl out if need be.


http://youtu.be/1ovr55k6evE


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## DPM (Feb 8, 2012)

Maine iac said:


> If he called for help that means he can't walk out.
> 
> Pony up and crawl out if need be.
> 
> ...



I saw that the other day. That fella is as tough as a woodpecker's lips!


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## Handsome Robb (Feb 8, 2012)

Hellsbells said:


> For the love of god, you Americans are so paralyzed by fear of litigation.
> 
> The salient point in this query is that its a wilderness type situation (more or less) not an urban or rural situation. Clearly, its not ideal to have this pt walk out, but the situation may dictate some form of assisted ambulation on the pts part, where no weight is put on the injured leg.
> 
> ...



I'm pretty sure the OP was referring to a sporting event, but I may be wrong. 

There is no reason unless it is your only option to have a patient walk on a broken leg, splinted or not. 

Worsening the break, further damaging surrounding soft tissues, nerves and vasculature all can result in a much worse disability to the patient.

Yes we are all afraid of litigation because our country is so freakin sue happy. Now if you are a bystander you're covered under most good sam laws but as a employee of an EMS agency any lawyer worth anything could tear you to pieces if it made it to court and the patient had suffered a significant disability from it.


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## Hellsbells (Feb 8, 2012)

> Hey Everyone
> 
> What are your opinions on a pt walking on a splinted suspected broken tib/fib, no obvious deformities, just point tenderness. Pt said he heard a crack when he put his foot in a hole. Pain 5/10.*Walk is 400 yards along a cut line to the road* or bring an quad with a rescue sled in.



Doesn't sound like any sporting event I'm aware of. Unless you know of a game played on a 400 yard field. 

 Anyway, I do agree with you, not good to walk a pt, not promoting doing it, just saying if equipment/manpower is not up to par, then one can help support his weight and have him hop on the good leg. 

Litigation here in Canada is (sadly) on the rise. However, not to anywhere near the point it is in the US. We have some standard CYA precautions here, but I am not aware, at least personally, of any recent situations where Paramedics have been sued, successfully or otherwise.


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## Tigger (Feb 8, 2012)

NVRob said:


> I'm pretty sure the OP was referring to a sporting event, but I may be wrong.
> 
> There is no reason unless it is your only option to have a patient walk on a broken leg, splinted or not.
> 
> ...



This country may be sue happy, but not to the point that you're first consideration when figuring out how to transport a patient is YOU COULD BE SUED. You're considerations should revolve around what is medically correct and ethical. Do that and the chance of litigation drops tremendously.


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## Hellsbells (Feb 8, 2012)

Well said Tigger.


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## hippocratical (Feb 11, 2012)

Walk out? Not me.

Although I did bungy jump with one...


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## beefaroni (Feb 29, 2012)

Yes, you always walk on the leg after splinting to test the splint job.. Bls protocol #451


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## TatuICU (Feb 29, 2012)

Shoulda rubbed some dirt on it first


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