# bicycle accident



## chri1017 (Aug 6, 2013)

EMS called to the scene for the bicycle down.  EMS finds a 20 year old male who crashed while riding a road bike.  Patient fell and has obvious deformity to his arm.  Patient stated that he did hit his head.  No loc , neck/ back pain, numbness tinglint.  Patient was wearing helmet and is CAOx3.  Who would backboard this patient?


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## Medic Tim (Aug 6, 2013)

chri1017 said:


> EMS called to the scene for the bicycle down.  EMS finds a 20 year old male who crashed while riding a road bike.  Patient fell and has obvious deformity to his arm.  Patient stated that he did hit his head.  No loc , neck/ back pain, numbness tinglint.  Patient was wearing helmet and is CAOx3.  Who would backboard this patient?





upper arm or lower arm deformity?

either way I probably wouldn't


This is VERY similar to one of the scenarios I had during my PHTLS class last weekend.


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## NomadicMedic (Aug 6, 2013)

Eh. It would depend on how distracting the arm was. I'd say probably not.


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## TomP (Aug 6, 2013)

No, however I am lucky and my protocols allow me to clear c-spine on scene.


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## teedubbyaw (Aug 6, 2013)

From reading that, no. But, it would depend on pt presentation and more info on MOI.


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## Carlos Danger (Aug 6, 2013)

Unless I have some reason to believe the patient is lying to me about striking his head, then there is no indication for spinal immobilization.


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## Wes (Aug 6, 2013)

If I remember correctly, there are multiple studies debunking MOI as an indicator for spinal precautions.   

And I'm not seeing any need to subject this patient to an unnecessary backboard and collar.


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## Akulahawk (Aug 7, 2013)

chri1017 said:


> EMS called to the scene for the bicycle down.  EMS finds a 20 year old male who crashed while riding a road bike.  Patient fell and has obvious deformity to his arm.  Patient stated that he did hit his head.  No loc , neck/ back pain, numbness tinglint.  Patient was wearing helmet and is CAOx3.  Who would backboard this patient?


In short, no backboarding for this patient if I don't see any actual need for it. MOI is a very poor predictor of _actual_ injury, but it's very good at telling me _where_ to look.


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## DesertMedic66 (Aug 7, 2013)

DEmedic said:


> Eh. It would depend on how distracting the arm was. I'd say probably not.



This.


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## CPRinProgress (Aug 8, 2013)

Had a motorcycle accident on a highway. pt aox3, was wearing a helmet, negative loc, head/neck/back pain. he just had scrapes on his arms and legs. he did admit to be traveling at close to 90 mph.  we backboarded.  In NJ, we cant clear c spine.


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## Tigger (Aug 8, 2013)

It's not clearing c-spine if taking c-spine precautions is not indicated in the first place.


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## CPRinProgress (Aug 8, 2013)

Tigger said:


> It's not clearing c-spine if taking c-spine precautions is not indicated in the first place.



True


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## wadford (Aug 10, 2013)

In the county I work for we have a protocol where we can choose to not place someone in full c-spine precautions if all of the criteria in the protocol are met. 

No complaint of neck discomfort
Normal mental status
No evidence of intoxication
No significant distracting injury
No neurological deficits
No spinal tenderness, guarding or limitation of movement. 

And if there is any doubt whatsoever then we board and collar.


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## PotatoMedic (Aug 10, 2013)

wadford said:


> In the county I work for we have a protocol where we can choose to not place someone in full c-spine precautions if all of the criteria in the protocol are met.
> 
> No complaint of neck discomfort
> Normal mental status
> ...



Very similar to mine.  Except that when we call a report to the hospital the nurses always tell us to "HAVE THE PATIENT BACKBOARDED!!!"  We did it once to make them happy.  Told the pt that this will be uncomfortable and painful.  After that we just pull the page out of our protocol book that allows us to not backboard if xyz are met and show it to them as they still yell at us for not having the pt backboarded and how can we really know they don't have a spinal fx and yada yada yada...


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## Fortion (Aug 26, 2013)

no backboarding for this patient


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## Btalon (Aug 27, 2013)

How badly was the helmet damaged?  The shell and the foam lining, how bad was it compressed?  

We had a similar one the other day, but the difference was a complaint of neck pain, they were immobilized and transported.

We had a guy fall off his porch - about 3 feet and immobilized him due to pain and loss of sensation, C5 and C7 fractures.

MOI is only a guide and there are always exceptions to every rule.  I have been questioned by ER staff as to the lack of a backboard and explain protocols and the patient being negative for spinal precautions, but I've also had patients that protocols called for a backboard and the ER doc comes in and takes stuff off without an x-ray or really talking to patient.

I'm not sure how they ultimately decide on releasing them, I haven't been able to figure it out.

In your case I probably wouldn't backboard, not knowing all the facts I couldn't absolutely rule it out, but I'm siding with the people that say no.


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## yz125rider (Aug 29, 2013)

How fast was the bike traveling? Damage to bike? Helmet damage? Is A&o3 missing one for you, for us its missing one making them altered. 

The only way I would is as a cya depending on the other criteria due to protocol. Factors

Distracting injury?
Speed > 20? 
Results from assessment


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## EMDispatch (Aug 29, 2013)

In terms of MOI, what is the exact MOI here?
Did he go over the over the top? or did he go off sideways? 
Doe he remember how? and how were you able to verify no LOC?

Back in college I underwent significant MOI incident falling down a flight of bleachers on my head and neck about 70 feet. I popped back up on adrenaline, and if it weren't for a friend telling me I didn't get up right away, I wouldn't have gone to the hospital. As it was, I still went to the ER in my personal car. I didn't begin to feel the incident until about 36 hours later.


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## Akulahawk (Aug 29, 2013)

EMDispatch said:


> In terms of MOI, what is the exact MOI here?
> Did he go over the over the top? or did he go off sideways?
> Doe he remember how? and how were you able to verify no LOC?
> 
> Back in college I underwent significant MOI incident falling down a flight of bleachers on my head and neck about 70 feet. I popped back up on adrenaline, and if it weren't for a friend telling me I didn't get up right away, I wouldn't have gone to the hospital. As it was, I still went to the ER in my personal car. I didn't begin to feel the incident until about 36 hours later.


Interesting MOI. Just remember that MOI may give you a suspicion that an injury occurred. It won't tell you if one happened. If you know the MOI, you might be able to figure out where to look for injury based on that. 

If your patient got struck in the face by a board, you're not going to look at the abdomen for injury. Frankly, I wouldn't look for injury below T1 with that...

I don't ask people if they remember being unconscious. They won't remember being knocked out or they won't want to admit to it. However, if you ask them "do you remember waking up..." they just might! That's positive LOC.


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## EMDispatch (Aug 29, 2013)

Akulahawk said:


> Just remember that MOI may give you a suspicion that an injury occurred. It won't tell you if one happened. If you know the MOI, you might be able to figure out where to look for injury based on that.



See, that's the thing I found interesting, people seem to be glossing over the exact MOI.  Falling off a bike to the left or right vs laying it down vs over the handle bars are 3 very different MOI that can be present when your dispatched to a call like this. If the patient went over the bars  assuming the patient went over the handles, I'd be signifcantly more concerned about a possible spinal injury. If he laid it down or fell to a side I'd have significantly less. 

I'm also not really a field provider these days though, and I defer to the more knowledgeable and skilled out there.


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## Handsome Robb (Aug 29, 2013)

Is he able to follow my assessment and isn't distracted by the upper extremity injury? 

Assuming no gross intoxication is present and he is able to focus on my assessment then no backboard.


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## EMT B (Aug 30, 2013)

Wes said:


> If I remember correctly, there are multiple studies debunking MOI as an indicator for spinal precautions.



i dont think i have heard anything about those studies...i do live under a rock though...



chri1017 said:


> EMS called to the scene for the bicycle down.  EMS finds a 20 year old male who crashed while riding a road bike.  Patient fell and has obvious deformity to his arm.  Patient stated that he did hit his head.  No loc , neck/ back pain, numbness tinglint.  Patient was wearing helmet and is CAOx3.  Who would backboard this patient?



any alcohol? any pain or tenderness on palpation of the spine? im assuming csms were normal except for that arm with deformity. there is no alcohol, no pain or tenderness on spinal palpation, no abnormal csms and the arm is not a distracting injury, protocols allow me to say no board.


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## ZombieEMT (Aug 31, 2013)

CPRinProgress - I actually had an interesting conversation with an employee at NJOEMS a few weeks ago and became quite suprised. I was informed that due to the fact that NJ has no state wide medical director, there are no specific state guidlines on what we can do. Instead, your state guidline is to follow what was provided in our EMT training. I brought up a questions (as I previously asked my medical director) as to when to use cspine precautions and longboard and if we can rule it out. PHTLS allows some differences other than basic training. I was not given a clear answer when talking to the state, but they did say follow the training and you will be covered.


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## NBFFD2433 (Oct 12, 2013)

If upper arm I might. Depends.


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