The answer to the question "should I have immobilized this patient?" is always No. Rigid immobilization is not helpful and most likely harmful. (if you're asking about a behavioral patient the term is "restrained")
The correct question is, "should I have ensured motion restriction of the patient's cervical and/or thoracic spine?"
Anyways...
She said she didn't fall and neither did her family that was there claimed she had fallen but when I came back after getting the stretcher with my driver, my partner was assisting her getting out of the floor and had moved her to the hallway because she couldn't walk!
Skin, tissue, and bone sits between the spinal cord and the outside environment in all humans with normal anatomy.
Were there significant findings to anything between the spinal cord and the outside environment?
So that threw me for a loop.
Look at it this way: She's been sitting on that floor for a while because for whatever reason she couldn't walk. The #1 treatment for this patient is moving them to a position of comfort, which is likely your stretcher's mattress.
Moreover, if you have paralysis due to a traumatic cord injury you're going to have some outward sign of an injury.
I then asked if she had any neck or back pain and she denied.
Patients with true neck/back pain will tell you about it without prompting. This goes for just about any complaint a patient may have. Very few are actively seeking to withhold vital information. Very few.
Should this patient have been backboarded? I felt c-spine was compromised after my partner had moved her.
You would have seen the compromise immediately. Immediately. Injuries to the spinal column are broken down into primary or secondary. Primary insults, such as moving your patient inappropriately, will have immediate results. Secondary insults have a gradual onset due to inflammatory processes.
If I had known she couldn't walk I probably would have immobilized right then and there.
Zero indication for spinal motion restriction. Even with this patient's signs of neurological compromise, we still have zero indications.
Only oxygen gets more overuse in EMS than the rigid extrication board (incorrectly called a "long spine board" as placing a patient on it cannot possibly confer any benefit to the spine; although if the term is used to mean 'causes unnecessary and harmful pressure to the spine' then I will agree it is used appropriately).
Do you think this was a cause of brain cancer of not being able to balance or a possible floor level fall resulting in damage? Her family stated she had an operation on the tumor last week but it wasn't completely removed and she has been missing treatments along with medication dosages.
This is most assuredly due to her brain cancer. Unless your assessment found some nasty ecchymosis or step-offs.
Injuries to the spinal column do not cause altered mental status on their own, they'd need a contributory finding to support it as a cause of a loss of CPP (cerebral perfusion pressure), like neurogenic or hypovolemic shock.
I've seen some nasty ground level falls, so I don't want you to think I don't believe this patient could have sustained a grievous injury. But all of these patients had significant physical findings.
To suggest this patient suffered a clinically significant fracture of her cervical or thoracic spine producing neurological deficits without any outward indications to the overlying structures is truly a Zebra medical case!
I'm sort of freaking out, and with good reason... my *** is no longer covered.
I'm going to remove the use of personal pronouns because this is not directed just to you:
I take a dim view of folks who perform procedures to CYA. Providers should perform procedures based on patient-centric outcomes. This means providers need at the very least an indication prior to performing any intervention or procedure...and they had better back it up with an assessment.
"My ***" is not an indication for anything.
Our crews who do these sorts of unnecessary procedures get remediation.
I don't want you to read this thinking I'm placing any special blame on you for worrying about your partner killing somebody over simple patient movement. We've all been sold war stories as literature in EMT and paramedic school, many times over (good news, we're not alone in our misunderstandings in medicine). I have been pretty bad at parroting them over the years and actively seek to remove them from my teaching.
I'm very happy to see you challenge your assumptions in an open forum!
