Any interesting anecdotes about interference with patient care from a CNA, lifegurad, etc.?

[VentMonkey]

Nurses seem to be the worst about trying to butt in... We see it fairly often in the Athletic Training world too. I had one last year insist that a kid go to the ER for a CT scan for a concussion. I tried to explain to her (and to the kid's dad) why that wasn't necessary. But she had scared him enough to go. Guess what... CT didn't show anything! (Just like I told them it wouldn't).

And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?

Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?

 

[hops19]

And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?

Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?

Of course we have guidelines. First of all, let me say this: We don't grade concussions. That's a thing of the past. A concussion is a concussion. But a concussion itself is not grounds for a CT scan. Certain signs and symptoms would warrant referral to the ER for a CT scan. Those would include repeated vomiting, slurred speech, deterioration of symptoms. This kid never displayed any of these signs or complained of any "red flag" symptoms. Had he done so, I probably wouldn't have let him leave with dad.. I'd be calling for an ambulance. I've seen somewhere in the range of probably about 150 concussions in my career (~7 years) and less than 10 of them have been referred to the ER. Only two that I can remember did I send to the ER strictly for concerns about a brain bleed. The remainder were sent by EMS to rule out a neck injury.

Any time I have a kid suffer a concussion, the parents are given instructions for that night. Signs and symptoms to be looking for, and when is it time to head to the ER. What they should do that night (get a little food and get some sleep). And they are always referred to a concussion specialist, who typically sees them in the 24-72 hour range.

 

[VentMonkey]

@hops19 I'd love to hear your take on CTE, but alas, perhaps another time, and in another thread.

 

[Akulahawk]

Nurses seem to be the worst about trying to butt in... We see it fairly often in the Athletic Training world too. I had one last year insist that a kid go to the ER for a CT scan for a concussion. I tried to explain to her (and to the kid's dad) why that wasn't necessary. But she had scared him enough to go. Guess what... CT didn't show anything! (Just like I told them it wouldn't).

And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?

Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?

Nurses don't usually get a really good and thorough education in evaluation of concussion. For that matter, neither do Paramedics. I am ATC trained, Paramedic trained, and RN trained. Nurses and Paramedics are basically taught to punt to the ED because of the possibility of various forms of ICH, some of which will be visible on CT, some require MRI. Concussions normally will not show any structural abnormality on CT. The CT scans aren't "fine" enough to be able to show any damage. The ATC knows how to test for concussion and knows the signs/symptoms to watch for if the athlete actually suffered a more severe CHI, and when to send the athlete to the ED. The ATC also has a very specific advantage that Nurses and Paramedics do NOT have: the ATC knows his/her athletes incredibly well and knows what's normal behavior for each athlete. The AT is very well educated in other areas as well. The minimum for entry into the field is a Bachelors and it's the reason why Paramedic and Nursing school didactics were seriously easy for me. While my knowledge base isn't as good as that of a PA, I do have to be quite cognizant of my limitations while working, particularly when answering questions that a patient may have.

 

[ERDoc]

@Akulahawk, check out the PECARN head injury studies. It sounds like something you might really be interested in, especially when you have to deal with the super nurses and MAs.

 

[Akulahawk]

@Akulahawk, check out the PECARN head injury studies. It sounds like something you might really be interested in, especially when you have to deal with the super nurses and MAs.

@ERDoc Thanks for the reference! I will certainly take a better look at it when I have some time. Just a cursory look at the site showed that there's quite a bit of info available.

 

[ERDoc]

The study is really more about who needs CT (and radiation) and who doesn't but it is very useful to help with discussion and you can shut those know it alls up when you ask them which PECARN criteria the meet. It still annoys me when someone says that their relative who is a (insert alphabet soup here) sent them in for a head CT to see if they have a concussion. You can't see concussions on CT, it's a clinical diagnosis.

I'm going to go against the grain and the intent of the OP and post about a time when another medical person was happy to turn over care. I rolled up on a guy hit by a car in my POV when I was an EMT. There is someone with obvious medical knowledge holding c-spine, I assumed another EMS type person. I walk up, identify myself and ask what I can do to help. She looks up and says, "You can tell me what to do. I'm an RT. I'm happy to help but this is above my paygrade." She was great and really helped until EMS arrived.

 

[Alan L Serve]

I've had EMTs from other fire depts stop at scenes soon after I arrived with me my FD and asked if we needed help. In the rural area I work we often tone out for mutual aid and it just so happens those off-duty EMTs were about to be toned out and be made on-duty. I've even heard for pagers sounding and the county dispatch speaking through the speaker just as they were asking if we needed help.

I appreciated it every time, esp in the situation where we had more patients than on-duty providers.

Except for the guy who came up with his cat on a dog leash. That was just odd.

 

[hops19]

I'm going to go against the grain and the intent of the OP and post about a time when another medical person was happy to turn over care. I rolled up on a guy hit by a car in my POV when I was an EMT. There is someone with obvious medical knowledge holding c-spine, I assumed another EMS type person. I walk up, identify myself and ask what I can do to help. She looks up and says, "You can tell me what to do. I'm an RT. I'm happy to help but this is above my paygrade." She was great and really helped until EMS arrived.

I'll share. Again, Certified Athletic Trainer at a high school. We had an SCA event at an alumni baseball game this year. Nursing student and a nurse came out of the stands to perform CPR, one of our coaches is a retired FF/paramedic. The three of them handled CPR duties. Coach told me later that had the guy not responded, I would have been next on the chest. I applied the AED and ran that machine. When the engine and ambulance arrived about 8 minutes later, the man was conscious. You better believe I was happy to see that nurse and that nursing student come down to help!

 

[NUEMT]

Think about how often (pre)hospital folks don't bag well. She probably hasn't touched one since CPR class, it's not that surprising.

This is backed up by research. Bagging can be deceptively hard in reality.