Conflicting info, please help

[MikeRi24]

okay... i'm an emt in ny state, and i have never seen that. please post where you are quoting that from. C-spine considerations not only are part of the scene size up done PRIOR to AVPU, but if you didn't do it that way on the practical you would have failed. so i'd really like to know where you got that from.

the c-spine consideration is due to mechanism, which is determined PRIOR to reaching the patient. if you talk to him, it is possible to rule out c-spine, but it is applied FIRST before talking and ruling it out.

what if he hit is head and doesn't remember? what if the pt is unconscious??

i don't know of any NYS document that says what you said.

I will have to reference the state sheet...in class they have been telling us to to talk to the patient first, because let's say in an auto accident, you get in behind the pt for c-spine immobilization, and you just grab the guys neck from behind, he's prob gonna freak and move. if you walk up to them from the front, talk to them and in the process say something to the effect of "my partner is going to come up behind you and hold your neck, I want you to remain still and dont move your head" then you can get an idea of your LOC and do c-spine.

I just used an MVC as an example, but if its like for a hurt extremity or something, in the process of of doing LOC and initial assessment, we will ask the pt "did you fall?" in which case we will then consider c-spine also.

I'm not disagreeing with you at all, but thats what they teach us. I have the NYS protocol book and I am going to go look it up for my own information because I don't want to screw that up on the exam. Personally, I'm a big fan of erring on the side of caution and collar/boarding people. If we are called for something medical, and the person is on the ground and no one saw how they got there, then I'm collaring and boarding them no matter what the medical emergency is because their medical emergency may have just lead to a trauma. If theres a person there that said they helped them to the ground or the pt laid down them selves, then I'm not so concerned about it. If a person fell down a flight of stairs and hurt their leg, I'm collaring them and boarding them. I actually had that the other day, when I was on a basic ambulance, we had someone complaining of pain in their ankle after they slipped and fell down a flight of stairs. the person was never boarded or collared, and I asked the EMT i was with why they didn't do it. when they asked the person if they hit their head, they said they ddin't think so, but they could still have a back, head or neck injury and just not know it yet.

 

[skyemt]

I will have to reference the state sheet...in class they have been telling us to to talk to the patient first, because let's say in an auto accident, you get in behind the pt for c-spine immobilization, and you just grab the guys neck from behind, he's prob gonna freak and move. if you walk up to them from the front, talk to them and in the process say something to the effect of "my partner is going to come up behind you and hold your neck, I want you to remain still and dont move your head" then you can get an idea of your LOC and do c-spine.

I just used an MVC as an example, but if its like for a hurt extremity or something, in the process of of doing LOC and initial assessment, we will ask the pt "did you fall?" in which case we will then consider c-spine also.

I'm not disagreeing with you at all, but thats what they teach us. I have the NYS protocol book and I am going to go look it up for my own information because I don't want to screw that up on the exam. Personally, I'm a big fan of erring on the side of caution and collar/boarding people. If we are called for something medical, and the person is on the ground and no one saw how they got there, then I'm collaring and boarding them no matter what the medical emergency is because their medical emergency may have just lead to a trauma. If theres a person there that said they helped them to the ground or the pt laid down them selves, then I'm not so concerned about it. If a person fell down a flight of stairs and hurt their leg, I'm collaring them and boarding them. I actually had that the other day, when I was on a basic ambulance, we had someone complaining of pain in their ankle after they slipped and fell down a flight of stairs. the person was never boarded or collared, and I asked the EMT i was with why they didn't do it. when they asked the person if they hit their head, they said they ddin't think so, but they could still have a back, head or neck injury and just not know it yet.

i think you are confusing "c-spine considerations" and applying c-spine stabilization...

for the purpose of the exam, "c-spine considerations" is part of scene size-up, and done before pt contact is made... all that means for your exam, is verbalizing that due to mechanism, you are going to apply c-spine stabilization to the patient. if you don't do that, and just wait until you get to the patient, the evaluator will assume you were not thinking about mechanism, and it could cost you passing the test.

two separate issues, that your are merging into one.

 

[MikeRi24]

i think you are confusing "c-spine considerations" and applying c-spine stabilization...

for the purpose of the exam, "c-spine considerations" is part of scene size-up, and done before pt contact is made... all that means for your exam, is verbalizing that due to mechanism, you are going to apply c-spine stabilization to the patient. if you don't do that, and just wait until you get to the patient, the evaluator will assume you were not thinking about mechanism, and it could cost you passing the test.

two separate issues, that your are merging into one.

the NYS Practical for Trauma and Medical Assessment goes as follows:

1) Takes or verbalizes proper BSI precautions
2) Determines that the scene is safe
3) Determines Mechanism of Injury
4) Considers Stabilization of Spine
5) Verbalizes general impression of patient
6) Determines responsiveness/LOC
7) Determines Chief Complaint
8) ABCs and so on

I see what you're saying, and I see what the protocol is saying, but the way we have been doing it is kind of killing 2 birds with 1 stone: lets say you are called for possible head injury, and when you get there, the pt is sitting on their couch in the living room. its hard to determine a MOI based on that. You ask the pt "what happened" and they either tell you, or they are unresponsive and maybe someone else tells you. theres your LOC right there. if theres no one around to tell you what happened and the pt cant tell you what happened, then you go for your c-spine right away. I know a lot of whats on the Practical is very very repetitive, and you'll repeat yourself a few times, but out in the field I have noticed that a lot of times its really easy to get a lot of information and do a lot of things at once. Its especially difficult to go work in the field for 2 days, then come back into the classroom and slow down and go back to the sheet and get back in the habit of verbalized ever move you make.

 

[skyemt]

really, forgetting the "field" for a moment...

you are trying to pass your practical...

the practical is all about doing the CRITICAL STEPS IN THE CORRECT ORDER..

they DO NOT want to hear about "the field"....

do what you like... but if you deviate from state sheets, you will have a good understanding of the field while you retake your EMT class.

have seen it happen many times...

 

[MikeRi24]

really, forgetting the "field" for a moment...

you are trying to pass your practical...

the practical is all about doing the CRITICAL STEPS IN THE CORRECT ORDER..

they DO NOT want to hear about "the field"....

do what you like... but if you deviate from state sheets, you will have a good understanding of the field while you retake your EMT class.

have seen it happen many times...

Yeah, a lot of people have been saying that, i can;t tell you how many times in class someone has said "well, when I was on the ambulance the other day, they did it like this" and even our instructors have said on some occasions "you have to know this because NYS says you do, but when you get out there, 9 times out of 10 it's going to be like this"

I think the whole debate of how drastically different the state exam and the real world are is something that leaves a lot to be discussed, but this isnt the place for that...