medichopeful
Flight RN/Paramedic
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By the way, I commend you for seeking advice and looking to improve your care!
Did I provide sufficient EMT care? 7 y/o hit head on slide
- Thread starter r4state
- Start date
By the way, I commend you for seeking advice and looking to improve your care!
firetender
Community Leader Emeritus
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I have a couple of things
First, as a report to us, this was very incomplete. If you're going to ask us to make a call on your judgment, include all the information you would need to tell a Doctor at your receiving station.
This is a HUGE gap. Why would the Lifeguards board her? My first impression is a loss of consciousness. It could have been as simple as her standing up in the water complaining of pain and holding her Owwiee though. That info is ESSENTIAL to the narrative.
What was the mechanism of injury? Did you ask the Lifeguards? We'd never know. Did she bump her head on the slide, the pool wall, another kids head?
Sorry, Kiddo, if you're going to ask my opinion I want to know you did a thorough head-to-toe exam. If the kid's not directing you to areas of discomfort or injury, you best find them. "a quick pat down" is not enough for me in a report. I have NO idea of what you may have missed. How can I help you?
The fact that she came backboarded to you and THEN you directed someone else to support her neck while you applied a C-collar tells me you had to have had SOME suspicion of injury. Where did that come from?
You are reporting, not determining. Though you're likely correct in your assumption you jumped to a conclusion. What I see is by bringing this up in the first place, you committed to giving me follow-up. Now, for this to be a complete report, I expect you to tell what happened after she was dried off and, say, fifteen minutes had passed. It's possible you noted this, but that info never came to me and if I'm gonna help, I need it.
Again, it appears to me you did not put in adequate observation time to make this call...
I take it your job is to DECIDE whether an ambulance should be DISPATCHED to the scene. When do you make that determination?
HOW did that "call" come to you? "Girl down on waterslide"? "Possible drowning"? "Fall injury in water"?
What was your response time? Were I the PARK, my directive would be if an emergency call of any sort originates in my facility, an ambulance is dispatched and my In-house medic (YOU) responds immediately and then DECIDES whether the ambulance needs to be cancelled or stepped up.
Apparently you were empowered to make the determination to DISPATCH the ambulance. You don't tell me how long of a process that would be. I really need to know.
Based on what you presented, I would not allow the Mom to do anything but get the kid in for a thorough exam. You sound unsure enough (why would you ask?) at the time, so I think your best judgment would have been to get the ambulance in there for a Second Opinion. You really sound like you were in over your head. You release a kid to her mother when you're SURE!
Perhaps it's only by your presentation, but I don't hear paranoia, I hear doubt. I don't think YOU have clear enough of a picture of what and how it happened, let alone your role in the chain of emergency medical care, to even ask our opinion.
I'm not picking on you, please understand; but it IS your first job and, as you present it, you really need to get clear on what you're doing.
First, as a report to us, this was very incomplete. If you're going to ask us to make a call on your judgment, include all the information you would need to tell a Doctor at your receiving station.
This is a HUGE gap. Why would the Lifeguards board her? My first impression is a loss of consciousness. It could have been as simple as her standing up in the water complaining of pain and holding her Owwiee though. That info is ESSENTIAL to the narrative.
What was the mechanism of injury? Did you ask the Lifeguards? We'd never know. Did she bump her head on the slide, the pool wall, another kids head?
Sorry, Kiddo, if you're going to ask my opinion I want to know you did a thorough head-to-toe exam. If the kid's not directing you to areas of discomfort or injury, you best find them. "a quick pat down" is not enough for me in a report. I have NO idea of what you may have missed. How can I help you?
The fact that she came backboarded to you and THEN you directed someone else to support her neck while you applied a C-collar tells me you had to have had SOME suspicion of injury. Where did that come from?
You are reporting, not determining. Though you're likely correct in your assumption you jumped to a conclusion. What I see is by bringing this up in the first place, you committed to giving me follow-up. Now, for this to be a complete report, I expect you to tell what happened after she was dried off and, say, fifteen minutes had passed. It's possible you noted this, but that info never came to me and if I'm gonna help, I need it.
Again, it appears to me you did not put in adequate observation time to make this call...
I take it your job is to DECIDE whether an ambulance should be DISPATCHED to the scene. When do you make that determination?
HOW did that "call" come to you? "Girl down on waterslide"? "Possible drowning"? "Fall injury in water"?
What was your response time? Were I the PARK, my directive would be if an emergency call of any sort originates in my facility, an ambulance is dispatched and my In-house medic (YOU) responds immediately and then DECIDES whether the ambulance needs to be cancelled or stepped up.
Apparently you were empowered to make the determination to DISPATCH the ambulance. You don't tell me how long of a process that would be. I really need to know.
Based on what you presented, I would not allow the Mom to do anything but get the kid in for a thorough exam. You sound unsure enough (why would you ask?) at the time, so I think your best judgment would have been to get the ambulance in there for a Second Opinion. You really sound like you were in over your head. You release a kid to her mother when you're SURE!
Perhaps it's only by your presentation, but I don't hear paranoia, I hear doubt. I don't think YOU have clear enough of a picture of what and how it happened, let alone your role in the chain of emergency medical care, to even ask our opinion.
I'm not picking on you, please understand; but it IS your first job and, as you present it, you really need to get clear on what you're doing.
OP
OP
r4state
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thanks firetender, i am in over my head. I guess I never learned that a c-collar alone won't do anything. I'm pretty embarssed, but I'm glad I know better now.
mycrofft
Still crazy but elsewhere
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Hang tough there.
Especially if you are new, it can be daunting to decide to board or not, especially with the current anti-spine boarding discussions going around. Your instructor should have made it clear, then it is up to you. It is usually not your call to roll back another responder's care (spineboard by lifeguards). It is not ok to split the difference between a full tx and a half one; I doubt that your protocols say you can put someone only in a cervical collar, and especially after they have already been boarded.
Go back to your books and your employee protocols. If your employee protocols are vague, look out!
Especially if you are new, it can be daunting to decide to board or not, especially with the current anti-spine boarding discussions going around. Your instructor should have made it clear, then it is up to you. It is usually not your call to roll back another responder's care (spineboard by lifeguards). It is not ok to split the difference between a full tx and a half one; I doubt that your protocols say you can put someone only in a cervical collar, and especially after they have already been boarded.
Go back to your books and your employee protocols. If your employee protocols are vague, look out!
medichopeful
Flight RN/Paramedic
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Don't be embarrassed my friend. In all seriousness, there's a reason that they call what people do in the medical field "practice."
You'll screw up. EVERYBODY does. It's what you take away from those errors that will make you a better provider!
JPINFV
Gadfly
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I would agree if this wasn't a first aid situation. It doesn't matter quite as much if the patient is going to be transported regardless of anything else. However part of a first aid EMT's job is to decide deposition. The only possible deposition for a patient who is backboarded is the hospital via 911 ambulance. So if the lifeguards are overzealous with their backboard, it is very much a valid argument to remove it if it is unnecessary.
This is also why I'm against fresh-grad EMTs from working first aid jobs solo. Waterpark first aid is a clinic, but EMTs are trained for transport.
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r4state
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Thanks everyone for your support. I am a bit frustrated. My orientation consisted only of filling out New hire paperwork and introductions. I plan on seeking out the protocols an more of what is expected of me. When I started this job, I was very uncomfortable with the minimal information my supervisors gave me. Maybe this is because my nature of work isn't so urgent?
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JPINFV
Gadfly
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It's also because you have options that aren't normally available. The default mindset when working on an ambulance is every patient gets transported. So EMS can get away with stupid things like backboards for every trauma or non-rebreathers for every patient. That transport assumption is no longer valid. You have to make the decision now, "Can this patient go back to the park? Does this patient need an emergency department? How long am I willing to let the patient who hasn't been drinking enough water and is now light headed sit in first aid?" These aren't issues addressed in EMT training and you aren't going to find a protocol that will lay out who gets what when simply because it's not that simple.
...also for some background, I worked 2 summers during undergrad as an EMT at a water park.
What he said ^. The only addition I would make is to emphasize the importance of providers having experience or observation with BLS, ALS and ED care-- so they can make more educated decisions, knowing what treatments to expect from each disposition option.
mycrofft
Still crazy but elsewhere
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J'Accord.
........
........I'm paranoid 
If the patient was presented to me on a back board and my suspicion was to c-collar and the patient was cool and clammy I wouldn't have taken her off board, moved her to a relatively sheltered location to see if the environment was the issue (provided additional blankets, etc.) and waited on an ALS/BLS unit to come and confirm or reject my impressions. I agree there needs to be more history here and that's a good thing to get into while the other unit is incoming.
Yes, I would definitely talk it over with my supervisor and get a copy of protocols.
That said I don't know if I could have done much better or definitely would have done different than you as I wasn't on the scene and didn't see what you saw.
If the patient was presented to me on a back board and my suspicion was to c-collar and the patient was cool and clammy I wouldn't have taken her off board, moved her to a relatively sheltered location to see if the environment was the issue (provided additional blankets, etc.) and waited on an ALS/BLS unit to come and confirm or reject my impressions. I agree there needs to be more history here and that's a good thing to get into while the other unit is incoming.
Yes, I would definitely talk it over with my supervisor and get a copy of protocols.
That said I don't know if I could have done much better or definitely would have done different than you as I wasn't on the scene and didn't see what you saw.
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OP
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r4state
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I'm paranoid
If the patient was presented to me on a back board and my suspicion was to c-collar and the patient was cool and clammy I wouldn't have taken her off board, moved her to a relatively sheltered location to see if the environment was the issue (provided additional blankets, etc.) and waited on an ALS/BLS unit to come and confirm or reject my impressions. I agree there needs to be more history here and that's a good thing to get into while the other unit is incoming.
Yes, I would definitely talk it over with my supervisor and get a copy of protocols.
That said I don't know if I could have done much better or definitely would have done different than you as I wasn't on the scene and didn't see what you saw.
i'm glad i'm not the only one!
For my company any pt we find immobilized we have to ask MD to remove c spine precaution after report of a complete head to toe with vital signs.
practice makes perfect on your pt assessment. doesn't matter if it's a full code, anaphylaxis, or a scratch on the head.
for all refusals assess thoroughly! explain risks and document it like your life depends on it because you don't know if that priority 3 will come back to bite you in the (__!__)
practice makes perfect on your pt assessment. doesn't matter if it's a full code, anaphylaxis, or a scratch on the head.
for all refusals assess thoroughly! explain risks and document it like your life depends on it because you don't know if that priority 3 will come back to bite you in the (__!__)
What exactly did this kid hit her head on? It's not like it was a 20ft "fall from height", she was going down the slide and what, bumped her head?
Brown has fallen out of two trees, fallen onto concrete and ran into a beam as a youngin, all of which resulted in Brown being knocked unconscious for a period of time. Say, that might explain a lot
The point is all but one of these happened at school and Brown just shook it off and the teacher said Brown go home and let Mum know if Brown got worse to go to the Doctor.
Unless this kid showed some sort of gross neurogenic deficit or abnormality she needs to go home and be observed for several hours to make sure there is no deterioration warranting further investigation.
No back boards, cervical collars, tens of thousand of dollars worth of CT machines or trips to hospital are necessary.
Brown has fallen out of two trees, fallen onto concrete and ran into a beam as a youngin, all of which resulted in Brown being knocked unconscious for a period of time. Say, that might explain a lot
The point is all but one of these happened at school and Brown just shook it off and the teacher said Brown go home and let Mum know if Brown got worse to go to the Doctor.
Unless this kid showed some sort of gross neurogenic deficit or abnormality she needs to go home and be observed for several hours to make sure there is no deterioration warranting further investigation.
No back boards, cervical collars, tens of thousand of dollars worth of CT machines or trips to hospital are necessary.
JPINFV
Gadfly
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One thing to consider, also (and this goes back to my earlier posts) is that releasing a patient from your care and the patient leaving AMA is not the same thing.
True, now this is where it gets confusing.
Ambulance Officers here have no legal obligation to treat or transport anybody; there is a requirement to offer treatment or transport if it is thought medically necessary.
In this scenario, if it is thought in the professional judgement of the attending Ambulance crew that no treatment or transport is required, then so be it, we can grab our Thomas Pack and drive off into the sunset.
At no time are we bound by any provision to transport that patient unless we have provided "significant intervention".
Brown gathers the same is not true across the Pacific?
Ambulance Officers here have no legal obligation to treat or transport anybody; there is a requirement to offer treatment or transport if it is thought medically necessary.
In this scenario, if it is thought in the professional judgement of the attending Ambulance crew that no treatment or transport is required, then so be it, we can grab our Thomas Pack and drive off into the sunset.
At no time are we bound by any provision to transport that patient unless we have provided "significant intervention".
Brown gathers the same is not true across the Pacific?
medichopeful
Flight RN/Paramedic
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Not always, but sometimes tests are definitely necessary.
http://en.wikipedia.org/wiki/Natasha_Richardson
JPINFV
Gadfly
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Oh course here's the wrinkle. What if there is no ambulance crew since you're providing first aid services, not transport services?
"First aid" is different, somebody with a Red Cross first aid certificate is not legally responsible for anything.
We provide private-hire of our Ambulance Officers for sporting events and such like, and the same rule applies as if we were working on an Ambulance even if we are not. If Nana is found collapsed at the supermarket and we identify ourselves as an AO then the same rule applies.
JPINFV
Gadfly
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...then it's more like event standby than first aid. What I was told when I was working at a water park in California was that the park was required to have an EMT on site during operating hours by state law. Also, unlike New Zealand, EMS providers in the US operate under the assumption and training that all patients are going to be transported, which is not a proper assumption for standby work.