Did this provider mess up?

[frdude1000]

Last night, I was walking back to the dorms from an event on another side of a College campus on a somewhat dark sidewalk. About 25 feet ahead of me, I saw a crowd around someone who appeared to be down. I quickly walked to the person to discover he had fell while walking backwards. He was conscious when I first came up to him. Also on scene was another certified EMT-B. She instructed me to take c-spine precautions, which I did, as falling backwards and striking the head hard is a significant mechanism of injury. We then proceeded to examine and question the patient, who said he was not sure if he was unconscious or not for a small period of time. The patient was alert and oriented to person, place, and time, but he was still a bit dazed. He also complained of pain on the back of his head where he hit the pavement and pain in his wrist. The wrist was not deformed, and the possible head, neck, or back injury was most important. 911 was called, and and ambulance from the college fd responded to the scene. Once the crew arrived, a young woman approached me and told me she would take over. She told me to completely let go of the head, and I hesitated for a minute. She told me it was ok, and I then complied with her request as she was in charge on scene. After she told me to let go we stepped aside. The crew proceeded to talk to the patient and they asked him if he thought he could get up. He said he thought he could, and with no help, she had him sit up. Then, she proceeded to ask him if he wanted to go to the hospital. As the patient was 16, he had no choice as he was a minor and he cannot refuse care. Then, the female instructed the patient to get up and walk to the cot. The wrist was not splinted and no provider stabilized it. The crew then transported the patient to the hospital. I feel as an EMS provider that this woman did not handle this call appropriately. WHat do you think??

 

[JPINFV]

I would have to see the patient to make any sort of actual judgment. Any back or neck pain or tenderness? Pulse/motor/sensation intact and equal in all extremities? If there's nothing past, "The back of my head hurts where it hit the pavement, my wrist hurts where I tried to brace the fall, and I'm 95% sure I didn't lose consciousness" then no, I don't see anything wrong.

 

[usalsfyre]

as falling backwards and striking the head hard is a significant mechanism of injury....

Is it really in an otherwise healthy 16 year old?

Did you do any further assesment? Did your assesment findings indicate injury? Or was mechanisim the only assesment done?

Inapproprite spinal precautions are one of the worst things you can do to a patient. Please make sure your applying a board and collar for a reason.

 

[EMT-IT753]

Based solely on what you provided, it could go either way depending on the lead medic. We have at times cleared c-spine precautions in the field. If a thorough assessment was done and pt denies any pain, tenderness, and does not have any numbness or tingling to extremities, we will slowly allow pt to sit up on their own accord. If anything changes such as dizziness or pain while doing so, then the game plan would change to full c-spine consideration.
Not every fall or hit on the head warrants c collars and longboards. If the patient was alert and oriented and able to make their own decisions, we allow the pt to do so.
I beleive you did the right thing initially with the care you provided. It sounds like further assessment ruled out any serious injury. However, I would have advised the pt to seek care if later they felt nausea, vision changes, or simply didn't feel "right".

 

[Shishkabob]

No neck / back pain or tingling, and no major distracting injuries, and I'll probably clear the spine as well.




I also typically don't like to judge what other providers did based on a 3rd person account.

 

[jjesusfreak01]

Its never wrong to ask questions about what you see happening in the field though. I know you couldn't in this case, but talking to the medic on the call afterwards will probably give you the best answers.

 

[terrible one]

I think i'd have been a bit more worried about why the pt. all of a suddden fell back and hit thier head. In a 16 y/o with no medical problems and having a ground level fall onto the ground isn't a serious MOI in my opinion. of course there are circumstances that could change my mind

 

[Prophet]

Here in my area we can't c-spine on mechanism alone. There has to be another indicator.

 

[Aidey]

MOI has been found to be a poor indicator of actual injury.

A fall like that in a 16 yo? I probably would have done the same thing.

 

[Akulahawk]

MOI has been found to be a poor indicator of actual injury.

A fall like that in a 16 yo? I probably would have done the same thing.

I've known that for at least the past 15-20 years. One thing that MOI is good for is showing you where to look for injury. If someone's foot gets run over, I'm not going to look for finger injuries...

 

[Jay]

Being that C-Spine was already being held and precautions were already taken, I think that it was sloppy to d/c them in the field even if only to cover your own :censored::censored::censored:. That being said a normally healthy 16 y/o should not being passing out which raises the question whether this was medical or trauma or even both. I would first try to rule out the obvious medical issues and not focus too much on MOI as I would be investigating the root cause... Was this a blood sugar issue? Were there drugs and/or alcohol involved? Seizure? Any Hx that could shed some light (and I would keep pressing because Pt's do lie, it is one of their favorite pastimes).

One more thing that strikes me as odd is why was a 16 y/o on a college campus at night (possible indicator to partying?) Unless they are Doogie Howser (this is getting a bit retro for anyone who does not remember this show) they are a bit too young to be on a college campus at night during a weekend. Were there any friends who could help you out? I always like to remind them that we are EMS and not the police, our goal is to help their friend not make sure that they end up behind bars.

 

[Aidey]

Being that C-Spine was already being held and precautions were already taken, I think that it was sloppy to d/c them in the field even if only to cover your own :censored::censored::censored:.

Say what? How is it "sloppy" to d/c in the field?

 

[JPINFV]

Being that C-Spine was already being held and precautions were already taken, I think that it was sloppy to d/c them in the field even if only to cover your own :censored::censored::censored:. That being said a normally healthy 16 y/o should not being passing out which raises the question whether this was medical or trauma or even both. I would first try to rule out the obvious medical issues and not focus too much on MOI as I would be investigating the root cause... Was this a blood sugar issue? Were there drugs and/or alcohol involved? Seizure? Any Hx that could shed some light (and I would keep pressing because Pt's do lie, it is one of their favorite pastimes).

So if someone takes manual c-spine it should always progress to full c-spine precautions? If you think an intervention was done in error or done as a precaution pending further evaluation and you can stop it from progressing further (by completing an assessment or realizing it is in error), then why progress further to full spinal immobilization?

One more thing that strikes me as odd is why was a 16 y/o on a college campus at night (possible indicator to partying?) Unless they are Doogie Howser (this is getting a bit retro for anyone who does not remember this show) they are a bit too young to be on a college campus at night during a weekend. Were there any friends who could help you out? I always like to remind them that we are EMS and not the police, our goal is to help their friend not make sure that they end up behind bars.

One of my friends in middle school was taking college level math classes at night. In high school, a lot of the band and percussion competitions occurred at colleges. ...and no, we weren't always directly supervised and weren't given a parental escort to go from the staging area post competing back to the gym or field to watcher later competitors. Are you saying that because someone is younger than X, they shouldn't be on a college campus period?

 

[Jay]

One of my friends in middle school was taking college level math classes at night. In high school, a lot of the band and percussion competitions occurred at colleges. ...and no, we weren't always directly supervised and weren't given a parental escort to go from the staging area post competing back to the gym or field to watcher later competitors. Are you saying that because someone is younger than X, they shouldn't be on a college campus period?

Not at all, what I am suggesting is not to rule anything out. I myself started college early on but being that it was a Saturday night would at least prompt me to ask more questions. Also, I didn't see anything about trying to rule out a medical scenario aside from the trauma, what if there was more involved like a 16 y/o diabetic having a drink and passing out resulting in the head injury?

Wouldn't you have to wonder these things too considering it was the weekend plus there was no mention of certain precursors that could have been indicators to answering many of the questions being posed???

 

[Jay]

Say what? How is it "sloppy" to d/c in the field?

If it's someone you know, perhaps from your rescue squad and the right questions were being asked then and only then there is nothing sloppy about it, however when a "young" person comes up and you have a gut feeling that they are jumping the gun as frdude100 did then at the very least I would want to make sure that they are qualified to take over, know what they are doing and seem responsible... I am sure that you have had that happen at least once where you knew something wasn't right and could ultimately be held liable for someone elses mistakes. It's a situation that I myself would not risk if I was just "helping out" and something didn't feel right to me.

As for the other person being "young", I am not referring to age, I know some awesome and very mature medics that are barely 20 and I also know some guys much older that shouldn't be in EMS period. It's a responsibility thing and how much maturity you feel the person taking over is presenting, this directly translates to how comfortable I am in handing over my patient.

 

[Aidey]

It doesn't matter what frdude thinks of the people who came and took over. The fact is they were acting in an official capacity and he was not. They have ever right to tell him to go away if they want to. Heck, in some states they could have him arrested if he hadn't listened.

If you (general you) happen upon an incident, and you don't agree with what the official responders do your best course of action is to write it all down, including their names if you can get them and report them to their agency and/or the state. DO NOT cause a scene on scene. Since you (general you) are not there in an official capacity you will always lose.

In this case since he was no acting in any official capacity he could not be held responsible for anything that the official responders did.

Now, say they were both responding on the same squad then he may be able to be held responsible.

And yes, I have been in situations where I have though "WTF is that guy doing". One of the benefits (and downfalls) of my system is that the first paramedic on scene is in charge of patient care. They technically have to transfer care to me before we transport. If I don't like what the fire medic has done I can refuse to accept care, forcing the fire medic to ride in and explain it to the doc himself (or herself).

 

[Fox800]

What are the transporting EMS agency's protocols for field c-spine clearance?

I'm inclined to clear this pt.'s c-spine as well, as long as he's alert and oriented, sober, GCS=15 and has no neck/back pain and no neuro deficits and no distracting injuries

 

[zmedic]

Ground level falls in non elderly people are generally not considered significant mechanism for spinal injury, therefore you don't need to "clear the spine" or even use selective spinal immobilization, you just say no MOI and move on. Now that being said, if in the course of my trauma assessment the patient complained of neck pain I'd probably backboard him, but that would be more of a "keep the thing that hurts from moving" rather than because I think this (I assume) healthy person has a spinal fracture from a ground level fall.

Now if the patient was 75 years old, had a disorder like osteogenesis imperfecta, was doing something other than walking (skateboarding, rollerblading etc) it would be a different story.

 

[silver]

you mentioned that it was a college campus. Was there any alcohol involved? That makes the line of clearing c-spine much more ambiguous.

I wouldnt say it is appropriate or not in this situation without being there, but I would say that this provider didn't "mess up." It may have been at risk behavior to not fully evaluate though.

 

[Hellsbells]

at the very least I would want to make sure that they are qualified to take over, know what they are doing and seem responsible...

What makes you think that the personell from the FD who were dispatched by 911 are not qualified to take over?

Without trying to sound overly pretentious, the only difference between Super Man and myself is that I don't need to get changed in a dirty old phone booth prior to saving a life.

Yeah, I'd say you sound overly pretentious.