Flying a fall Victim

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CPRinProgress

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I recently went a on a call for a 60 y/o male that fell down the stairs. We are a bls squad and als and a helicopter were also dispatched. When we got there the pt was intoxicated but his speech was not slurred and I couldn't smell it on his breath . We did a rapid trauma and he didn't complain of any pain. We ended up canceling medics and the helicopter. We back boarded and brought him to the local hospital. A couple days later we found out that he had broken a vertebrae in his neck and back and that the local hospital had flown him to a trauma center.
My question is should we have flown him or driven him to the trauma center even though he didn't complain but solely on the mechanism? Vitals were normal and pupils were PEARRL. Did we do the right thing.
 
As long as you're confident in your assessment skills, and you can verify that you did a thorough assessment and the patient didn't complain of any pain, it seems like you did the right thing to me.

Until they start putting imaging devices on ambulances and training EMTs to use them, this type of triage will continue to happen.

Patient falls down, patient doesn't hurt, patient was transported to hospital. Hospital discovers injury not immediately evident, hospital transports patient to specialized care facility. That's the way it's supposed to work.
 
CPRinProgress said:
I recently went a on a call for a 60 y/o male that fell down the stairs. We are a bls squad and als and a helicopter were also dispatched. When we got there the pt was intoxicated but his speech was not slurred and I couldn't smell it on his breath . We did a rapid trauma and he didn't complain of any pain. We ended up canceling medics and the helicopter. We back boarded and brought him to the local hospital. A couple days later we found out that he had broken a vertebrae in his neck and back and that the local hospital had flown him to a trauma center.
My question is should we have flown him or driven him to the trauma center even though he didn't complain but solely on the mechanism? Vitals were normal and pupils were PEARRL. Did we do the right thing.
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In my opinion this patient should have at least received and ALS assessment and trauma center if assessed to be serious enough. You state the patient was intoxicated, which means his pain threshold can be different and he might have hidden injury that due to alcohol he was not feeling. Can I ask, did he admit to alcohol, or it was assumed? Also, the mechanism alone is enough to at least warrant the ALS assessment.
 
The only thing was he was drunk and he had a small laceration to his head. But he said he only fell from a couple steps up. Even if he did fall from the top'it was only 10 ft and significant mechanism is 15 ft so that was out thinking.
 
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HaleEMT said:
In my opinion this patient should have at least received and ALS assessment and trauma center if assessed to be serious enough. You state the patient was intoxicated, which means his pain threshold can be different and he might have hidden injury that due to alcohol he was not feeling. Can I ask, did he admit to alcohol, or it was assumed? Also, the mechanism alone is enough to at least warrant the ALS assessment.
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I agree that we should have let the medics come in but I talked to a paramedic and he said they might not have been able to detect the fractures. I also agree that we should have went to the trauma center. His wife said he was drunk but i can't remember if he admitted it himself. Originally he didn't even want to go but his wife made him so I think that affected our decision, although it probably shouldn't have.
 
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Ok thanks for the additional info. By the way you worded the OP I thought you were refering to an entire flight of steps vs just several steps at minimal height. I think there are other factors that should play into the consideration of ALS/Helicopter. For example, what surface did he land on? Is the patient on blood thiners? Did the patient hit his head or lose consciousness? How intoxicated is "intoxicated', does the patient have an altered mental status? Other medical conditions.

Not saying necessary wrong but more to the story. Like previously said, we do not have an xray machine on hand and can not do anything to be for sure in the field, ALS or not.
 
HaleEMT said:
Ok thanks for the additional info. By the way you worded the OP I thought you were refering to an entire flight of steps vs just several steps at minimal height. I think there are other factors that should play into the consideration of ALS/Helicopter. For example, what surface did he land on? Is the patient on blood thiners? Did the patient hit his head or lose consciousness? How intoxicated is "intoxicated', does the patient have an altered mental status? Other medical conditions.

Not saying necessary wrong but more to the story. Like previously said, we do not have an xray machine on hand and can not do anything to be for sure in the field, ALS or not.
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Well we don't exactly know how far he fell. Sorry about the confusion. He said he was almost at the bottom but the wife said she heard him fall pretty far but she could have been exaggerating. He had a history of a brain bleed after a fall but it was 10 years ago. he was allergic to coedine. The wife stated he was intoxicated but I didn't smell any thing and his speech wasn't slurred. He was aox4. No loc. He landed on a carpeted floor. he was sitting up when we got there
 
This is one of those scenarios that everyone can over-think And get Monday morning quarterbacked to death. From the scenario that the OP posted, the patient is conscious, alert and oriented. He tripped and fell a couple of steps onto a carpeted floor. Not complaining of pain. Doesn't have any distracting injuries. Sitting up, and probably got up and walked around? He admitted to alcohol, but that's it. Put them on a backboard, put a collar around his neck and take him to the hospital.

If I were the paramedic, after assessing him, taking a set of vitals and ascertaining he wasn't altered in any way and wasn't taking any medications that would cause me to think he might have some issues (like Coumadin) I would send him BLS

Is a paramedic going to palpate his neck or spine any differently than an EMT is? Were his vital signs stable? How long was the transport to the hospital? Do you frequently transport BLS patients from motor vehicle accidents complaining of neck or back pain without a paramedic?

I mean, really guys. At some point we have to let BLS patient be BLS patients.
 
DEmedic said:
This is one of those scenarios that everyone can over-think And get Monday morning quarterbacked to death. From the scenario that the OP posted, the patient is conscious, alert and oriented. He tripped and fell a couple of steps onto a carpeted floor. Not complaining of pain. Doesn't have any distracting injuries. Sitting up, and probably got up and walked around? He admitted to alcohol, but that's it. Put them on a backboard, put a collar around his neck and take him to the hospital.

If I were the paramedic, after assessing him, taking a set of vitals and ascertaining he wasn't altered in any way and wasn't taking any medications that would cause me to think he might have some issues (like Coumadin) I would send him BLS

Is a paramedic going to palpate his neck or spine any differently than an EMT is? Were his vital signs stable? How long was the transport to the hospital? Do you frequently transport BLS patients from motor vehicle accidents complaining of neck or back pain without a paramedic?

I mean, really guys. At some point we have to let BLS patient be BLS patients.
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This is what I was thinking. I was just too lazy to type it all out lol. ALS isn't going to do anything for this patient that BLS can not do.
 
Transport time to closest hospital is 10 minutes and to the trauma center it is 40. We transport most trauma bls. Medics come along when there is loc or ams and life threatening injuries but if the injuries are that bad we usually fly. We very rarely transport with medics all the way to the trauma center.
 
CPRinProgress said:
Transport time to closest hospital is 10 minutes and to the trauma center it is 40. We transport most trauma bls. Medics come along when there is loc or ams and life threatening injuries but if the injuries are that bad we usually fly. We very rarely transport with medics all the way to the trauma center.
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In all honesty, as an EMT if I responded to call, I would have done the assessment followed by backboarding followed by a nice smooth ride to the closest hospital.
 
DesertEMT66 said:
In all honesty, as an EMT if I responded to call, I would have done the assessment followed by backboarding followed by a nice smooth ride to the closest hospital.
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That's exactly what we did. Some people said we should've flown him but I don't think that would have helped him to much a couple broken vertebra are not very time sensitive.
 
DesertEMT66 said:
In all honesty, as an EMT if I responded to call, I would have done the assessment followed by backboarding followed by a nice smooth ride to the closest hospital.
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That's exactly what we did. Some people said we should've flown him but I don't think that would have helped him to much a couple broken vertebra are not very time sensitive. Plus, if he didn't have a broken back, we would have been under fire about why we flew for no reason.
 
There are 9 helicopters in NJ... just fly him, got to justify their existance.

What would the paramedics have done that you wouldn't have? even if he had the fx.... good call cancelling them.

depending on how far the trauma center is, I might have made the drive (dependng on how far and my mood at the time), but I'll be honest, I probably would have done the exact same thing you did.
 
DrParasite said:
There are 9 helicopters in NJ... just fly him, got to justify their existance.

What would the paramedics have done that you wouldn't have? even if he had the fx.... good call cancelling them.

depending on how far the trauma center is, I might have made the drive (dependng on how far and my mood at the time), but I'll be honest, I probably would have done the exact same thing you did.
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We use Atlantic. We probably should have at least drove to the trauma center but it was kind of late and we were tired.
 
No need for medics, no need for chopper.

Lets say you got on scene and knew (somehow) that he had a fractured back and everything else is the same....still

No need for medics, no need for chopper.


what is a medic or a chopper going to do for this patient that you can't (Even knowing about the fracture). Other then a smoother ride in a chopper (maybe) making transport marginally faster does nothing for this guy.

I take him to the closest hospital not knowing, every time.
 
If you palpated back/neck and he didn't go 'ow' and you didn't see deformity/stair stepping you had no reason to suspect a fracture. Trauma center not indicated, unless you wanna rethink the fall height since nobody will give you a clear story, but I dunno if I would have even done that. Transport BLS, enjoy a Mountain Dew afterwards.
 
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"People said", "his wife said"...a new category of "SUBJECTIVE is needed "Bystander Subjective".

Good replies up there!

Never presume someone is "intoxicated" as in drunk; intracranial injury, diabetic ketoacidosis, atypical baseline presentation (status post brain injury recovery, multiple sclerosis, etc), other toxins, or just plain being a jackass can all present like that.
 
Intoxication could be mistaken for DKA, so helicopter was not a bad call.
 
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