Footnote

[mycrofft]

I wonder what the synergistic effects of beer and girls has on perceived pain?

 

[Akulahawk]

I wonder what the synergistic effects of beer and girls has on perceived pain?

While I'm not entirely certain, I suspect that it is definitely related the amount of ice used and seriousness of facepalm applied later...

 

[Medic Tim]

Can't fault you for the truth if you give an honest, full, and accurate description of the risks.



The caveat would be that the Ottawa rule was validated in the ED setting, and applying it on scene may or may not be as accurate. Two good reasons might be that you're not as smart as an ED doc, or that "ability to ambulate since the accident" is one of the rule-ins and you're assessing them much earlier, thus less opportunity to walk. Neither of those seem to apply, since you're very smart, and they ruled out anyway. Still, it hasn't technically been validated for EMS use, unless I missed that study.



A somewhat abbreviated description of all this would be a part of informed consent...

We use the Ottawa rules where I work. A mix of Ambulance and medical clinics. This is the cheat sheet we have posted in my clinic.

 

[Brandon O]

Do you ask 'em to walk if they haven't tried yet?

 

[Medic Tim]

Do you ask 'em to walk if they haven't tried yet?

We ask them the "bear weight" or ambulate if they feel comfortable doing so.

 

[mycrofft]

I used that exact chart to try to cram for my first (and second to the last) Spartan Race.

And trying to walk…talk about rapid results...

 

[Rialaigh]

Let patient know it's probably not broken, see what they want to do.

Hate to agree with the "non medical" answer but basically this. Regardless of whether it is broke or not based on the description and the complaint they don't need an ambulance. They don't need an ER visit. I can give them a phone number for the orthopedic in the area, they can schedule an appointment or head to an urgent care. Save them time, money, and headache...I guess I would even be super nice and do an ace bandage and some ice before they leave.

 

[Medic Tim]

Hate to agree with the "non medical" answer but basically this. Regardless of whether it is broke or not based on the description and the complaint they don't need an ambulance. They don't need an ER visit. I can give them a phone number for the orthopedic in the area, they can schedule an appointment or head to an urgent care. Save them time, money, and headache...I guess I would even be super nice and do an ace bandage and some ice before they leave.

Pretty much what I do. I transport less than 5% of my pts( probably closer to 1%). Most all are treat and release or treat and refer. I get the odd AMA but they are rare.

 

[Rialaigh]

Pretty much what I do. I transport less than 5% of my pts( probably closer to 1%). Most all are treat and release or treat and refer. I get the odd AMA but they are rare.

we are still a fairly behind the times US system. However we are really trying to implement some community programs so as to have referral lists on every ambulance for every conceivable complaint including free clinics, dental clinics, detox places that take Medicaid and Medicare. the whole works...really trying to reduce ER visits and get people to a primary care or specialist that can directly deal with the problem.

 

[Melclin]

Can't fault you for the truth if you give an honest, full, and accurate description of the risks.

The caveat would be that the Ottawa rule was validated in the ED setting, and applying it on scene may or may not be as accurate. Two good reasons might be that you're not as smart as an ED doc, or that "ability to ambulate since the accident" is one of the rule-ins and you're assessing them much earlier, thus less opportunity to walk. Neither of those seem to apply, since you're very smart, and they ruled out anyway. Still, it hasn't technically been validated for EMS use, unless I missed that study.

A somewhat abbreviated description of all this would be a part of informed consent...

Its worse when these rules use "brought in by ambulance" as a criteria. How do you take that in the prehospital environment?

I've used Ottawa ankle rule in the past. Got the cheat sheet in pocket along with the rest of things I can't be arsed remembering. Its usually a moot point though, on account of the need, or lack there of, for pain relief.