Lifting patient with possible dislocated shoulder

akflightmedic said:
You are asking about a better way to lift/carry/position a patient who is heavy (190 pounds), has a flight of stairs involved, already injured and elderly....and part of the plan was to wave off ALS due to patient denying any pain control (at that time)? Was any consideration given that more manpower or a different perspective would be a benefit? Just sayin...you had tools at your disposal and decided to not use them.
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We had a full engine company on scene so manpower wasn't an issue. This was more an exercise to see how others would approach this situation and I have to say there have been a lot of helpful insights.

For some reason I thought that all patients had to be packaged up for transport, so in this case a stair chair, scoop stretcher, etc. A number have commented on the other ABC (ambulatory before carry) and after checking the NH protocols I couldn't find anything related to that. In this particular case would there be any concerns to injury further by the patient moving herself with assistance down the stairs and out to the ambulance? I'm just thinking of the risk/reward if she fell or something (accidental) during the walk between floor and ambulance.

Thanks all for the feedback!


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SpecialK said:
We have the following non-opiate pain relief:
Paracetamol
Ibuprofen
Entonox
Methoxyflurane
Ketamine

Opiate or opioid medicines:
Tramadol
Fentanyl
Morphine

Most patients who reckon they are "allergic" to morphine have just had a bad experience on it, and it is not true allergy.
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I checked the NH protocols and most of the non-opiate drugs aren't listed in our paramedic protocols with the exception of Ibuprofen and Ketamine (looks like it's only in the RSI protocol vs pain management). I know this is only at the BLS level but is there a contraindication to give ketamine to a patient which would then act as a sedative? Or is the dosing such that you can just take the "pains edge off" without altering their mentation?


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If the patient can stand and walk, and walk down the stairs themselves, no need to risk hurting yourself doing unnecessary work. We'll have someone walk down behind the patient, and someone walking down in front facing the patient (with a firefighter behind them, going down the stairs first, just to make sure they don't trip over backwards).

NOW, if you stand the patient up, and they get dizzy or woozy or otherwise don't feel good, and/or they're stutter stepping or wobbly on their feet, or anything else that makes you go "I don't feel comfortable having this person walk down under their own power" then yeah, get the stair chair. For an upper extremity injury I don't see any reason they can't go in the stair chair vs. being carried on a flat/scoop.
 
Pillow or two under armpit, pillow on the outside, secure it with the sheet. Even if she was walking wounded, you wouldn't want her to walk down stairs just in case. Whether the use or stair chair or scoop was more appropriate is on you, you kno the scene better than us.
 
OCemt86 said:
Pillow or two under armpit, pillow on the outside, secure it with the sheet. Even if she was walking wounded, you wouldn't want her to walk down stairs just in case. Whether the use or stair chair or scoop was more appropriate is on you, you kno the scene better than us.
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In case of what?
 
OCemt86 said:
Pillow or two under armpit, pillow on the outside, secure it with the sheet. Even if she was walking wounded, you wouldn't want her to walk down stairs just in case. Whether the use or stair chair or scoop was more appropriate is on you, you kno the scene better than us.
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So you never let patients walk?
 
Keep in mind too; it's a transfer home. What's the plan for self-care and getting around the house. If she's not safe to walk up stairs, she's probably not safe to discharge home.
 
WolfmanHarris said:
Keep in mind too; it's a transfer home. What's the plan for self-care and getting around the house. If she's not safe to walk up stairs, she's probably not safe to discharge home.
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HUH? Where did you get this was a transfer home?
 
And even if (magically) it was a discharge home, do you feel confident enough to call out the doc who signed the PCS ?
 
Qulevrius said:
And even if (magically) it was a discharge home, do you feel confident enough to call out the doc who signed the PCS ?
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Is it calling out or just making sure the PCS was signed for the right patient? It would be unusual to discharge an actual shoulder dislocation.
 
It is our job to make sure the discharge papers are present and in order, but it is the doc's job to make sure that he/she has a good reason to discharge the patient. So whilst I personally feel comfortable with x2-checking and making inquiries, there's less than a zero chance I would openly question the doctor's decision.
 
Qulevrius said:
It is our job to make sure the discharge papers are present and in order, but it is the doc's job to make sure that he/she has a good reason to discharge the patient. So whilst I personally feel comfortable with x2-checking and making inquiries, there's less than a zero chance I would openly question the doctor's decision.
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I suppose it's all about context. At our local hospital we will happily talk to the doc if we think a discharge home is not appropriate without more care than has been around. They want to know that sort of thing, some times they don't get the whole story and if our crews are out at that patient's residence a lot we can provide additional insight.

Tact matters.
 
Tigger said:
I suppose it's all about context. At our local hospital we will happily talk to the doc if we think a discharge home is not appropriate without more care than has been around. They want to know that sort of thing, some times they don't get the whole story and if our crews are out at that patient's residence a lot we can provide additional insight.

Tact matters.
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I understand where you're coming from. We do not interact with doctors too often. It's mostly due to procedural constraints, since our primary hospital contract works through company rep who handles the paperwork before we even show up on scene. And if it's a 911/ER dropoff, we still do the usual triage nurse/MICN thing and if the doc suddenly shows up, we simply restate the report.
 
Qulevrius said:
It is our job to make sure the discharge papers are present and in order, but it is the doc's job to make sure that he/she has a good reason to discharge the patient. So whilst I personally feel comfortable with x2-checking and making inquiries, there's less than a zero chance I would openly question the doctor's decision.
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Not here. My role is to advocate for my patient. Hospital staff often do not have a complete picture of the living conditions or social determinants of health. I have brought transfers home and then turned around to hospital as the living situation was so precarious as to be dangerous. We then engage with the Geriatric Emergency Team at the hospital, social services and home care to ensure that the patient has the right resources in place. This is a rare occurrence as social work is typical a key player in discharge planning here.

I do love my socialized single payer health care system of which Paramedic Services are becoming an integral part.
 
Ketamine.

But if she doesn't like the effects of opiates she probably won't life the pain management effects of ketamine either.

With that said she probably won't care while she's on the ketamine anyways so it's a moot point.

As far as getting her off the floor without hurting her shoulder. Use a sheet or a mega mover that's folded long-ways a couple times. Slide it behind her down near her waist then around to the front, cross it and then pull. Pops them right up and doesn't put pressure on the shoulders.


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