Mistake? Should I have backboarded?

[Veneficus]

I have never seen so much focus on a coat before...

Let us think logically about this?

What likely happened? Guy was thrown to the ground with some soft tissue injury.

As the inflammatory process advanced, pain (increased sensitivity, not to mention pain and cold receptors are the same), swelling, loss of range and motion restriction,

Considering the anatomy of how neurovascular tracts run from the upper extremity to the spine, a shoulder injury is likely to aggrivate nerves.

Chronic degenrative upper spinal diseases also manifest similar to this.

Obviously I wasn't there and have no idea what happened to this guy, but if I was a betting man, soft tissue injury described above puts the odds heavily in my favor.

 

[legion1202]

Are=arm.. Sorry for the other miss spellings and grammer

 

[NYMedic828]

4/10 pain.

20 yr old male
thrown to the ground in some snow
hurt his shoulder.
he didn't feel like driving.
He denied neck and back pain and refused us carrying him
I looked over his shoulder, back and neck and didn't find anything.
I hear the pt saying he now thinks something is wrong with his spine.

There is literally nothing in the above that warrants the slightest consideration of backboarding.

He was pushed into snow. Which is natures cushion at that point. The human body, especially that of a 20 year old is designed to fall from its own height. It would take substantial outside force to cause cervical spinal injury which is not present from another human pushing him.

He called an ambulance because he didn't want to drive himself and when he got to the ER he claims spinal injury? Hes playing the game.

I have never seen so much focus on a coat before...

Let us think logically about this?

What likely happened? Guy was thrown to the ground with some soft tissue injury.

As the inflammatory process advanced, pain (increased sensitivity, not to mention pain and cold receptors are the same), swelling, loss of range and motion restriction,

Considering the anatomy of how neurovascular tracts run from the upper extremity to the spine, a shoulder injury is likely to aggrivate nerves.

Chronic degenrative upper spinal diseases also manifest similar to this.

Obviously I wasn't there and have no idea what happened to this guy, but if I was a betting man, soft tissue injury described above puts the odds heavily in my favor.

Can't you be less smart for one day!

 

[legion1202]

Thanks ny..

Thats what i was thinking on scene but i didnt know if because i was tired if i should have done something diffrent.

 

[NYMedic828]

Thanks ny..

Thats what i was thinking on scene but i didnt know if because i was tired if i should have done something diffrent.

Unless some legitimate circumstances present themselves, if a 20 year old told me he called an ambulance because his friend pushed him into the snow and he got a boo boo, but didn't want to drive... I would for lack of a better word consider him a whiny :censored::censored::censored::censored::censored:.

 

[medic417]

Unless some legitimate circumstances present themselves, if a 20 year old told me he called an ambulance because his friend pushed him into the snow and he got a boo boo, but didn't want to drive... I would for lack of a better work consider him a whiny :censored::censored::censored::censored::censored:.

You might do that but then you would transport because you work for a you call we haul department.

 

[NYMedic828]

You might do that but then you would transport because you work for a you call we haul department.

Hate to break it to you but 99% of the US works for a you call we haul agency. Doesn't make the kid less of a wimp.

 

[Veneficus]

Hate to break it to you but 99% of the US works for a you call we haul agency. Doesn't make the kid less of a wimp.

Old school, I like it.

 

[medic417]

Hate to break it to you but 99% of the US works for a you call we haul agency. Doesn't make the kid less of a wimp.

Guess that puts me in the 1% club then.

Wimp or not though if you must transport keep in mind a patient can refuse any and all treatments and all you can do is document the refusals.

 

[Tigger]

1. No, he didn't need a LSB.

2. Epic, epic assessment fail. His jacket should have been removed. It is cold is a crappy excuse. Turn on the heat in the back. Give him a blanket. Have him take his arms out so the coat can be draped over his shoulders.

Sheesh, a "double epic" fail.

I've taken plenty of people that didn't want to take their coat off. Heat in the back cranked up, all the blankets we have, still doesn't matter sometimes. If they want their coat, they want their coat.

If it's raining/snowing and the patient can put on a jacket, we will. Not that hard to take off in the truck and we aren't bringing piles of blankets into the house usually. I don't think most people carry much more than a sheet, bath blanket, and a wool blanket on their stretcher. If it's 14 degrees out that's nothing. If I already assessed them in the house and we are going 5 minutes to the ED there's not much point in exposing them again.

 

[Veneficus]

Sheesh, a "double epic" fail.

I've taken plenty of people that didn't want to take their coat off. Heat in the back cranked up, all the blankets we have, still doesn't matter sometimes. If they want their coat, they want their coat.

If it's raining/snowing and the patient can put on a jacket, we will. Not that hard to take off in the truck and we aren't bringing piles of blankets into the house usually. I don't think most people carry much more than a sheet, bath blanket, and a wool blanket on their stretcher. If it's 14 degrees out that's nothing. If I already assessed them in the house and we are going 5 minutes to the ED there's not much point in exposing them again.

There is a joke in the ICU called "positive glasses sign."

If a patient wakes up, realizes they are not wearing their glasses. Knows they need them, and has the presence of mind and dexterity to look for them and put them on...

The prognosis is very good and discharge likely very soon.

I think deciding before hand you need a coat, despite injury suffer through putting it on, knowing you have to endure the pain again to take it off at the hospital, clearly means you are not hurt that bad.

 

[NYMedic828]

Guess that puts me in the 1% club then.

Wimp or not though if you must transport keep in mind a patient can refuse any and all treatments and all you can do is document the refusals.

How s your service not a "you call we haul" agency?

If the person calls, your job is ultimately to haul them to the hospital like everyone else in America...

 

[abckidsmom]

There is a joke in the ICU called "positive glasses sign."

If a patient wakes up, realizes they are not wearing their glasses. Knows they need them, and has the presence of mind and dexterity to look for them and put them on...

The prognosis is very good and discharge likely very soon.

I think deciding before hand you need a coat, despite injury suffer through putting it on, knowing you have to endure the pain again to take it off at the hospital, clearly means you are not hurt that bad.

Amen.

Also the wet hair sign in EMS. If you have been sick for several days, and feel terrible, but are in clean clothes and have showered recently enough that your hair is wet, I am not terribly concerned and wish you would have ridden to the doctor in one of the 8 cars in the driveway.

 

[NYMedic828]

Amen.

Also the wet hair sign in EMS. If you have been sick for several days, and feel terrible, but are in clean clothes and have showered recently enough that your hair is wet, I am not terribly concerned and wish you would have ridden to the doctor in one of the 8 cars in the driveway.

To quote Vene...

Can you walk?

No...

Have you tried?

 

[Veneficus]

To quote Vene...

Can you walk?

No...

Have you tried?

That was not my quote, I learned it on my first day of EMT class. The instructor who said it is now a fire chief in Ohio.

 

[Tigger]

There is a joke in the ICU called "positive glasses sign."

If a patient wakes up, realizes they are not wearing their glasses. Knows they need them, and has the presence of mind and dexterity to look for them and put them on...

The prognosis is very good and discharge likely very soon.

I think deciding before hand you need a coat, despite injury suffer through putting it on, knowing you have to endure the pain again to take it off at the hospital, clearly means you are not hurt that bad.

Or you are drunk.

99% of the patients I transport are not hurt that bad. I accept it. I then take them to the hospital, because if I do not I will struggle to remain employed. Most people have an alternative way to get to the hospital, but for whatever reason they chose me. I take them because it is easier and it is what they and my bosses want. Hopefully I will not work in such a system for much longer, but for now I see little alternative.

The place I work is pretty aggressive taking 911 backups from the city. In most other places this would be foolish, as the risk of reimbursement is high. But in glorious Massachusetts everyone has insurance, so we are pretty much guaranteed to break even every transport (so I am told). If they have additional insurance, well that's just a bonus.

 

[Veneficus]

Or you are drunk.

99% of the patients I transport are not hurt that bad. I accept it. I then take them to the hospital, because if I do not I will struggle to remain employed. Most people have an alternative way to get to the hospital, but for whatever reason they chose me. I take them because it is easier and it is what they and my bosses want. Hopefully I will not work in such a system for much longer, but for now I see little alternative.

The place I work is pretty aggressive taking 911 backups from the city. In most other places this would be foolish, as the risk of reimbursement is high. But in glorious Massachusetts everyone has insurance, so we are pretty much guaranteed to break even every transport (so I am told). If they have additional insurance, well that's just a bonus.

I agree with you.

I never suggested they did not need, deserve, or should not be transported by ambulance.

I simply stated they are not hurt that badly and their prognosis is good. I guess I should have added it means you don't have to be too broken up about worrying about occult spinal injury and the lack of immobilization.

 

[STXmedic]

You might do that but then you would transport because you work for a you call we haul department.

Glad mines not a haul-all department Take yourself or a taxi. Hell, I'll even give you a "free" taxi voucher...

 

[STXmedic]

How s your service not a "you call we haul" agency?

If the person calls, your job is ultimately to haul them to the hospital like everyone else in America...

Not like everyone else. Mine is certainly not that way. If the tools at my dept are allowed to initiate refusals/no loads, there's no way we're the only ones.

 

[NYMedic828]

Not like everyone else. Mine is certainly not that way. If the tools at my dept are allowed to initiate refusals/no loads, there's no way we're the only ones.

We can initiate a refusal but I don't know anyone who has ever done it because the process is more work and massively more time consuming than just transporting the patient for whatever their nonsense be.