Went on a call to a reported fall. Upon arrival found a 35 y.o male who reportedly fell from unknown height in warehouse. Found pool of blood, and broken teeth at sight of fall. Located next to shelves that go approx 25' high. Pt was AAOx2. BP 145/90. HR: 140, everything else who. We started c-spine precautions, medic arrived and told us to remove collar and lift pt onto gurney. I'm not playing Monday morning qb, but is this the right call given situation?
No C-Spine... Right call?
- Thread starter Zredmond
- Start date
EMSComeLately
Forum Crew Member
- 85
- 21
- 8
No...for our selective spinal protocol, GCS under 15 and patient inability to take role in their care to describe pain, location, etc., would buy a board.
Jim37F
Forum Deputy Chief
- 4,331
- 2,922
- 113
First and foremost what do your protocols say? Are they a hard and fast "You will board and collar these patients" with no consideration to actual patient condition, or does it give you leeway to decide different levels of SMR based on patient assessment (I.e. full board and collar, collar and position of comfort on gurney, neither, etc) What follow on assessment did the medics do? What was the distal CMS in all four extremities? Was the patient moving around at all, attempting to sit/stand up? Any other injuries besides the broken teeth, where was the bleeding from? How well was the patient tolerating the collar to begin with? (We once had an auto vs. scooter patient we put in a collar, and he immediately began gagging so we took it off)
FWIW a trauma patient here, with a fall greater than 15 feet, head injury, and ALOC would get a full board and collar and transport to the local Level I or II trauma center (depending on which one is closer), but LA Co SMR policy is still a bit more restrictive than a lot of other places lol
FWIW a trauma patient here, with a fall greater than 15 feet, head injury, and ALOC would get a full board and collar and transport to the local Level I or II trauma center (depending on which one is closer), but LA Co SMR policy is still a bit more restrictive than a lot of other places lol
TheLocalMedic
Grumpy Badger
- 747
- 44
- 28
I guess my question is in regard to the "unknown height". Does that mean he could have fallen from something up high? If he was next to those high shelves, he's ALOC (and the tachycardia is interesting too) I would think that would buy him a board.
I was with fire, and a third party ambulance showed up for transport. That's when the medic took off our collar.
I definitely agree, but defined wasn't going to question a medic.
Anjel
Forum Angel
- 4,548
- 302
- 83
Sometimes medics need to be questioned, but at an appropriate time and place.
He would of got a collar from me. Not a board.
Thank you for the input. I agree on at least the collar. I realize we are human beings and we aren't perfect.
BOS 101
Forum Crew Member
- 54
- 9
- 8
honestly, with him being altered and a possible moi like that(blood and teeth on the ground) i would have done full c-spine and ignored the medic
Sorry medic, but thats just a risky call for the patient, and just plain stupid really given the circumstances
Not even a collar? foolish, remember paramedics are individuals, some arent very good, cuz theyre lazy or stupid, same with police, nurses or whatever
they give everyone else a bad name, so we should stop them from making those calls (appropriately), and making us look bad
DesertMedic66
Forum Troll
- 11,316
- 3,488
- 113
So if the medic said "hey guys let's not c-spine him" you would have said "too bad, I'm still going to c-spine hime" regardless of the fact that the medic has more training that yourself, and that in thr majority of systems the person with the highest medical training is in charge of patient care? Ooh man, you would have a wonderful time if you did that in the majority of systems (by wonderful I mean calls to your supervisors, write ups, and whatever else could be thrown at you)
CALEMT
The Other Guy/ Paramaybe?
- 4,541
- 3,370
- 113
Same here. With the new spinal immob. protocols they have to meet one of the NSAID requirements. I'm fine with a collar and a position of comfort. But if the medic downgrades then so be it, his decision, his license/ p-card on the line if anything happens.
- 4,520
- 3,243
- 113
You might make an argument against placing a c-collar to begin with, but why on earth would you remove one that someone else already placed?
That medic sounds like one of those paramedics that gives EMS a bad image.
That medic sounds like one of those paramedics that gives EMS a bad image.
That kinda left a bad taste in all of our mouths. The other firefighters and myself were incredibly confused, but we just packed up and went on our way. Plus the tachycardia really doesn't show this guy is in good health
Just for my own knowledge, the controversy isn't over collars, it's over LSBs correct?
Amelia
You're stuck w/ me now (insert evil laughter here)
- 457
- 86
- 28
If his teeth were smashed in, he hit his head. Hit the head, you crank the neck/spine..... and when in doubt immobilize. And who tells you to take a serious precaution off once its been placed?! Uggg.... I hope the guy is ok.
CALEMT
The Other Guy/ Paramaybe?
- 4,541
- 3,370
- 113
Correct.
LACoGurneyjockey
Forum Asst. Chief
- 778
- 437
- 63
Dat MOI doe...
So you know better than everyone else ever on scene with you? When there is a paramedic with a higher level of education than you, you do what you wanna do because you're right and JESUS LOOK AT THAT MECHANISM!
If you tried that with me you'd be kindly asked to leave my scene, and I'd have your supervisor on the phone. You're ridiculous. Not your patient, not your call once there is a higher level of care on scene.
Do you go around stopping "lazy and stupid" cops too?
BOS 101
Forum Crew Member
- 54
- 9
- 8
Well to put it simply, im just being passionate
Obviously I know that the medic has ultimate final say BUT it is obviously stupid to not take cspine precautions here
I would bug and bug the medic as much as I could before I went with it his way, and even then I would talk to his boss afterward
Im not stupid, I realize it wouldnt be beneficial to sit and argue on scene either, but If you think no cspine here is smart, or that this medic is defendable, please show me how
BOS 101
Forum Crew Member
- 54
- 9
- 8
Ok so you seem a little personally offended, not sure why
And, its not an over reaction, If a guy possibly fell over 20 feet and landed on his head is that not a big deal??
The kind of big deal that cspine precautions freaking exist for?
ME ridiculous? You are ridiculous, If you dont think I'm right that he needs cspine, quite frankly you're foolish
This whole "MOI means nothing" thing that people pull seems to have gotten out of hand
I dont have some massive ego, nor think im always right, but i know how to take care of a patient, and I would urge the medic in this case to change his tune if possible or talk to his boss
Dont be so ridiculous yourself, you act like you're 12 geez