"Non-Injury" Traffic Accident

[Ewok Jerky]

Whoops. Looks like I missed a word in there. I meant to say without stopping.

Inspecting the cars and talking to parties involved can simply be a "person not a patient" scenerio. That is due diligence. But calling it in without even stopping?

 

[DesertMedic66]

If it looks BS or we were just driving and we saw it we will normally stop and roll down a window and ask, unless we need to do traffic control.

 

[Tigger]

I forgot I posted this oops. In any case I posted this after getting into discussion with my partner about how I would have been comfortable writing a refusal on this patient after a quality assessment and some time discussing the advantages of being transported. My partner was absolutely adamant that this patient had to be transported. He was also pissy that I didn't start an IV "since you know the hospital is going to call a trauma alert." I figure it's not my issue that our less than adequate facility is going to call a team on this guy with no complaints, so I am not going to go looking for them.

You did 12 cranial nerves?

12 (well technically 11) point cranial nerve exams are very popular round these part. One AMR CES employee got people to start doing them and kaboom, now everyone in the region does them. There's no rhyme or reason as to when or why, just a "hey why don't you do one on him." Sometimes I just do as I am told.

 

[Pond Life]

75 year old male - am I joking about him possibly having arthritis - no. Am I joking about him possibly being on meds and so on which may mask alterations in his vital sign, nope again.

End of this year we in the UK will be adopting new criteria beyond CCSR and Nexus to allow us to ask patients to self mobilise onto stretchers from RTCs (MVAs) even if they have bony tenderness (as long as there are no red flags elsewhere). With this scope of practice comes an increased responsibility to look beyond the obvious which I think you are missing.

Insight into pre crash phase has been around for donkeys years and is applicable now as ever.

75 year olds are prone to fractures and if you believe this not to be the case I suggest you have a chat with your medical director and see have s/he thinks.

 

[Ewok Jerky]

...except this patient isnt presenting with any signs of acute fracture, spinal injury, or hemorrhage. Arthritis is not an acute condition requiring any special imobalizaton after a MVA or during transport.

The biggest concern for this fellow is some sort of hemorrhage, most likely in his arm, leading to compartment syndrome. What is the ED going to do? Nothing that he can't do at home with some proper education.

I would have to look back but I don't think anyone is saying absolutely no reason not to transport, but if this guy wants to AMA I wouldn't fight him hard on it, provided he is aware of the risks of pradaxa.

 

[Pond Life]

apologies, got the wrong end of the tread in that case.
Agreed if the patient has capacity and demonstrates such then it's his right to decline ED AMA. In fact to force him is assault/battery, certainly in the UK and I'm sure it's the same across the pond.
again - apologies

 

[TransportJockey]

apologies, got the wrong end of the tread in that case.
Agreed if the patient has capacity and demonstrates such then it's his right to decline ED AMA. In fact to force him is assault/battery, certainly in the UK and I'm sure it's the same across the pond.
again - apologies

No worries. I can see now why you posted what you did, since you read the beginning and didn't quite make it to the end lol. You're very right that we do not force patients who can decide for themselves into a treatment modality.

 

[Brandon O]

...except this patient isnt presenting with any signs of acute fracture, spinal injury, or hemorrhage. Arthritis is not an acute condition requiring any special imobalizaton after a MVA or during transport.

Ankylosing spondylitis might be!

 

[ERDoc]

As others have said, if you properly assess the patient and explain your findings with him and he refuses, as long as he has the capacity, you can't make him go. I would agree that he probably needs to be checked out in the ER but you can't force him. OP, it sounds like your partner made the decision to force the pt to go but you were the one in the back. If your partner was so adamant about it, why didn't he run the call?

 

[Tigger]

He had somewhere to and it was a late call. Normally I make him take the patient in these sorts of situations.

 

[ERDoc]

No offense, but it sounds like you need a better partner.