Parnter and C-Collars

Jondruby

Jondruby

The PLS of BLS.
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So I occasionally ride with an individual in our ambulance who has been on the crew for quite a while. (5years or so) anyway I am still the new guy although we do have another guy who is newer than me. I have seen this partner put on a C-collar wrong 2 time. The first time she did not put the chin strap up and the mask slid over the PT face, there was another EMT there who say it as well we tried to fix it best we could enroute. Then the last call I was on I got called away to tend to another PT, the driver of the other car, and I helped get this girl PT#1 out of the car her C-collar was wrong as well. Unfortunatly I had to go attend to the other PT before I could intervene. I am bothered by this because, #1 She is an (more) experienced EMT, and I am the new guy and can see that it is wrong. #2 I am concerned for PT care when I am not riding with her. I have not seen any thing other than this, but I keep thinking if she cannot do this correctly and see something is wrong, what other things is she missing when it comes to assessments, trending, etc. I mean last night we had a class and were talking about Peds calls where children will compensate and compensate then crash, which is scary to think about esp, if someone doesnt recognize the symptoms right away. I dont mean to be derogatory to her or anyone else, but it bothers me.
Thanks
 
Next time you are at the station say "hey, I haven't practiced putting a collar on someone in a while, can we try?" It makes it seem as if you are the one who needs tips/pointers and opens it up for discussion.
 
Or you can tell the individual what she's doing wrong. I'm not saying be douche about it, but more along the lines of "hey, I noticed you have done this on a couple calls now. Are you sure it should be done this way and not that way.". I wouldn't say that verbatim but you get the idea. Obviously the place to have this discussion would be at the station or post and not while a call is in progress.

This is just me, but if I was unknowingly doing something wrong I'd sure want to know about it before it becomes a major issue with pt care.
 
Yea, I have to feel it out. Its not that she gets worked up and doesnt think, but even in a calm situation just doesnt do it right. I feel kinda bad because I am the new kid, and C-collars seem like something that an EMT should do unconsciously, I mean in any car crash, fall, or trauma we collar everybody and maintain C-spine. It seems really awkward, she has been an EMT for a long time, longer than I initally thought in my first post. To me not only does it make PT care an issue of concern, but it looks like your service does sloppy work or that you really dont care for your PTs, or that your just a moron.
 
I agree if your going to be putting on a c-collar you should be able to do it properly. And that the time/place to have the discussion is at station after the call....but there's also nothing wrong with removing, fixing, and properly reapplying the c-collar on scene when you see its messed up.

Also I really hope you'renot being 100% literal about every TC, fall, and other trauma patients getting full SMR, 'cuz if all I have is say an ankle injury, that board isn't gonna do me any good...
 
Right and I do try to correct mistakes when I see them and I do not make a scene about it. And no we dont collar and backboard every trauma. Just stuff the relates to head neck and spine injuries, usually someone says their neck/back is sore. Standard precautions tho I would rather collar someone who doesnt need it than not collar someone who does, no matter how significant or minimal the injuries. You dig me?
 
all great comments so far.
1-if you see a collar applied incorrectly, fix it. It takes 20 seconds.
2-talk to your partner after the call, or at the station. No need to make a big deal about it but no reason to through her under the bus in front of her peers either.
3-maybe the company just got new collars and she has been used to applying another type for however many years and simply doesn't realize you have to fold the chin out of these new ones?
 
Jondruby said:
Right and I do try to correct mistakes when I see them and I do not make a scene about it. And no we dont collar and backboard every trauma. Just stuff the relates to head neck and spine injuries, usually someone says their neck/back is sore. Standard precautions tho I would rather collar someone who doesnt need it than not collar someone who does, no matter how significant or minimal the injuries. You dig me?
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I do not.

We put c collars on when it's indicated. A sore neck in itself does not indicate that. Backboards and c collars can cause harm. Spend a little time in the Google looking for articles about Nexus criteria, pressure sores and backboards, and movement caused by extrication techniques. Might be a bit eye opening.
 
Tigger said:
I do not.

We put c collars on when it's indicated. A sore neck in itself does not indicate that. Backboards and c collars can cause harm. Spend a little time in the Google looking for articles about Nexus criteria, pressure sores and backboards, and movement caused by extrication techniques. Might be a bit eye opening.
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So how do you determine when you collar someone? Sometimes a PT who has been in a car accident and is able to move with no direct head/neck trauma we dont collar, but the ER's get bent out of shape when we bring someone in who could've had C-spine injuries and they dont have a collar.
 
Well I did read one article and I am definitely going to read more. The points they made, make sense. Obviously when we took our NREMT clinicals of course backboarding and C-collars were a huge thing. The article I read was basically to effectively immobilize you have to immobilize the entire spine. What does this mean for us now. On our service we have a some who can't and won't keep up with the newest techniques. They know what they learned 20 years ago, and new stuff is foreign, but to get a whole service to revamp what they have been doing for years is difficult. We do have educators come in every month, which would be a good chance for discussion. My question is, are we being "safe than sorry" by taking precautions with PT who we think may have C-spine injuries? There has been times we really did not need a collar, but in class we learned if someone sustains an injury that even leaves a bruise on their head, that person could have C-spine injuries. ??
 
Jondruby said:
but the ER's get bent out of shape when we bring someone in who could've had C-spine injuries and they dont have a collar.
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Excuse my language, but tough feces. Its 2015 and they of all people, doctors and nurses, should be up with the times.

You know who gets a collar? People who have midline neck pain. Mechanism is a terrible indicator of actual injuries When your applying the collar, make sure the chin is fully seated on the step. And if its not applied correctly then take it off and reapply, or leave it off if you dont think its indicated and its your patient.
 
Jondruby said:
but the ER's get bent out of shape when we bring someone in who could've had C-spine injuries and they dont have a collar.
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And they COULD have a mid shaft femur fracture as well, but you don't put a traction splint on every trauma patient do you? Why not? Because they don't show any signs/symptoms of a fracture? So why apply a splint on the neck for only a vague complaint of pain with no other signs/symptoms of cervical damage? You're not being safe, you're doing extra unneeded interventions that current literature no longer supports.
 
Jim37F said:
And they COULD have a mid shaft femur fracture as well, but you don't put a traction splint on every trauma patient do you? Why not? Because they don't show any signs/symptoms of a fracture? So why apply a splint on the neck for only a vague complaint of pain with no other signs/symptoms of cervical damage? You're not being safe, you're doing extra unneeded interventions that current literature no longer supports.
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My go to example is MIs. Yeah they are having trouble breathing, but what if they are having an MI? You can put AED pads on everyone just in case?
 
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