Scenario today.

[mc400]

Called to a teen rodeo event. Pt. was riding a bull and thrown of with the horns hitting his right upper back.

Pt stood up and walked several hundred feet.

-LOC, A&Ox4, Pain in Upper R back with 10" abraision and minor swelling.
Pain in lower back as well. Neg ABD pain, Neg pelvic pain, Neg Neck pain, Neg step-off or deforminties of entire spine.

Vitals 124/82, 122SR, 20 NL clear = bilat neg. pain on palp or insp. 100% RA sat. Pain 6/10 Thinking possible rib fracture/bruising Upper right side.

Pt walked over and got into rescue and sat on the the gurney.
Pt was eposed and evaluated and he did not want to go to the hospital and his mother wanted to take him POV. We convinced her otherwise.

Here is my only question this patient was transported without C-spine precautions, what is everyones thoughts on this? He had no C-spine pain or deformities, walking around not altered, moving head all around on arrival and DNVFx4.

I will tell you the diagnosis after.

 

[reaper]

I would have let mom take him.

 

[socalmedic]

AMA and let mommy take him.

 

[mc400]

T4 compression, L4 compression and perforated bowel.... C-spine wouldn't have changed anything but you never know what someone will say. Still interested in more opinions.

Also the ER was about to discharge him and when he stood up he got lightheaded. They did ortho's and he was like 60/40 BP....

 

[firetender]

This call needs to be looked at in context. The kid was riding a bull. What do you think might be the cultural mores of that? It's like, keep your mouth shut unless your bowels are trailing five feet out your butt!

You are limited in what you can deliver; especially at the scene. If you can get away with transporting, you're actually doing pretty well, after all...

It's a rodeo!

 

[EMT-IT753]

This call needs to be looked at in context. The kid was riding a bull. What do you think might be the cultural mores of that? It's like, keep your mouth shut unless your bowels are trailing five feet out your butt!

You are limited in what you can deliver; especially at the scene. If you can get away with transporting, you're actually doing pretty well, after all...

It's a rodeo!

You couldn't have said this any better. I competed in rodeos riding bulls and bareback horses for 9 years. If someone actually gets a patient in the truck that is not unresponsive, you have some great negotiating skills
It is a pride thing as well as being "tough" to NOT be taken away in the "meat wagon" as we call it.

 

[TransportJockey]

You couldn't have said this any better. I competed in rodeos riding bulls and bareback horses for 9 years. If someone actually gets a patient in the truck that is not unresponsive, you have some great negotiating skills
It is a pride thing as well as being "tough" to NOT be taken away in the "meat wagon" as we call it.

This.
I would personally let the kid ride with his mother.

 

[emtech419]

Cultural context is a whole separate issue from the question of whether C-spine is indicated.

The patient has a mechanism suspicious for C-spine injury and it sounds like there are some possibly distracting injuries. Per my state's protocols, this patient does not meet criteria for c-spine clearance in the field, and our medical director would have jumped on us with a scalpel if we had transported him un-immobilized absent a refusal form.

 

[Veneficus]

Now I have to get involved

Per my state's protocols, this patient does not meet criteria for c-spine clearance in the field, and our medical director would have jumped on us with a scalpel if we had transported him un-immobilized absent a refusal form.

I think that is a bit extreme of a response from the medical director. I think you should directly ask him/her for a clarification on this issue.

All the physicians I have ever I would wager would not advocate fighting somebody to a LSB and c-collar just to say he was immobilized due to suspicion. The potential damage that could be caused by the fault of the provider far exceeds the tenuous benefit of the LSB.

As well, many physicians I know would rather a patient be transported by EMS as opposed to finding their own way if there existed considerable injury potential. The matress on the cot likely does way more for spinal immobilization than a board ever will. A patient willing to come quietly is far better and easier than forcing them to refuse or deny transport because of any single intervention.

There is also the issue that a patient or guardian can refuse treatment in part, but not in whole, or choose to refuse care but not refuse transport. Nobody goes around forcing patients to sign a refusal of care for every intervention they deny. It is simply documented what treatments/procedures were refused and an explanation of consequence was made.

Dealing with a patient's culture is just as much of patient care as any medical procedure.

The cultural respect of a rodeo person is no different than that of a person from various religions, nations, or personal values of any kind.

 

[Mobey]

If he is refusing LSB, then that is your answer.

I have/would just try to resrict movement on the cot, ie: tape head to stretcher.

The fact he had injuries has nothing to do with refusal.

 

[Aidey]

Anyone besides me thing at least one of those compression fractures may have been old?


Edit: Securing the head and not the rest of the body isn't a good way to go.

 

[Mobey]

Anyone besides me thing at least one of those compression fractures may have been old?


Edit: Securing the head and not the rest of the body isn't a good way to go.

Evidence?

The body is strapped down with at least 3 belts (2 + 4 point torso harness here). Then tape down the head.....
How is this any different than using a LSB, other than the pt is spared the added stress/pressure injuries of the LSB.

 

[cmetalbend]

Personally I would have asked the people who witnessed it also. Did he land on his head? Did he get stepped on(bruising might not be present yet), previous injurys, and such. Maybe you did, I dunno. I think that relating to this fella would go along way to getting him to accept transport. "Don't make this your last ride, Cowboy."

 

[medicheil]

CYA....Call Medical command and inform them of the MOI and your findings, have them talk to the patient if possible. If the patient still refuses have him or his mother sign the refusal form. Be sure to document that you informed them of the risks of refusal/treatment/transport, up to and including death. If they sign you fly..bye bye tough guy!!

 

[usalsfyre]

CYA....Call Medical command and inform them of the MOI and your findings, have them talk to the patient if possible. If the patient still refuses have him or his mother sign the refusal form. Be sure to document that you informed them of the risks of refusal/treatment/transport, up to and including death. If they sign you fly..bye bye tough guy!!

The patient and/or guardian has a right to refuse specific treatments but not transport. This isn't an all or nothing deal.

 

[8jimi8]

Called to a teen rodeo event. Pt. was riding a bull and thrown of with the horns hitting his right upper back.

Pt stood up and walked several hundred feet.

-LOC, A&Ox4, Pain in Upper R back with 10" abraision and minor swelling.
Pain in lower back as well. Neg ABD pain, Neg pelvic pain, Neg Neck pain, Neg step-off or deforminties of entire spine.

Vitals 124/82, 122SR, 20 NL clear = bilat neg. pain on palp or insp. 100% RA sat. Pain 6/10 Thinking possible rib fracture/bruising Upper right side.

Pt walked over and got into rescue and sat on the the gurney.
Pt was eposed and evaluated and he did not want to go to the hospital and his mother wanted to take him POV. We convinced her otherwise.

Here is my only question this patient was transported without C-spine precautions, what is everyones thoughts on this? He had no C-spine pain or deformities, walking around not altered, moving head all around on arrival and DNVFx4.

I will tell you the diagnosis after.

Didn't read the replies. One question, what is your agency policy on distracting injuries?

Does it sound like he needed no. But do we definitively diagnose? Do you have spinal clearance protocols in the field?

Are you willing to lose your license over the odd chance that he did have a spinal injury?

No judgement, just bored because no one is posting because they are all watching football.

 

[medicheil]

The patient and/or guardian has a right to refuse specific treatments but not transport. This isn't an all or nothing deal.

Guess it depends where you are from. Even after giving a diabetic D50 and they are A&O x4 and with a family member/friend they can refuse transport..
Unless implied consent applies of course...

 

[Akulahawk]

Having read the whole thread... my thoughts in red...

Called to a teen rodeo event. Pt. was riding a bull and thrown of with the horns hitting his right upper back.

Pt stood up and walked several hundred feet.

-LOC, A&Ox4, Pain in Upper R back with 10" abraision and minor swelling. I'm not that concerned with this unless he landed on his head/neck/shoulder.
Pain in lower back as well. This could very well be a concern, depending upon how he landed. If he landed hard in a seated-like position, I'd be HIGHLY suspicious of L-Spine fractures. Neg ABD pain, Neg pelvic pain, Neg Neck pain, Neg step-off or deformities of entire spine. Vertebral compression FX won't show up necessarily as a step-off. It may show if you use a tuning fork or do some mild tapping.

Vitals 124/82, 122SR, 20 NL clear = bilat neg. pain on palp or insp. 100% RA sat. Pain 6/10 Thinking possible rib fracture/bruising Upper right side.
He's compensating for something. Pain alone normally doesn't kick the HR over 100 or so...
Pt walked over and got into rescue and sat on the the gurney. Given Rodeo Culture, this should be an alarm bell. They may want to go see the Trainer (if there is one) but to get into the RA/meat wagon... speaks volumes.
Pt was exposed and evaluated and he did not want to go to the hospital and his mother wanted to take him POV. We convinced her otherwise.

Here is my only question this patient was transported without C-spine precautions, what is everyones thoughts on this? He had no C-spine pain or deformities, walking around not altered, moving head all around on arrival and DNVFx4. I wouldn't have put him into Spinal Precautions unless I had a strong suspicion of a spinal injury, with a positive mechanism and physical findings that suggest a spinal injury. Remember that "mechanism" can tell you where to look, but not that actual damage occurred...

I will tell you the diagnosis after.

While I wouldn't have picked up on the perf'd bowel... I probably would have pushed to transport him instead of letting him go by POV.

 

[Akulahawk]

The patient and/or guardian has a right to refuse specific treatments but not transport. This isn't an all or nothing deal.

Actually, yes... a patient who is competent (or parent who is competent) can refuse care, including transport. To transport someone who doesn't fit implied consent rules and refuses transport can be considered kidnapping, false arrest, or false imprisonment. Be VERY sure you have authority to take a patient against their will without putting them under arrest...

Your local system might be set up differently, but in mine... that would be a BAD thing to do...

 

[Aidey]

I think you guys misunderstood him, I read that as they can request transport while refusing specific interventions. Just becuase they refuse specific interventions doesn't mean they are refusing to be transported.