Transfer of a Pediatric Patient

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LeclairEMSI

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WHat type of immobilization device would you use if you had to transfer a 2 year old with a nail impaled in the side of the skull? We used a papoose, PD1 aspen cervical collar and tape across the forehead. The medical director stated we should have used a different type of soft restraint. I contacted 2 Pediatric Trauma Centers and could not get a clear answer. Any ideas?
 
Welcome to the site, wrong area to post but I will answer with a question. I too would wonder what more, if the Doc did not like it then I would had asked them what would he had used. Chances are, they would not know either, just rather be able to complain about something.

R/r 911
 
The comments came from the Medical Director who was not even in the ED that day. I spoke with him again and got the typical response from a manager who does not have an answer "You should know what I am talking about." With all due respect sometimes I think the M.D. stands for Mentally Deficient.
 
To me, if it was located up at the side of the head, I would question why such restraint was even thought to be necessary. Remember the purpose of such intervention is to prevent movement of the spine or to restrain a patient who is being completely uncooperative. It seems a little heavy handed to papoose and c-spine the kid for a nail in his head which isn't really an indication for c-spine precautions especially after initial evaluation in hospital.

I would back up your medical director's decision to call you on it and would have brought this case up for audit and review if it had occurred at the services I worked as a supervisor for.

With all due respect sometimes I think the M.D. stands for Mentally Deficient.
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Well, in a lot of cases where people don't understand why their supervisor or medical director calls them on doing something they shouldn't have, they take the same stance you're taking (the same attitude most elementary school kids take: "You're stupid!") when a lot of them simply prove that EMS could stand for "Every Moron Standing" if we judge a group based upon the actions of those amongst us who are a little slow on the pickup.
 
This sounds like a tough but, common problem. I know very few people that like to be "called on the carpet" with QA but, it is there for a reason. It sounds like a judgement call that you now have to stand up and be accountable for. Most medical directors will listen to your theory about why you did as you did.
If he still is not happy ask him/her for a reccomendation on how to deal with this particular case. Any medical deirctor worth their weight would be willing to answer your question. If they provide you with additional grief just explain to them that you want to provide the best care possible and that you are asking for their expert knowledge and experience to make yourself a better EMS provider. Yes it does help to lube up the medical director some times to smooth things out and get your back side out of fire. Just be sure to keep it professional and learn from the experience.
 
Trauma Review

Thanks for all the input. Here is some follow information.

This case was presented at the monthly Trauma Review. Pediatricians, Trauma Surgeons, ED Doctors, RN's, Paramedics and there is still no perfect answer. I stood by my treatment as to "error on the side of caution" and a majority agreed with the treatment provided. A 1 1/2 hour transport in the back of an ambulance, anything could have happened. A follow up call to the receiving Pediatric Trauma Center had positive results. They felt there would be no permanant brain damage. It will still take time to evaluate all the effects.
 
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