Trauma Activation

[abckidsmom]

No TTA.

 

[lightsandsirens5]

I'd keep your guy in c-spine or atleast on the board just for CYA purposes, not that it would necessarily have any benefit ***(crazy world right)***

Understatement of the day right there.

Unfortunately it is very true.



Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.

 

[Trevor]

In my system, we would only activate the trauma team IF he had some type of neurologic sign or symptoms...

In my system we have a pretty liberal spinal clearance protocol... (Based on NEXUS and the Canadian C Spine Rule Study).
I HATE backboarding people, however i do it (and probably more then most of my co-workers) because its the Standard of Care (in my system and assuming they meet some criteria for it)...

Look up this study...Out-of-hospital Spinal Immobilization: Its Effect on Neurologic Injury
Mark Hauswald, MD, Gracie Ong, MBBS, Dan Tandberg, MD, Zaliha Omal; MBBS
1998.

 

[usalsfyre]

So I somehow missed the FACILITY boarded the patient and not the crew. My apologies, I doubt I would have removed them either.

I HATE conventional long boards. With the fire of 1000 suns. Probably because there's zero evidence they do any good, but plenty of evidence of harm. There's nothing "patient centered" about keeping them. If spinal motion restriction is a valid concept (and I have my doubts about that in the conscious patient with acute injury) then you can't convince me we can't do better.

 

[Trevor]

So I somehow missed the FACILITY boarded the patient and not the crew. My apologies, I doubt I would have removed them either.

I HATE conventional long boards. With the fire of 1000 suns. Probably because there's zero evidence they do any good, but plenty of evidence of harm. There's nothing "patient centered" about keeping them. If spinal motion restriction is a valid concept (and I have my doubts about that in the conscious patient with acute injury) then you can't convince me we can't do better.

agreed....

 

[Ramathorn90]

Thanks for all of the feedback guys.

I ended up continuing C-spine precautions on the notion that the Pt was already on a back board with a c-collar and a terribly MacGyvered version of a head bed. I felt uneasy removing him from spinal precautions based on the report given by the Dr and the Pt being a terrible historian. I also took the Pt to the hospital of his choice, without activating the trauma team. My reasoning being that he had been neurologically asymptomatic since the event. And aside from midline lumbar pain, has not had any issues otherwise. However, my concern as to whether or not it should have been a trauma was raised when I had 2 nurses give me baffled looks as to why I brought the Pt to their hospital.

Unfortunately, in my system, we are required to activate traumas per MOI as well. Therefore, any MVA >40mph would be a trauma activation. This has been quite a nuisance for many cases as the belted driver who reports she was driving 40mph but has minimal damage and no complaints greater than an ache would be given the "minor" trauma tag at our local trauma center.

 

[mycrofft]

Ramathorn90, you've been most patient.

Thanks for sharing.

 

[ah2388]

So I somehow missed the FACILITY boarded the patient and not the crew. My apologies, I doubt I would have removed them either.

I HATE conventional long boards. With the fire of 1000 suns. Probably because there's zero evidence they do any good, but plenty of evidence of harm. There's nothing "patient centered" about keeping them. If spinal motion restriction is a valid concept (and I have my doubts about that in the conscious patient with acute injury) then you can't convince me we can't do better.

To the first paragraph...Hey now

as for the second, agree 100%

 

[DrParasite]

Unfortunately, in my system, we are required to activate traumas per MOI as well. Therefore, any MVA >40mph would be a trauma activation.

while that maaaaaay be the policy, it isn't absolute. after all, while the crash was at 90mph, it was 3 days ago.

for example, if I was involved in an MVA in 1998 where I hit the wall divider at 120 mph, and it messed up my knee, and today I'm calling you because my knee is still hurting, would you make me a trauma because of the mechanism?

If the doc puts the patient on a board and collar, unless I have a really good reason, 99% of the time I'm not going to remove it. not that I think they do much, but if someone (MD, FFs, sports trainers, etc) boards someone, it's just easier to leave them on it.

I had 2 nurses give me baffled looks as to why I brought the Pt to their hospital.

because the signs said emergency entrance, and you figured sick and injured people should go there, instead of to the bus stop, the local shelter, Wall Street, the state capital, or McDonalds?

 

[Melclin]

Are you serious?

Have I missed something here? I would get laughed out of the trauma centre if I took this person there and if the case got reviewed, my team manager or CSO would be having words with me.

I wouldn't immobilise this person and to be honest, I'm not even sure he really needs to go to hospital. Maybe I don't get the "urgent care" thing, but isn't this something they could handle and refer to hospital if it was something needing surgical intervention? They don't have xray at the urgent care? This MD sounds like a f**k knuckle to me.

 

[CAOX3]

No board, no trauma alert, no trauma center and he should probably take himself to the hospital to avoid a whopping bill that is going to be determined by his insurance company to be absolutely un warranted transport.

 

[tom.watkins]

If the pt or doc are adamant that they go by ambulance, I'd say a KED just for CYA and pt "comfort". C-spine, pshhh.... We dont need no stinken' c-spine. A definite no-go on the trauma alert, though. Let's save it for when we need it. We have a hospital where I work that is now triaging our reports and determining what to do themselves instead of just listening to us. Guess there were too many wolf cries.... <_<