X-Ray eyes?

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Ops Paramedic

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We often turn out to multiple trauma casualty scenes. Upon arrival you can easily triage 30 patients or more. As recources are limited and x-ray machine are mounted in our busses (if you can get a bus), one has to decide who gets full spinal immobolization, and who stays sitting during transport.

I try to consult with another ALS practitioner prior to clinically clearing c-spine, but is not always possible. We follow an algorythm, which is adopted from hospital (Controlled environment), and use clinical assesment and triage skills to decide. As we all know the risk involved of causing futher damage to an possibily compromised c-spine, there is also the legal aspect, as well as increasing morbidity of the patient. There are also a lot of walking wounded (Green) patients who walk around with c-spine fracture on scene, with out presenting with signs or symptoms of such an injury

Do you clinically clear c-spine pre hospital, and if so what are the deciding factors or do you immobolize each of the patients??
 
Ops Paramedic said:
We often turn out to multiple trauma casualty scenes. Upon arrival you can easily triage 30 patients or more. As recources are limited and x-ray machine are mounted in our busses (if you can get a bus), one has to decide who gets full spinal immobolization, and who stays sitting during transport.

I try to consult with another ALS practitioner prior to clinically clearing c-spine, but is not always possible. We follow an algorythm, which is adopted from hospital (Controlled environment), and use clinical assesment and triage skills to decide. As we all know the risk involved of causing futher damage to an possibily compromised c-spine, there is also the legal aspect, as well as increasing morbidity of the patient. There are also a lot of walking wounded (Green) patients who walk around with c-spine fracture on scene, with out presenting with signs or symptoms of such an injury

Do you clinically clear c-spine pre hospital, and if so what are the deciding factors or do you immobolize each of the patients??
Click to expand...

Okay, I might not know Africa's system, but seriously you have x-tay machines in the back of your busses (transit systems) or EMS units? Why as well and whom reads and inteperts them? Wow what a delay!

Also routinely triaging 30 people?

C'mon it's not April 1'st is it?

R/r 911
 
Even with standard X-ray it is hard to clear the C-spine in some cases. If the patient requires a head CT for trauma, they also get a CT of the C-Spine.

Are you shooting both AP and lateral in the field?

Do they get another set done again in the hospital?

Is there a physician present at these scenes?

If you are clearing the C-spine, how many hours of training for shooting AND reading the X-rays?
 
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Apology

I have to apolize for that one to rid and vent. It was intended as sarcasm to try and get the point across. NO, for sure we don't have X-ray machine in the back of our busses. The closes we get to any fancy hospital equipment mounted pre hospital, is that there is a service which has one or two busses fitted with an ABG machine, but those are reserved for interfacility transfers.

As for the 1st of April, well then i guess i have a lot of 1st Aprils in my my year. Our taxis, are not like your yellow sedan type cabs. We have what they refer to as minbusses. The manufacturer recomends a total of 12 passenger & a driver. These taxis move a lot of the workforce around, and is often the only means of transport, hensce loding them up with up 22 passengers. These vehicles are only equipped with 2 safety belts, and then sorry for the rest. They are in a poor state of roadworthyness and often uses a wrench as a steering wheel, or tie the brakepads together with a piec of wire. Tyres are aslo driven onto the steel radials.

This and having no respect for traffic regulations and laws, makes them more prone to being involved a traffic accident. No if you get collidng with each other you can easily sit with 40+ patients. The majoraty of the time they present with minor injuries to there lower legs (Seat Configuration), but you will for sure get them where you a few red code patients, amungst some blue code patients. Delay, hmmm, that varies alot, but to wait 45 mins for an ambo is not unusual, and you can imagine you have two of these taxi accidents on the go in nearby areas.

To reply to vent with regards t the x-rays, as said we don't have them pre-hospital, nor do have physcians on the road. There are a few ER Drs for a few services on the road though. We don't routinely check the x-ray of the patient during an interfacility transferdue to the training. It has only recently become of one of our training course's curriculum, and even them it is only a chest X-ray and still very basic in nature when compaired to radiologist.

I hope sincerely that you accept the apology as well as furhter info supplied.
 
We do have some big mobile units equipped with everything that can respond to disasters and MCIs. They can set up a mini hospital, do surgery and many diagnostics. Carolinas Med Center (North Carolina) has one of the largest units. There are a few smaller units around the country.

A few doctors in South Florida also have mobile offices that can do X-rays and labs on home bound patients.
 
Ops, thanks for the clarification. As far as your first post on clearing C-Spine prehospital, it depends on the service you work for. For the ground service I work for part time, they need to have minimal mechanism of injury (minor damage to vehicle with no rollover or ejection), no LOC, no neck pain/tenderness, and pulse/motor/sensory must be intact to all 4 extremeties. If we have ANY one of these, or even just a high index of suspicion of injury, me must package.

Hope this helps
 
SA Triage

I would have to say that is similar to yours, whereby the first highest medical practitioner is the triage officer, and IC. He will then later on be replaced by someine with a higher qualification as they arrive.

For the patients, we have what we call: P1 for priority 1 (Should be your Red code patients), and then P2 (Your yellow/orange code) and the P3 (greencode). Our P4 patients are your blue codes. We used to use the colour black for them, but it was changed to blue, as it had racial connetations. I have seen some of those triage tags where you tear it of until you get to the appropriate colour and tie it to the patient for other to see, we dont use them. We use a permanent marker and indicate on the patient's hand his priority for others to see.

In general, it is safe to say that the patients who are walking around are the P3s or walking woundeds, those lying down and can verbally communicate are the P2s and those lying down and not responding are either P1 or P4. How to distinguish between the P1 and the P4... if the patient is breathing and has pulses present, and he is P1. He may also be turned lateral by the triage officer at this stage to at least give him a fighting chance until you can come back or have the recourses to treat him. The P4 presents with with no pulse. All this is done without the use of any equipment except for PPE. As help arrives or you are finish with your triage, you can allocate practitioners accordingly, or start treatin them yourself.
 
It does not seem true that we can have 30 odd patients at one time. Especially on our highways we get a lot of taxi accidents and patients count up!

We do not always have a choice in clearing c-spine pre-hospital. It is a tricky situation as our resources are limited, but nevertheless we have to. The problem comes in that not everyone know how to clinically clear a c-spine.

I have seen it done numerous times and we covered it in our training, but I have seen doctor's miss fractures on xrays!!!

Generally if they walk around on the scene its a mass casualty, provided the dont have any facial, head or indicative injuries they will be one of those sitting in the ambulance.

One thing I could never understand is medics putting on c-collars on the patients that walk around on scene and leave them...
 
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