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First, I suspect Rebecca's experience is highly atypical. I have
never seen such, and been doing either pre-hospital, hospital or both
since ~1972. One case where the patient, still trapped in the car,
inverted, turned his head and quad'ed himself prior to extrication, but
that's it. I think the alcohol in the older case, and the age
in the younger case that she presents constitute
"distractions". It is interesting that both occurred IN
hospital, not pre-hospital. <br><br>
Second, if a patient is already ambulating, what risk is there in
continuing that some few yards to the ambulance? I suspect so close
to zero as to be negligible. I have been out of pre-hospital for a
while, but when a PHTLS Instructor, we taught standing backboard
application. If this occurred after walking the patient to the
ambulance, I would say all was perfect, no matter how conservative local
protocol might be. If no neck, back pain/tenderness/muscle spasm
and no distracting injury/condition, I would have trouble second guessing
the crew at letting the patient step into the ambulance and
immobilization applied there for transport.. I suspect Pret will be
the expert on this one. <br>
<br>
I have to add that I have actually seen attempts to forcibly restrain
patients for "immobilization". I can't even do sit-ups
without cervical tightening unless I concentrate on it. If a
patient is unwilling to be immobilized, I don't care about
"competency", "refusal", etc. It defies
logic and good practice to FORCE a patient into restraints for
immobilization. This will ALWAYS produce more risk and more
stress/strain on any spinal cord injury than letting them sit in the
"Captain's Chair" and driving smoothly to the hospital.
While documentation and witnesses would be prudent, I think a provider
attempting to force a patient into immobilization who THEN developed
neurologic deficit would be on VERY shaky ground, compared to one who
takes the patient to the hospital without immobilization and has the name
of their crew plus and Fire Department/Law Enforcement who can state that
force would have been required to immobilize. <br>
Lawyer: "Let me get this straight, you thought FIGHTING with my
client to tie him down was in his best interests? If so, why is he
now paralyzed, which started while fighting you?" <br><br>
I understand that there exists, but I have been unable to find, a study
in Germany which compared NO immobilization with FULL immobilization
(including use of NMB) by MD staffed ambulances in different parts of the
country. I am told by a USN corpsmen who saw the data at a class in
Germany that there was NO difference in outcome. Anyone know of
this study? Did it have enough resolving power to mean anything?
<br><br>
Lorick<br><br>
<br>
At 08:45 AM 8/17/2007, rjtucker@peoplepc.com wrote:<br>
<blockquote type=cite class=cite cite="">Anyone else on this list ever
seen the patient who "didn't seem to need" immobilization,
comes into the ER, is turned, x-rayed, etc., only to make one false move
and ends up paralyzed? I have. Twice in my career. One was a 9 year old
girl hit by a car, walked at the scene, and the other was a 48 year old
man who had been drinking and fell down some stairs. Both ended up C4-5
and C5-6 quads. I can also recall one instance where we accidentally
found a C-spine fracture on a MVA victim and C-spined after the fact. He
did well, but in a halo for six months.<br>
Rebecca<br>
----- Original Message ----- From: "Bob Waddell II"
<bobwaddell@bresnan.net><br>
To: "'Trauma &amp; Critical Care mailing list'"
<trauma-list@trauma.org><br>
Sent: Thursday, August 16, 2007 8:50 PM<br>
Subject: RE: Question for the prehospital experts<br><br>
<br>
<blockquote type=cite class=cite cite="">The greater question is,
"what is the ethical considerations for spinal<br>
immobilization?" More and more data showing that we in the US
over<br>
immobilize without medial benefit to the patient. One only has to
look<br>
at the X-game "Boarder" with the WELL documented vertical fall
from 45<br>
ft without any spinal injury. He did have other injuries that
were<br>
treated upon admission to the hospital.<br><br>
All or nothing? A protocol with historical roots that refuses
to<br>
acknowledge evidence based advancements? There are times I
truly<br>
believe (tongue in cheek) that in the days of Sheriff Matt Dillon
they<br>
used coffin lids as a way to carry the shot bad guys up stairs to
Doc's<br>
office. If they lived they came off the coffin lid and went
to jail.<br>
If they died they were carried down to the stable, the died guy and
lid<br>
were quick flipped over and nailed down to the coffin. At some
point in<br>
time a really smart medical person saw all this and decided that the<br>
coffin lids was actual a spinal protective device and history tells
the<br>
rest!<br><br>
Where is the care of the patient in the protocol?<br><br>
Take care,<br>
Bob<br><br>
<br>
bobwaddell@bresnan.net<br><br>
307 920 2020<br>
-----Original Message-----<br>
From: trauma-list-bounces@trauma.org<br>
[<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a>] On Behalf Of Ben Reynolds<br>
Sent: Thursday, August 16, 2007 8:00 PM<br>
To: Trauma &amp, Critical Care mailing list<br>
Subject: Question for the prehospital experts<br><br>
When, if ever is it acceptable for a patient involved<br>
in an MVA to be made to walk from the car into the<br>
back of the ambulance to be boarded and collared? Use<br>
the following example from which to springboard your<br>
answer:<br><br>
21 year old restrained female head on collision with a<br>
stationary vehicle. Airbags deploy. Patient has a<br>
large cut on her head but is out and walking around.<br><br>
Ben Reynolds, PA-C<br>
Pittsburgh, PA<br><br>
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</blockquote>
<x-sigsep><p></x-sigsep>
<br>
</font><font face="Lucida Handwriting" size=3><b><i>LFFox, MPAS,
PA-C<br>
</i></font><font size=2>Fellow, AAPA<br>
CCA, American College of Cardiology<br>
Associate, Society for Critical Care Medicine<br>
Associate, Underwater and Hyperbaric Medical Society <br><br>
</b></font><div align="center"><font size=1>Lorick Fox, MPAS, PA-C<br>
SEAVIN/Peace Vector IV<br>
Unit 64903, Box 1201<br>
APO, AE 09868-4903<br>
(cell) +20-18-230-4448<br>
(landline) +20-45-240-9450<br>
<a href="http://www.lorick.org/" eudora="autourl">www.lorick.org<br>
</a></font></div>
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