c-collar for 7 month old?

[MedicBender]

Just another example of why Maryland is pretty much only useful as an example of how not to run an EMS system

Amen.


During my rotations at STC you would rarely see anyone under 18 there. With Hopkins fairly close by, STC will tell them to head over to that way.

 

[CANMAN]

Amen.


During my rotations at STC you would rarely see anyone under 18 there. With Hopkins fairly close by, STC will tell them to head over to that way.

My question is what is the matter with the above practice? Also Shock Trauma will gladly see anyone who is 15 years old and up. I am assuming your clinical at STC was a whole 8 hour share day/night in which you got to see less then <50% of the patient population that Shock Trauma sees. The two hospitals are 3.0 miles apart.....Maryland certainly may not be the most progressive EMS state in the nation but between UMMS and Hopkins medical care doesn't get much better. STC has little to nothing with how progressive or not progressive MD protocols are written.

 

[mikie]

I beg to differ...

STC has little to nothing with how progressive or not progressive MD protocols are written.

Dr. Alcorta - state medical director & practicing physician at STC...Are you sure there is no connection?

 

[JJR512]

Dr. Alcorta - state medical director & practicing physician at STC...Are you sure there is no connection?

Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.

I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which is a trauma center).

 

[CANMAN]

Yes, I know where he works, but what relation does him working at Shock Trauma have to do with how progressive the protocols in the state are or aren't. That doesn't make any senes. Trauma care is trauma care. Medical interventions are usually where you find progression in a state EMS system and where MD is lacking. What if he worked at Hopkins? MIEMSS is not an office of UMMS or the other way around. The state protocols are devised by a board of health care practioners from many different systems and facilites.

To help stay on topic, in my experience the only C-Collars that even remotely fit peds patients (correctly) are Miami J Collars.

 

[CANMAN]

Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.

I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which is a trauma center).

Thank you from someone who actually knows what they are talking about and works in the system as do I......Rarely do you ever find backup on this site haha.

 

[mikie]

So it has been a while

Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.

I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which is a trauma center).

It was about ten years ago, check out his little bio at the bottom of the page.

edit: you know what, i maybe confusing myself w/ scalea

 

[CANMAN]

It was about ten years ago, check out his little bio at the bottom of the page.

edit: you know what, i maybe confusing myself w/ scalea

Read it: It says Suburban which is in Montgomery County, not Baltimore. I find it funny that he called is Suburban Hospital Shock Trauma Center because they are far from a top notch trauma care center..... I think you are confusing him with Thomas Scalea who is the Physician in Chief @ Shock Trauma....

 

[JJR512]

It was about ten years ago, check out his little bio at the bottom of the page.

edit: you know what, i maybe confusing myself w/ scalea

Dr. Thomas Scalea is the head guy (not sure of his exact title off the top of my head) at STC.

What might be the confusing factor is the way Dr. Alcorta says he works at the Suburban Hospital Shock Trauma Center. I've seen it written that way both in the article you just linked to as well as a few other places. So if that's what it's truly called, it's a STC, but not the STC, lol.

Thank you from someone who actually knows what they are talking about and works in the system as do I......Rarely do you ever find backup on this site haha.

You're welcome, and I do try to help out where/when I can. However, I do feel I should point out, just for the record, that mikie is actually in the Baltimore area as well. Mikie, are you still in this area?

 

[mikie]

i divert to PM as this thread is about ped's collars.

 

[Tigger]

I fail to see the rationale behind banning the use of carseats for c-spine precautions. Again this come down to sound judgement, if the seat is clearly mangled maybe don't use it? The unforeseen damage argument is silly, if the exterior shows no sign of intrusion, there's not going to be any protrusions in the seat's interior. As stated above, removing the child without excessive movement is going to be difficult.

Here towels and tape are used if the child is not in a car seat and c-spine precautions is necessary. If possible and the child does not need c-spine precautions, we will transport the child in the car seat, which is both safer and more comfortable for the child.


Sent from my out of area communications device.

 

[attnondeck]

right from the NY state WREMAC protocals from 2011.

Do not transport a pediatric patient who meets Major Trauma criteria in the car seat involved in the crash.

 

[Handsome Robb]

Well what is WREMAC's major trauma criteria?

Most all of our trauma criteria are based on mechanism alone, not pt presentation.

 

[attnondeck]

Age < 15 should be transported to the pediatric trauma center.

Glasgow Coma Scale < 14
• Respiratory rate < 10 or > 29 breaths per minute (< 20 breaths per minute if < 1 year old)
• Systolic blood pressure < 90 mmHg (adult) or < (age(yr) x 2) + 70 (pediatric to age 10)

these are the ones that apply.... but pretty much any kid is going to be transported to woman and childrens hospital in buffalo(15-25 min from our district) WHICH IS out ped trauma center...

 

[IRIDEZX6R]

When I was in emt school, my instructor was big on teaching alternative ways to do things. My favorite c-collar replacment is the vacuum splint and tape. works really well. I've had to use it in the field when I couldn't get the pt midline, agonal and extreme pain on movment so I used the vac splint to keep the neck stable in that posistion.

 

[jbrynels]

I have had to immobilize a patient like this one time. The patient was in the carseat, so I cut out the car seat and left the child in, but prior to this I just rolled a towel and curved it around the head in between the head and the seat, it made a great immobilization device and I used tape to hold it in. It was extremely easy to do. The hardest part is that children do not like to sit still, especially infants, especially when they are uncomfortable. But yeah I found it super easy.

 

[hoss42141]

It's fairly standard, guys, the strip of wide tape across the forehead. And it's medical tape, not duct tape.

Not all the time. I have seen "duct tape" used to help immobilize a pt. Yes, medical tape would have worked too, but you grab what is the closest to you. No need to run to the truck to get medical tape if duct tape is closer.

 

[mycrofft]

Hey, argue about people elsewhere...like PM's?

And about the New York thing?:
"Do not transport a pediatric patient who meets Major Trauma criteria in the car seat involved in the crash".

That's because after the accident the car seat is no longer considered safe and needs to be replaced. I think that applies more to LE chucking the kid into the squad car after an accident, but some desk brain applied it to EMS without specifying the circumstances.

Any studies about it? Like the ones about removing football or motorcycle helmets?

 

[BlakeFabian]

C-Spine doesn't necessarily mean using a C-Collar. The goal is to immobilize the head, neck, & back. You're allowed to use whatever you have to in order to accomplish that.

If your Ped collar is too big, go grab a towel & some tape and/or coband.

 

[Calichic]

I like to call duct tape 'Universal Rescue Tape'. Makes me feel better about it haha.

I like that one, In San Diego, Ca..we don't get anything fancy only the nicer areas get the good equipment .. for c-spine we get white duct tape..

kid immobilization
when we responded to a multi pt MVA there were a couple kids involved
1 toddler was immobilized to the carseat towel wrapped around neck and pillows and whatever available to fill in voids and the infant was on a backboard with a t-shirt wrapped around neck for a collar
Kids were not my pts , but thats how I saw the other unit handle it
I have not had a peds yet