GSW/Stabbing Immobilization

[Tigger]

Nope. No spinal motion restriction without neurological signs and symptoms.

We aren't required to spinal these patients by protocol either, thankfully.

Protocol says "Consider spinal motion restriction if indicated"

I want to know how many people have protocols like yours and mine (which covers all of Massachusetts), yet still say "protocols require us to spinal." It seems to me that there are many out there (not specifically you AnthonyM83!) that through lack of education, fear the worst and spinal everyone and therefore can only hope to justify their actions with their protocols. Just because it's mentioned in the protocols, does not not mean you have to do it, unless it specifically says you must. Most treatments are to be given when indicated.

Beside.

And I bet his wasn't moving much with that pelvis. Ideally, you'd use the scoop to get him onto the stretcher and just transport. I would make sure he laid as close to flat as possible, though.

It seems to me that having someone properly strapped to a scoop, along with proper stretcher seatbelts, would sufficiently prevent the patient from moving in such a way to cause the bullet to move within the body no matter where it lies..

 

[Brandon O]

I want to know how many people have protocols like yours and mine (which covers all of Massachusetts), yet still say "protocols require us to spinal."

It's not what it says; it's how your medical director, CQI people, and basically your "boss" interprets it. And in Mass. it's broadly interpreted to mean "board everyone on the list."

 

[Pavehawk]

It's not what it says; it's how your medical director, CQI people, and basically your "boss" interprets it. And in Mass. it's broadly interpreted to mean "board everyone on the list."

What he said!!

All the science in the world will not trump the system. Until the system changes or until you are an MD calling the shots it is going to fall back on protocol and standard of care.

Once there are enough legal decisions validating the medical literature, for the most part spinal immobilization will be done "even when not needed" because the fear of litigation is too strong.

 

[NYMedic828]

NYC requires us to immobilize any penetrating trauma to the thorax.

It sucks.

 

[Tigger]

It's not what it says; it's how your medical director, CQI people, and basically your "boss" interprets it. And in Mass. it's broadly interpreted to mean "board everyone on the list."

I still maintain that much of it is done in fear of the CQI and at times the medical director though I do not have an especially active medical director at work. I've had discussions with our Quality Assurance director about these sorts of things, his point is just to be able to justify your actions. However it would seem that many are afraid to justify their actions or *more likely* in a predominantly IFT setting it is common to "over-treat" patients when the opportunity presents itself to, er, do EMT type things.

 

[Brandon O]

I've had discussions with our Quality Assurance director about these sorts of things, his point is just to be able to justify your actions.

Those discussions are smart to have before the event, although frankly, if it's not obtained in writing, it may end up having "never happened."

 

[Akulahawk]

Penetrating trauma, absent any signs of spinal compromise, will not have any spinal restriction applied by me unless I absolutely have to do so... as in my protocols leave me no wiggle room. I may have to place the patient in some kind of movement restriction if I have to intubate, to decrease the chance of extubation, but... that's not specific to penetrating trauma of a high speed or low speed variety.

 

[DrParasite]

All the science in the world will not trump the system. Until the system changes or until you are an MD calling the shots it is going to fall back on protocol and standard of care.

Once there are enough legal decisions validating the medical literature, for the most part spinal immobilization will be done "even when not needed" because the fear of litigation is too strong.

BINGO!!! I can quote studies, I can show data, but as long as protocols say to board them, despite evidence to the contrary I still need to board them. And if i don't, than the question of "well, when the lawsuit comes, and your intervention isn't up to the standard of care, and now the person is paralyzed, what will you do?" the fact that the patient was paralyzed before we got on scene is completely irrelevant....

That all being said, I think almost every penetrating trauma I've seen has been on a board. more often than not, they get carried from wherever they get picked up on a board, onto the cot, and transported to the trauma center. it's used as a carrying device, not an immobilization device.

 

[Tigger]

Those discussions are smart to have before the event, although frankly, if it's not obtained in writing, it may end up having "never happened."

Very true. While I trust that my bosses will generally look after their staff, I do not trust that they will choose defending me over being involved in any sort of potential law suit. Even with these conversations, there is no way to talk about every potential situation, so even if it were in writing, such discussions are unlikely to any actual incident by either side.

 

[mycrofft]

If you follow protocol and board them and they die of positional asphyxia, you're in trouble but not for failing protocol.

If you don't follow protocol and they don't die for whatever reason, especially not due to iatrogenic ones related to long spine boards, then you are in trouble maybe for not following protocol but the pt is alive, maybe because you used judgement.

A good documented PCR with the indications for what you do will be your saving grace if there are any.

 

[Brandon O]

the fact that the patient was paralyzed before we got on scene is completely irrelevant....

Well, generally a claim of negligence requires actual harm to be inflicted, so if you can demonstrate that you caused none you may be okay. Of course, you don't get a judge and jury when it comes to your employer or certifying agency.

 

[Christopher]

If by 2012 you're still performing spinal immobilization based on MOI alone just tear up your certification...you're not treating patients you're just pushing a button on a machine.

Using MOI with no other indications is no different than using information provided by a 3rd party caller to 911 as a reason to board and collar somebody.

MOI without any signs of deficit is nothing more than hearsay.

 

[Tigger]

If by 2012 you're still performing spinal immobilization based on MOI alone just tear up your certification...you're not treating patients you're just pushing a button on a machine.

Using MOI with no other indications is no different than using information provided by a 3rd party caller to 911 as a reason to board and collar somebody.

MOI without any signs of deficit is nothing more than hearsay.

Testify brother oh testify!

If only the absentee medical directors of the world could be made aware of this.