Mistake? Should I have backboarded?

[STXmedic]

Our guys probably overuse it (pisses me off sometimes), but it's not at all difficult. As simple as "Have your spouse drive you and sign here."

 

[medic417]

How s your service not a "you call we haul" agency?

If the person calls, your job is ultimately to haul them to the hospital like everyone else in America...

Actually no. We have the right to say no to transport. We actually can treat the problem if they need treatment then tell them no to ambulance transport. Just because they call and request ambulance transport does not mean they get transport.

 

[mycrofft]

In this case, LSB not needed 99% probably. If I recall, pt was intoX and had "an alcohol-like odor", so that affects everything including pharmacy.

OP, did good with VS and etc. We can't always say NO, and it's not our job to sort out Munchausens when neuro departments have trouble as well.

Schelp em into the ambo and think of England.

EDIT: word was supposed to be "INTOX"

 

[NYMedic828]

Actually no. We have the right to say no to transport. We actually can treat the problem if they need treatment then tell them no to ambulance transport. Just because they call and request ambulance transport does not mean they get transport.

Must be nice...

In NYC it's damn near a mortal sin to so much as tell the patient you don't think they need an ER.

 

[medic417]

Must be nice...

In NYC it's damn near a mortal sin to so much as tell the patient you don't think they need an ER.

Most services have that same philosophy and yet wonder why people abuse ambulance use.

 

[NYMedic828]

Most services have that same philosophy and yet wonder why people abuse ambulance use.

Everyone is under the impression that by suggesting the patient could just sleep it off and see a private doctor the next day that they are liable for anything that happens in their absence after leaving.

At a minimum it would be quite difficult in a court of law to prove anything the patient claims a provider told them. It's he said she said and no documented proof but what we write on the report.

 

[mycrofft]

Everyone is under the impression that by suggesting the patient could just sleep it off and see a private doctor the next day that they are liable for anything that happens in their absence after leaving.

At a minimum it would be quite difficult in a court of law to prove anything the patient claims a provider told them. It's he said she said and no documented proof but what we write on the report.

"Sleep it off" has particular dangers. Other conditions can mimic alcohol intoxication, and even ETOH can get you dead through respiratory arrest, aspiration/airway embarrassment while unconscious, wandering into danger when in toxic psychosis or withdrawls DT's, or other intoxications. Jail medical screenings arose from dead diabetic in Booking area holding tanks.

 

[NYMedic828]

"Sleep it off" has particular dangers. Other conditions can mimic alcohol intoxication, and even ETOH can get you dead through respiratory arrest, aspiration/airway embarrassment while unconscious, wandering into danger when in toxic psychosis or withdrawls DT's, or other intoxications. Jail medical screenings arose from dead diabetic in Booking area holding tanks.

I was referring more to the person who called EMS because they stubbed their toe or have a cold for more than a day...

 

[mycrofft]

I was referring more to the person who called EMS because they stubbed their toe or have a cold for more than a day...

Gotcha. I liked those who went to sleep drunk/high and woke up with unbearable back pain about 2 AM.

 

[Outbac1]

I see nothing in the OP to indicate a LSB etc. To walk a pt 200yd to the amb in winter, and I believe in the ABCs, I would hope he wants his coat. It's not a big deal. Put the injured arm in first or wrap the coat around him and zip it up. Please step this way and mind the ice and snow.
A suggestion for someone else to drive him may be made but if they want to pay the bill...

 

[NYMedic828]

I see nothing in the OP to indicate a LSB etc. To walk a pt 200yd to the amb in winter, and I believe in the ABCs, I would hope he wants his coat. It's not a big deal. Put the injured arm in first or wrap the coat around him and zip it up. Please step this way and mind the ice and snow.
A suggestion for someone else to drive him may be made but if they want to pay the bill...

Where did the two football fields come from?


Side note, where I come from the bill more often than not doesn't get paid. Not in full anyway. Furthermore, the amount that does get paid, comes out of my paycheck... I'd much rather them drive themselves.

 

[Outbac1]

Oh and from his door to the truck was about 200yrd.. I was more worried about keeping pt warm then about having to take jacket off again....

It was in another post on pg 2 I think.

I have nothing to do with billing. I'm sure some don't get paid but most do.

 

[Gheed]

Technically he meets S.D. protocol to back board since he was ETOH + and competing pain. On the other hand if your assessment was thorough and he refused treatment then you are fine. I would just make sure he didn't smell of ETOH, no impairment in LOC or sign of intoxication which can distort pain. Make sure he didn't hear any cracking or popping when hitting the snow. I would have asked if the snow was powder, compact or icy and if their were any hard objects underneath.

 

[firecoins]

No backboard needed.

 

[Christopher]

There is a joke in the ICU called "positive glasses sign."

If a patient wakes up, realizes they are not wearing their glasses. Knows they need them, and has the presence of mind and dexterity to look for them and put them on...

The prognosis is very good and discharge likely very soon.

I think deciding before hand you need a coat, despite injury suffer through putting it on, knowing you have to endure the pain again to take it off at the hospital, clearly means you are not hurt that bad.

Reminds me of the "Positive Texting Sign" w.r.t. MVC patients on backboards.

 

[Christopher]

My question is should I have boarded c collared this guy?

Good news: there are no indications to place a patient on a backboard for cervical spine immobilization, only tradition.

 

[mycrofft]

Good news: there are no indications to place a patient on a backboard for cervical spine immobilization, only tradition.

Pt in car after a collision with LOC, doors crammed down so they don't open, now c/o neck pain (general and point tenderness) and hands are tingling.

So, you going to use a spine board now? A KED? AT least for extrication?

 

[Christopher]

Pt in car after a collision with LOC, doors crammed down so they don't open, now c/o neck pain (general and point tenderness) and hands are tingling.

So, you going to use a spine board now? A KED? AT least for extrication?

(now now? I'm bound by protocol to cause harm and ignore science; working on fixing that locally)

Extrication sure, and the C-collar is indicated provided it fits. If you truly believe you need motion restriction then a backboard does not make physiologic sense for anything but movement to a stretcher. The pressures generated at the tissue-backboard interface almost guarantees that motion (during transport specifically) will be translated anteriorly thru the spinous processes. Moving them to a vacuum mattress once extricated would be ideal.

Even when we've done extrication right, the car is clamshelled and basically torn down to the chassis, there almost always is non-trivial motion of the C-spine. Thankfully, external motion doesn't correlate 1:1 with motion in the spinal column otherwise we'd be killing them every day.

{I've used a Reeve's sleeve once during an automobile extrication, but that patient was down in a ditch and I convinced folks it would be easier to slide up the slope and would thus confer greater protection (i.e. 100% better than 0 is still 0).}

 

[mycrofft]

(now now? I'm bound by protocol to cause harm and ignore science; working on fixing that locally)

Extrication sure, and the C-collar is indicated provided it fits. If you truly believe you need motion restriction then a backboard does not make physiologic sense for anything but movement to a stretcher. The pressures generated at the tissue-backboard interface almost guarantees that motion (during transport specifically) will be translated anteriorly thru the spinous processes. Moving them to a vacuum mattress once extricated would be ideal.

Even when we've done extrication right, the car is clamshelled and basically torn down to the chassis, there almost always is non-trivial motion of the C-spine. Thankfully, external motion doesn't correlate 1:1 with motion in the spinal column otherwise we'd be killing them every day.

{I've used a Reeve's sleeve once during an automobile extrication, but that patient was down in a ditch and I convinced folks it would be easier to slide up the slope and would thus confer greater protection (i.e. 100% better than 0 is still 0).}

OK, I'm mostly with you. I reserve the right to remain curmudgeonly.

As for this: "Thankfully, external motion doesn't correlate 1:1 with motion in the spinal column otherwise we'd be killing them every day", my dollar is on the square that reads "Hardly ever is the spinal cord so damaged or threatened by uncontrolled vicious force to the point that a conscientious use of proper equipment will create further exacerbation". E.G., the damage is done, you have to be a Gomer to screw it up worse, but there ARE Gomers out there.