"Non-Injury" Traffic Accident

[Tigger]

Dispatched to a two car traffic accident on a state highway. One vehicle crossed over and sideswiped a compact hatchback all down the left side at approximately 50mph. Side curtain airbag deployment with pillar deformity but no intrusion into passenger compartment. Rear axle no longer substantively attached to vehicle.

Arrive on scene to find your 75 year old male patient ambulating around vehicle and talking to other driver. Initially he is has no complaints though after being asked the usual litany of questions he states some "very minor" L arm pain from the airbag deployment.

At this point I am thinking about starting a refusal, in terms of history he says he has Afib and takes Pradaxa.

So now what? Physical, mental status exam entirely unremarkable, as was a 12 point cranial nerve screening. No other complaints. 130/70, HR 60 regular, 93%RA sat.

Transport? Refusal? POV transport? No ambulance needed?

My partner practices his own brand of medicine and as he is the medic, I often end up doing so as well, so I'd like to see what others would do.

 

[DesertMedic66]

With that, I would like to transport him but you can't force him to go.

 

[TransportJockey]

Inform him of risks of refusal, do a full workup (if the patient allows), and then ask him again what he would like to do. If he still states that he doesn't want to go, get a refusal signed and witnessed (preferably by family and at least one LEO) and go back in service.

 

[DesertMedic66]

Inform him of risks of refusal, do a full workup (if the patient allows), and then ask him again what he would like to do. If he still states that he doesn't want to go, get a refusal signed and witnessed (preferably by family and at least one LEO) and go back in service.

Same as this if he refuses. This is a standard process out here.

 

[Ewok Jerky]

Review the risks of anticoags with the old man. highlighting campartment syndrome and head bleeds. Hopefully transport, if not release AMA.

Even though I would like to transport this fellow, the ED isn't going to do much for him besides watch. There is no "antidote" to reverse the effects of pradaxa in the setting of a bleed.

 

[OnceAnEMT]

Review the risks of anticoags with the old man. highlighting campartment syndrome and head bleeds. Hopefully transport, if not release AMA.

This. Explain the worst case scenarios and encourage it like all else. I'd add a recommendation to call 911/go to the ED in the event that his s/s worsen over the next few days.

 

[Gymratt]

I agree with the above posters and honestly I always encourage all of my patients at this point in my career to allow transport and if I'm dealing with someone that might be high risk such as age or history then I will even call med control and allow the med control doc to speak directly to the patient as well.

 

[spnjsquad]

Agreed. Try and do a workup, and go over the RMA with him and how when he signs it we are not liable anymore. Be sure tell him the possible risks of not going to the hospital. If he can have someone else drive him, then I wouldn't think much of it. If he claims he wants a transport to x hospital, then I would but with no lights or sirens.

 

[rails]

Inform him of risks of refusal, do a full workup (if the patient allows), and then ask him again what he would like to do. If he still states that he doesn't want to go, get a refusal signed and witnessed (preferably by family and at least one LEO) and go back in service.

I like your reply. Can you elaborate on what you personally would state as the risks of refusal in this instance, and what kind of workup you'd do?

Hope you don't mind my question.

 

[EMT4EVA]

The way I would handle this would be to have him sign a refusal in the presence of one other witness.

Dispatched to a two car traffic accident on a state highway. One vehicle crossed over and sideswiped a compact hatchback all down the left side at approximately 50mph. Side curtain airbag deployment with pillar deformity but no intrusion into passenger compartment. Rear axle no longer substantively attached to vehicle.

Arrive on scene to find your 75 year old male patient ambulating around vehicle and talking to other driver. Initially he is has no complaints though after being asked the usual litany of questions he states some "very minor" L arm pain from the airbag deployment.

At this point I am thinking about starting a refusal, in terms of history he says he has Afib and takes Pradaxa.

So now what? Physical, mental status exam entirely unremarkable, as was a 12 point cranial nerve screening. No other complaints. 130/70, HR 60 regular, 93%RA sat.

Transport? Refusal? POV transport? No ambulance needed?

My partner practices his own brand of medicine and as he is the medic, I often end up doing so as well, so I'd like to see what others would do.

 

[Brandon O]

You did 12 cranial nerves?

 

[Ewok Jerky]

You did 12 cranial nerves?

Do you smell something?

"CN II-XII grossly intact" is a sufficent documentation of a cranial nerve exam.

 

[Carlos Danger]

You did 12 cranial nerves?

He's that good.

 

[medicaltransient]

If you are unsure you can elaborate your assessment. Give him you best impression of the risk and let him decide. Definitely not a no ambulance needed.

 

[Pond Life]

Pre-crash phase (old, ?meds, ?underlying arthritic issues) - place him on a Vac Matt and get him cleared by someone with more medico-legal cover than me.

 

[OnceAnEMT]

Pre-crash phase (old, ?meds, ?underlying arthritic issues) - place him on a Vac Matt and get him cleared by someone with more medico-legal cover than me.

Interesting, self-lacking comment from someone practicing in a remote area.

 

[TransportJockey]

Pre-crash phase (old, ?meds, ?underlying arthritic issues) - place him on a Vac Matt and get him cleared by someone with more medico-legal cover than me.

Please please tell me you're joking

 

[Akulahawk]

Something I was thinking about generally from the title... and sparked a memory from about 1999 or 2000. If you seen an accident and you can't stop, don't call it in as a "non-injury" accident. I was on-duty one day and heard a competitor's ambulance crew do exactly that. They didn't stop, called it in as a non-injury, and kept going. A few minutes later, a 911 crew arrived and found that not only was that not the case, at least one of the patients had to be transported emergently to a trauma center for care. I heard the county dispatchers confirm that the crew stated that it was a non-injury... and a few minutes later, asked for their cert numbers over the air. It wasn't a "report to quarters" or "report to EMS office" but "We need your cert numbers, NOW."

It's my understanding that both were disciplined, probably by having their certs yanked for a while, if not permanently.

In this particular instance, I may have ultimately found "no medical need" and therefore "no patient identified" but if that's the case, I would have also advised him about head-injury issues. I would have probably done a very thorough exam to be certain that the L arm pain is more likely musculoskeletal than cardiac in origin.

 

[Ewok Jerky]

To call in an on view accident as "non injury" without actually is assinine and they deserve whatever consequences became of it, up to and including pulling their certs.

 

[DesertMedic66]

To call in an on view accident as "non injury" without actually is assinine and they deserve whatever consequences became of it, up to and including pulling their certs.

Saying an accident is non-injury without fully assessing a patient is asinine?

I've had several traffic collisions where we get on scene and see there is very little damage to the cars, talk to the parties involved and see if they want medical attention. If they say no then it's just a matter of making sure they are not altered and then "dispatch Medic 310 is clear, non-injury TC."