EMT/Medics...scenario question

[Bubba Enfield]

Then can you wander back to your big red truck right now and let the medical folks handle the medical and trauma calls? When I need some water sprayed on something, I'll call you ?

Ah, clever. Rude, but clever. I don't have all the fancy certs you do Ian, but I've been an EMT for 15 years, career firefighter for 12, and we've been doing medical and trauma response for decades on my department. Lots of good EMT's, paras, prior service combat medics, etc. on my department. Hate to break it to you, but in practically all parts of the nation today firefighters = 'the medical folks'. Maybe you've had bad experiences with that, we happen to have a pretty great relationship with the transport and ALS guys/gals in our area, and our Medical Director (he's another guy with a few pretty impressive letters after his name) is likewise well respected...

Anyhoo, getting talked down to is one of the reasons, methinks, that the First Aid forums are so lightly populated and traveled. If a guy/gal with my credentials and street experience is told to 'go away' by those with higher credentials like yourself (those who are supposed to be both the real and de facto educators in the EMS field, IMHO), I imagine it's even more hostile for a person with no training or experience. Love to stay and visit, but I've gotta go find something to spray water on. Wouldn't want to bother 'the medical folks' anymore...

Don't sweat it, he hates on the ambulance folk too. You're right about this forum, though. Two out of three of the worst offenders don't come around any more. The third one just dissed you for not being HIM.

[IANMCDEVITT]

There's really nothing to "sweat".......................I just busted out a virtual box of friggin tissues for you guys...... An EMT-Basic with unknown experience asked a question with a bend towards why the medics who responded to the call acted the way they did and is what he did appropriate. There were a lot of answers to the effect of protocols rule the street, or always follow protocols...............Protocols guys are basically guidelines. They don't cover every situation that happens out here...............EMT's are expected to practice what they call (here at least) CRITICAL THINKING SKILLS............or a simpler way of saying that is common sense.......If you kling to your protocols like a safety blanket, again GET ANOTHER CAREER YOUR GONNA KILL SOMEONE..........So, the original author of this thread states it was a diabetic emergency? How'd you know? Just because of the nature verbaized during th initial tone? You didn't mention gaining a patient history or even making verbal patient contact IE: ANSWERS TO PETINENT NEGATIVES. Two basic level medical skills....you also mention that the patient had a dislocated shoulder...........describe to me right now what the injury looked like and HOW you DIAGNOSED THAT INJURY. That's not in your scope of practice. You should have treated that as a break and splinted it. FAIL...........Third thing is that if you have ever treated any hypoglycemic patient's, you'd know that the first sign of hypoglycemia is ALTERED MENTAL STATUS but he told you he "blacked out and had fallen"..........Do you really believe that patient's going to tolerate being fully C-spine immobilized effectively? If you do, get more experience...............The medic's acted the way they did because hypoglycemia is a LIFE THREATENING EMERGENCY WHICH YOU CAN DIE FROM YET YOU AS A BASIC FOCUSED ON C-SPINE IMMOBILIZATION??????? Can you die from back pain ? What type of report did you give the Medics? You should have started with the fact that this was supposedly a hypoglycemic event (if in fact it was). Did you?..................Now, I'l tell you what....If your able, follow up. No names, no addresses, go nowhere near a HIPPA but I will bet you....................that the patient you describe had absolutely no need for spinal imobilization.....The emergency here was the metabolic problem of hypoglycemia............BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

[Bubba Enfield]

I'm actually glad "Tacmedic" is back; the First Aid forum is entertaining once again. Could you imagine being partners with this guy?

There's really nothing to "sweat".......................I just busted out a virtual box of friggin tissues for you guys...... An EMT-Basic with unknown experience asked a question with a bend towards why the medics who responded to the call acted the way they did and is what he did appropriate. There were a lot of answers to the effect of protocols rule the street, or always follow protocols...............Protocols guys are basically guidelines. They don't cover every situation that happens out here...............EMT's are expected to practice what they call (here at least) CRITICAL THINKING SKILLS............or a simpler way of saying that is common sense.......If you kling to your protocols like a safety blanket, again GET ANOTHER CAREER YOUR GONNA KILL SOMEONE..........So, the original author of this thread states it was a diabetic emergency? How'd you know? Just because of the nature verbaized during th initial tone? You didn't mention gaining a patient history or even making verbal patient contact IE: ANSWERS TO PETINENT NEGATIVES. Two basic level medical skills....you also mention that the patient had a dislocated shoulder...........describe to me right now what the injury looked like and HOW you DIAGNOSED THAT INJURY. That's not in your scope of practice. You should have treated that as a break and splinted it. FAIL...........Third thing is that if you have ever treated any hypoglycemic patient's, you'd know that the first sign of hypoglycemia is ALTERED MENTAL STATUS but he told you he "blacked out and had fallen"..........Do you really believe that patient's going to tolerate being fully C-spine immobilized effectively? If you do, get more experience...............The medic's acted the way they did because hypoglycemia is a LIFE THREATENING EMERGENCY WHICH YOU CAN DIE FROM YET YOU AS A BASIC FOCUSED ON C-SPINE IMMOBILIZATION??????? Can you die from back pain ? What type of report did you give the Medics? You should have started with the fact that this was supposedly a hypoglycemic event (if in fact it was). Did you?..................Now, I'l tell you what....If your able, follow up. No names, no addresses, go nowhere near a HIPPA but I will bet you....................that the patient you describe had absolutely no need for spinal imobilization.....The emergency here was the metabolic problem of hypoglycemia............BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

Pop quiz, everyone: this is a)madness, or b)Sparta. (Hint: this ain't Sparta.)

OP: C-spine is one of those things that's up to the guy/gal running the call. Some pros would collar your patient, others wouldn't. If you collar him and there's no injury, that doesn't mean you were wrong; if you don't collar him and there's no injury, that doesn't necessarily mean you were right. Even doctors disagree on things that EMS educators think are carved in stone. (Show a wonky EKG strip to three different docs sometime, you'll get three very long and very different answers.) Based on what I've read here, I can't fault you for manual stabilization.

Ignore the "you're gonna kill someone" bs. It's been tossed around this forum before, and it's stupid every time.

[VXMerlinXV]

There's really nothing to "sweat".......................I just busted out a virtual box of friggin tissues for you guys...... An EMT-Basic with unknown experience asked a question with a bend towards why the medics who responded to the call acted the way they did and is what he did appropriate. There were a lot of answers to the effect of protocols rule the street, or always follow protocols...............Protocols guys are basically guidelines. They don't cover every situation that happens out here...............EMT's are expected to practice what they call (here at least) CRITICAL THINKING SKILLS............or a simpler way of saying that is common sense.......If you kling to your protocols like a safety blanket, again GET ANOTHER CAREER YOUR GONNA KILL SOMEONE..........So, the original author of this thread states it was a diabetic emergency? How'd you know? Just because of the nature verbaized during th initial tone? You didn't mention gaining a patient history or even making verbal patient contact IE: ANSWERS TO PETINENT NEGATIVES. Two basic level medical skills....you also mention that the patient had a dislocated shoulder...........describe to me right now what the injury looked like and HOW you DIAGNOSED THAT INJURY. That's not in your scope of practice. You should have treated that as a break and splinted it. FAIL...........Third thing is that if you have ever treated any hypoglycemic patient's, you'd know that the first sign of hypoglycemia is ALTERED MENTAL STATUS but he told you he "blacked out and had fallen"..........Do you really believe that patient's going to tolerate being fully C-spine immobilized effectively? If you do, get more experience...............The medic's acted the way they did because hypoglycemia is a LIFE THREATENING EMERGENCY WHICH YOU CAN DIE FROM YET YOU AS A BASIC FOCUSED ON C-SPINE IMMOBILIZATION??????? Can you die from back pain ? What type of report did you give the Medics? You should have started with the fact that this was supposedly a hypoglycemic event (if in fact it was). Did you?..................Now, I'l tell you what....If your able, follow up. No names, no addresses, go nowhere near a HIPPA but I will bet you....................that the patient you describe had absolutely no need for spinal imobilization.....The emergency here was the metabolic problem of hypoglycemia............BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

Quick question...where in there did you clear the c-spine?

[caemgen]

based on the scenario (altered loc, px complaint of "back pain" & shoulder dislocation), i'm going to go say that the op made the right call.

[johndoe]

So, the original author of this thread states it was a diabetic emergency? How'd you know? Just because of the nature verbaized during th initial tone? You didn't mention gaining a patient history or even making verbal patient contact IE: ANSWERS TO PETINENT NEGATIVES. Two basic level medical skills....you also mention that the patient had a dislocated shoulder...........describe to me right now what the injury looked like and HOW you DIAGNOSED THAT INJURY. That's not in your scope of practice. You should have treated that as a break and splinted it. FAIL...........Third thing is that if you have ever treated any hypoglycemic patient's, you'd know that the first sign of hypoglycemia is ALTERED MENTAL STATUS but he told you he "blacked out and had fallen"..........Do you really believe that patient's going to tolerate being fully C-spine immobilized effectively? If you do, get more experience...............The medic's acted the way they did because hypoglycemia is a LIFE THREATENING EMERGENCY WHICH YOU CAN DIE FROM YET YOU AS A BASIC FOCUSED ON C-SPINE IMMOBILIZATION??????? Can you die from back pain ? What type of report did you give the Medics? You should have started with the fact that this was supposedly a hypoglycemic event (if in fact it was). Did you?..................Now, I'l tell you what....If your able, follow up. No names, no addresses, go nowhere near a HIPPA but I will bet you....................that the patient you describe had absolutely no need for spinal imobilization.....The emergency here was the metabolic problem of hypoglycemia............BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

Maybe I'm interpreting this wrong, but it sounds like you're now attacking how I handled the situation because I didn't give you a step by step account of what I did on the scene. If I'm misinterpreting you, I apologize. If my read on this is correct, however...wow, just wow.

[duodecima]

I'm going with the OP on this one. Airway, breathing, and circulation were accounted for. First do no harm - it sounds like the patient was put in no increased risk by cspine precautions. OP states that diabetic issue was confirmed by the on-duty pro's when they arrived. As a bystander who happened to be trained, I assume he didn't have a glucometer on him (I don't EDC one...). And I've been brought a number of folks strapped with c-spine immobilization on the not-so-comfy back board. They all, including the otherwise injured, old, and diabetic, seemed to "tolerate" it. Well, not the guy who threw his full urinal at the nurse, but he was chasing an insurance payout and didn't like the wait time for the CT scan his degree of pain symptoms bought him... Like it? Hell no. Suffer further damage from it? No.

This is a purely civilian scenario - a tactical or combat situation would have additional considerations obviously. Are standard prehospital cspine procedures the last word in neuroprotection? Surely not. Are all of us supposed to act according to the best procedures of our licensed status? Oh yeah. For an emt-b ( and lots of the rest of us too) c-spine until otherwise directed by someone higher up was the right thing to do for your patient.

(All of tonite's typographical errors brought to you courtesy of my mobile device...)

[Doctor Jest]

I don't know jack about medicine. I have absolutely no idea what a lot of the words in this thread mean, from c-spine to loc to R1. But I do know that the purpose of ZS is to share and discuss information in a way that benefits this community. Comments like

I just busted out a virtual box of friggin tissues for you guys...... GET ANOTHER CAREER YOUR GONNA KILL SOMEONE.......... FAIL.....If your able, follow up....BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

do not advanced that purpose. IANMCDEVITT, consider this an official warning.

[emtmark]

Unwitnessed mech fall with positive loc gets a board until proven otherwise. Thought the call went well personally. Had a guy who played human ct machine on our local metro fd pull the board out from under a pt with no neck pain. Took his collar off and helped him to his feet at which point pt fell over with new onset of paraplegia. The back pain wasn't enough to rate a board in his eyes. He hasn't been seen since and we see "that guy" at spinal rehab. You can have every rule out trick lined out and double checked but if it ain't a doc looking at a film telling you nothings wrong it going Yo br your head that rolls. Painfully board surf or no pain or feeling at all. 0.02$

Btw that was most unprofessional outburst, your credibility is shot with at least myself if nothing else.

[macandcheese]

Btw that was most unprofessional outburst, your credibility is shot with at least myself if nothing else.

+1

[jamoni]

Am I the only one noting the fact that the OP wandered onto scene while off duty?
To me that means he has no equipment other than his EDC.
So, with only say, a pocketknife, cellphone, and flashlight, what else SHOULD he do, besides call for help, maintain C-spine, and monitor the patient?
Sheesh.

[johndoe]

Am I the only one noting the fact that the OP wandered onto scene while off duty?
To me that means he has no equipment other than his EDC.
So, with only say, a pocketknife, cellphone, and flashlight, what else SHOULD he do, besides call for help, maintain C-spine, and monitor the patient?
Sheesh.

Indeed, though I did have a stupidly extensive trauma bag in the car, and I took the WMI WEMT class so I suppose I could have improvised a splint/sling and swath. But truth be told, from the time I placed the call until they got on the scene was maybe 4 or 5 minutes. In a non-professional capacity I don't think it's my place to do anything besides immediate stabilization efforts. I certainly wasn't about to cut the dude's shirt into a sling and pop out my kit and drop a nasal airway or something else equally ridiculous. His ABCs were good, medics were on the way, c-spine was handled, so I really am not sure where the criticism was coming from. That said, I'm a basic and nowhere near as experienced as most of you guys, so if there's something I missed I would love to know.

[emtmark]

could you improvise a fallopian stretcher?
lol
your good man, nothing different, bls before als
ciao

[Medic Nemec]

OP did the right thing in his situation. I'm not sure of anyone remembers the algorithm for BLS medical calls anymore.

1: BSI
2: Scene Safe
3: Consider Additional Resources
4: Consider C-Spine
5: Airway
6: ...

[L1Z4RD]

Good work.

[PotatoMuncher]

OP did the right thing in his situation. I'm not sure of anyone remembers the algorithm for BLS medical calls anymore.

1: BSI
2: Scene Safe
3: Consider Additional Resources
4: Consider C-Spine
5: Airway
6: ...

7: Profit!

[Zombiepress]

I had a guy with a ground level fall due to a diabetic event and was wondering your opinions on the choice to maintain c-spine stablization. I entered the scene (I'm an EMT but I was not there in a professional capacity) and saw a male laying on the ground moaning in pain, with an obvious dislocated shoulder. He told me he had blacked out and fallen. I did not see any other issues apart from the very painful shoulder, but then he started saying his back was hurting very badly. I chose to hold C-spine until the medics arrived, and they sort of seemed confused at why I was doing so.

I was taught that ground level falls aren't a serious risk for spinal injury, but that if you have indicators to immobilize c-spine. To me, he had loss of consciousness and back pain, so I was concerned enough to do it, even though I was willing to bet there was no major injury there. Either way, I'd love to hear what you guys think. Overzealous or prudent precaution?

Unwitnessed mech fall with positive loc gets a board until proven otherwise. Thought the call went well personally. Had a guy who played human ct machine on our local metro fd pull the board out from under a pt with no neck pain. Took his collar off and helped him to his feet at which point pt fell over with new onset of paraplegia. The back pain wasn't enough to rate a board in his eyes. He hasn't been seen since and we see "that guy" at spinal rehab. You can have every rule out trick lined out and double checked but if it ain't a doc looking at a film telling you nothings wrong it going Yo br your head that rolls. Painfully board surf or no pain or feeling at all. 0.02$

John u did correct. as Emtmark stated "Unwitnessed mech fall with positive loc gets a board until proven otherwise." It is best to get chewed out for freaking out and going overboard with C spine precaution then not. The only real way to rule out C spine injury is with a X-rays ( Supine x-ray lateral c-spine) and possible CT& complete Nueorological examination My personal ideas and beliefs as far to treat any patient is to do it like they were “me” or my family. I rather see some one in a full body immobilization device that they don’t need Vs them needing it and not getting it. Down here EMTeams just hit the scene around 10 yrs ago. Shamefully mostly as a gimmick no real training And only in the last 2-3 yrs can I say that the patients get more benefit out of them. Monet is very tight so most of our State and Private First response teams are ill equipped and under trained . I have heard far to many times patients complain about the fact that they have been suffered nerve lesions from the actual extrication then the actual trauma or car……
PDF of C-Spine precautions
http://www.google.es/url?sa=t&rct=j&q=c%20spine%20precautions&source=web&cd=2&ved=0CCkQFjAB&url=http%3A%2F%2Fwww.ossur.com%2Flisalib%2Fgetfile.aspx%3Fitemid%3D7136&ei=cBi5TtaDIcfYgAfMo6zYCA&usg=AFQjCNEaSNwedqAilj6ZZKOJlO8XVqjc_w

[DialM]

There's really nothing to "sweat".......................I just busted out a virtual box of friggin tissues for you guys...... An EMT-Basic with unknown experience asked a question with a bend towards why the medics who responded to the call acted the way they did and is what he did appropriate. There were a lot of answers to the effect of protocols rule the street, or always follow protocols...............Protocols guys are basically guidelines. They don't cover every situation that happens out here...............EMT's are expected to practice what they call (here at least) CRITICAL THINKING SKILLS............or a simpler way of saying that is common sense.......If you kling to your protocols like a safety blanket, again GET ANOTHER CAREER YOUR GONNA KILL SOMEONE..........So, the original author of this thread states it was a diabetic emergency? How'd you know? Just because of the nature verbaized during th initial tone? You didn't mention gaining a patient history or even making verbal patient contact IE: ANSWERS TO PETINENT NEGATIVES. Two basic level medical skills....you also mention that the patient had a dislocated shoulder...........describe to me right now what the injury looked like and HOW you DIAGNOSED THAT INJURY. That's not in your scope of practice. You should have treated that as a break and splinted it. FAIL...........Third thing is that if you have ever treated any hypoglycemic patient's, you'd know that the first sign of hypoglycemia is ALTERED MENTAL STATUS but he told you he "blacked out and had fallen"..........Do you really believe that patient's going to tolerate being fully C-spine immobilized effectively? If you do, get more experience...............The medic's acted the way they did because hypoglycemia is a LIFE THREATENING EMERGENCY WHICH YOU CAN DIE FROM YET YOU AS A BASIC FOCUSED ON C-SPINE IMMOBILIZATION??????? Can you die from back pain ? What type of report did you give the Medics? You should have started with the fact that this was supposedly a hypoglycemic event (if in fact it was). Did you?..................Now, I'l tell you what....If your able, follow up. No names, no addresses, go nowhere near a HIPPA but I will bet you....................that the patient you describe had absolutely no need for spinal imobilization.....The emergency here was the metabolic problem of hypoglycemia............BTW, let me apologize right now if anyone is crying out there in cyberspace. Have a tissue on me.

Quick question...where in there did you clear the c-spine?

LOL! Win!

[EMTPaladin]

most of what IANMCDEVITT said is true, whether he's a nice guy or not. and i hate to put a collar on someone who can keep his head still by himself. even if you have a fracture, you will not likely worsen the injury if you stay within the normal range of motion. i really believe the c-collar does more harm than good. they never fit and almost always cause the pt to struggle (moving outside his normal range of motion). i pad the backboard with a blanket before i roll the patient on if i can as well. all that crap we do to them is uncomfortable... painful, and we don't know how long they'll lie on that torture device before being cleared. but we are unfrozen cavemen compared to any other medical personnel (at least that's the perception where i'm from), and it really comes down to protocols. i do 'c' my 'a' like anyone else. but a pt with a gcs of 15 has the right to selectively refuse treatment, and i explain that, "this spinal package is uncomfortable, and you can refuse it, though i must suggest you accept this treatment."

now, OP, your patient had back pain and shoulder ... deformity i guess?... so his fall was bad enough for you to suspect spinal injury and you did no harm by holding c-spine. it was correct. and you describe general douchebaggery on the part of the responding EMS crew. but, as a basic, you might have considered some oral glucose (sugar, honey, syrup, whatever you have on hand). if he's hyperglycemic, it's pissing in the ocean, so again, no harm. but if he's hypoglycemic, bam!, you did something more than "do no harm." i don't mean to get onto you. i'm only offering something for consideration. and if i was the medic on that scene, you would have gotten a pat on the back from me, whether you cared for it or not.

[sdjt60emt]

As both an EMT and a diabetic. I would ask him if he had any of the signs of spinal injury while keeping Cspine. If he had blacked out, fell and then woke back up it does not sound like a low blood sugar. You normally don't wake up from those from pain (personal experience). Normal precautions would work just fine but keep in mind he could have passed out again.

[NorthernAlpine]

1. OP walks into scenario while off-duty, OP does not say 'oh shit, I'm not on duty' and walk out. +50
2. OP does not ask 'hey fella, you ok' and get him up on his feet with a slap on the back and send him on his way. +10
3. OP follows protocols and doesn't get all 'House' with it by letting false sense of med skills take over. +10
4. OP does not harm, maintains a critical posibility in c-spine injury, alone, and is able to brief the responding EMS with sitrep and handover pt. +10
5. OP gets the stink eye from EMS responders. -50
6. OP walks out and says 'WTF just happened'. Priceless

OP deserves credit here regardless of perfect scenario execution or personal opinion. Life is not a work of art, it is chaos and madness with a blink of peace. It's eaasy to take potshots when it's not you. When we're out of uniform at times it takes us subconsciously out of the game when you walk into something like that. Personally, I would have taken my shoes off to hold the c-spine, administered a chest tube, crike, Mr. Miyagi'd my hands together for defib, and shat insulin to give him. Simultaneously. DannusMaximus, thank you for your service and not being an arse and walking out on that guy. My hat's off to you.

[thorian]

Cspine. Pt had LOC then fell. Risk is 5% for injury. Also he dislocated his should from the fall. It isn't much harder to damage the neck. Cspine no questions asked. It takes 5 minutes.

Ya did the right thing by taking cspine

Plus a big one you did good. We have a saying here go big go early, as it is a hell of a lot easier to let go of C spine then repair cord.

[croaker260]

OK, I have just passed through this thread, and as such I think I have gleaned the high points. I purposeflully passed over a lot of the"low points" as well.

Anyway, a couple of thoughts:

1- Any EMT/PARAMEDIC/NURSE/MD/PHD/OCD who is off duty without equipment is simply a well educated bystander. As such, dont beat yourself up, you are just as much out of your comfort zone as a surgeon walking in on the scene.

2- After reading the above, realize your role as that well educated, well intentioned, and (hopefully) well trained bystander, who is in another agencies area of operation. Tact, smiles, and thick skin will serve you well here.

3- I absolutely think you did the right thing. Secure C-=Spine and control the scene with in the limits of your role as an EDUCATED BYSTANDER", and smile at the EMS crew when they arrive, followed by helping out what ever/however you can.

4- I am a huge proponent of "Selective Spinal Immobilization" ( I hate the term "clearing the C-Spine" because that is not what we do), but a key part of that is a good assessment and a lack of distraccting injury. In the short time before EMS arrival, your ability to assess is limited. And given the shoulder injury and his response, he would be a poor assessment anyway because this is clearly a distracting injury. BTW, FWIW, I have seen 3 or 4 missed C-Spine injuries in 20 years, and they all involved poor assessments and two of them involved a distracting injury to the shoulder or upper arm.

5- To better understand the clinical concerns, I suggest you look at this excellant article by Doctor Keith Wesley. Its an excellant introducton to the concept of selective spinal immobilization. I am not saying one way or the other that the patient should have been immobilized, because I wasnt there and I have been on both sides of your situation. I am saying , lets give all sides the benifit of the doubt.

http://www.sehsc.org/news/cspine.htm

Peace Out.

[The Big Ugly]

Just read through this entire thread, the highs and lows, and I believe the OP absolutely did the correct thing. There was no way to clear C-spine on scene, and while temporarily painful, maintaining c-spine will not subject the PT to undue harm. The indicators (back pain, LOC) and MOI suggest caution to be prudent. The OP stated he had no knowledge that the incident was diabetes related until AFTER the medics confirmed with a blood glucose check, which means at the time of his decision he was dealing with a ground level fall with visible trauma to the upper extremities and c/o back pain.

The vast majority of medics I encounter are professionals who take pride in their work. Some may have held c-spine, others may not have. I've had the ER doc tell me to collar PTs brought in without c-spine precautions just because he was unable to r/o spinal injury at the immediate time. Other times I've had the doc remove a collar he felt was unneccessary. What I've never seen is a doc be disappointed by a medic trying to do the best by the PT.

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