London blasts and field triage

• Previous message: Family witnessed resuscitatioI would like to present ns
• Next message: London blasts and c-spine precautions
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

 
In a message dated 7/10/2005 9:52:53 A.M. Eastern Daylight Time,  
medic.steve at rogers.com writes:

Anybody  capable of offering any insights? How do I drag our management staff
away  from this burdensome practice, or is it in fact still an  advisable
practice? Anybody have such stats from Madrid and now  London?





This is just one of many good examples of how you must incorporate such  
issues into your own disaster plans--there is no flat answer to your question,  
but the question is a good one that you and your colleagues must decide upon in  
your planning, and then have the leaders of the disaster response discuss in 
the  earliest phases of the disaster response when there is some clearer 
picture of  casualty numbers, mechanisms of injury and available resources.  You 
must  look to the literature, as you indicate so wisely, to see what patterns 
can be  expected in a given scenario--and in fact you will find extremely small 
to zero  incidence of spinal cord injury or spinal fracture in 
bombings--however,  remember, you will find the same extremely small numbers in everyday 
trauma as  well, but we in the medical field have made the decision that global 
prevention  with c-spine precautions is worth it even to prevent an 
infinitesimal chance of  iatrogenic spinal injury.
One example of reasoning that may be applicable in your scenario--remember,  
there are no universal answers here--is that cervical immobilization is  
relatively easy( formal c-collars as long as they hold out, simpler things like  
sandbags, tape, etc after that), and may be instituted for any patient with  
evidence of blunt trauma above the shoulders or cervical tenderness on exam--no  
imaging need be done immediately, but, like all imaging, should wait until  
casualty influx has ceased and resources and remaining casualty needs then  
reassessed.  The usual criteria of clearance for awake patients with no  cervical 
tenderness can quickly be done at this time, and for others, there is  no 
hurry--it can wait days of need be for formal clearance in the usual fashion  
according to current guidelines.  In a very isolated or resource-poor area,  where 
imaging may not even be available (no CT scans in third world countries,  for 
instance), you must adapt and do what you can, and in this setting it may  
not be feasible to follow such stringent precautions in the interest of  
maximizing overall outcome.  Think how ridiculous it would have been  in Sumatra 
after the tsunami to worry about c-spine precautions when you are  faced with 
40,000 casualties and no hospitals, never mind CT scans.
 Remember too that most surviving casualties will be the "walking  wounded" 
in bombings who can easily be clinically cleared immediately--the  actual 
burden on the system in an urban scenario is not likely to be great if  these 
precautions are applied reasonably and sensibly---I agree that blindly  snapping a 
collar on every organism within a mile of the event is NOT reasonable  or 
sensible.  Again--there has to be some level of thinking involved,  especially at 
the planning stages--the less planning and rehearsal and thought  beforehand, 
the more and longer the chaos, and the greater loss of life
ERF

• Previous message: Family witnessed resuscitatioI would like to present ns
• Next message: London blasts and c-spine precautions
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]