List Archives

Fri Aug 17 19:21:09 BST 2007

Mr. Bjarkoy,

The type of incident(s) you describe is more common than the poor outcome(s)
as described earlier.  I personal believe that we use the "rule of care" and
over immobilize as a crutch or scapegoat instead of advancing our knowledge
and skills in area's that would more likely benefit the patients' outcome -
outcome to being discharge from the hospital not merely arrival at.  The
multiple failures you describe and allude to are embarrassing to us all, for
doing or failing to do good medical care and customer service.  Thank you
for providing a wonderful learning case.

Take care, 

Bob 

(307) 920 - 2020 cell

bobwaddell at bresnan.net 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Pond Life
Sent: Friday, August 17, 2007 12:00 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Question for the prehospital experts

I have recently been involved in an incident where this happened. Both
myself and another paramedic (both very experienced) identified there was no
indication to place the patient into a collar (and therefore onto a board)
as per our JRCALC guidelines here in the UK.

I walked the patient to the ambulance and a doctor (who was on scene) said
that he felt uncomfortable that we hadn't placed a collar on the patient
because of the MOI.

I respect the doctor concerned within his field in the ER, however he does
not respond to EMS MVA's and was out of his normal environment.

In an effort to not rock the boat (and not because the patient clinically
required it), I placed a collar on the patient and a blanket log roll around
the head and then strapped the patient to the stretcher. In the UK, if
journey times for such patients are greater than 20 minutes the spinal board
is contraindicated.

Got to the ER and three things happened?

1. We were criticized for not placing the patient on a board - I was
embarrassed for the staff as they were not up to date on our guidelines
(2004).

2. The junior ER doctor in the ER performed a c-spine check which was at
best sub-optimal - didn't even feel the c-spine! Certainly well short of our
c-spine examination guidelines. The doc was then bullied by a nurse into
writing up an x-ray just to prove a point that the patient required it and
we should have placed the patient on a board. 

3. and then to top it all... the ER dept ('suspecting a c-spine injury!!')
only taped the head and neck down of the patient. When I pointed out that
this did not constitute spinal immobilization and was in fact was inherently
dangerous we left the dept in disgust.

I learnt a bunch of lessons that day. Most of which related to out dated and
poor care in the ER.

A bad experience

Mike Bjarkoy.
Paramedic. UK.

List Archives

For your convenience, find the Trauma List Archive Below

Question for the prehospital experts