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Sat Aug 18 22:40:20 BST 2007

Now that I have been able to actually sit down at my computer and talk abt this at length I have an interesting case to propose to all pre-hospital BLS/ALS providers on this list

?Unit dispatched for Man V. Pole? U/A 1 17 Y/O Male PT positive ETOH with some bruising and scrapes to the right temporal reigon of his face, Patrol states the kid was runnin "5th gear w/o brakes" and smacks right into a light pole... rather comical (especially after you see the PD HQ video tape) so hes standing and there are obvious c-spine considerations due to his rather hard impact with his skull/body to the rigid metal pole but he has been walking around for more than 3-5 minutes prior to my BLS unit arrival. My partner and I were sort of at odds wether or not to board collar and immobilize said pt due to the fact he was walking but opted to anyway and did it....

?Now here is my question would we have been in the wrong for NOT boarding and collaring said pt?

Regards to all

?M. Schumacher EMT-B

-----Original Message-----
From: Matthew Reeds <mgreeds at reeds.uk.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Sat, 18 Aug 2007 2:39 pm
Subject: RE: Question for the prehospital experts

Dave,

If a patient is combative and has a reduced GCS with a potential for a
spinal injury, then they should be immobilised - that is easy. However, a
patient's refusal to be immobilised is usually due either to:-

(a)   confusion as a result of hypovolaemia/hypoxia,

(b)   apprehension

(c)   inability to comprehend the events

and they should be gently coaxed to comply with immobilisation. If they
can't and remain aggressive and you are PRE-HOSPITAL then I suppose that
there is not much that you can do about it and forcing immobilisation upon
them can do more harm than good and you must just keep the patients as still
as you possibly can...by no means an easy thing to achieve in such a
patient.

A different situation may arise where the patient has capacity and
understands the potential outcome of the circumstances but merely makes a
"competent" decision to do so. This is an issue relating to consent more
than a medical one and actions vary depending upon the laws of
consent/common law etc. which are different from country to country.

In your particular case, I was not there and therefore cannot appreciate the
severity of the MOI but I will make various assumptions here, the first of
which is that it was significant (given the findings that you describe.) You
SHOULD have been immobilised at the scene, but clearly you weren't. I
therefore assume that you had no injury (and also that you sustained no
SUBSEQUENT spinal injury etc.) You may have been either "lucky" or you just
had no injury as a result of the impact. Some MAY subscribe to the theory of
immobilising patients ASAP thereafter (when medical help arrives at scene)
either:-

(i)               to ensure that an injury that has occurred is not
worsened; or,

(ii)              because a patient is "lucky" not to have sustained an
injury so far (without immobilisation etc.) and that immobilisation at this
point will prevent a potential injury from occurring from that point
thereafter.

Matthew R

Surgery UK

-----Original Message-----
From: David Sullivan [mailto:fpcems at yahoo.com] 
Sent: 17 August 2007 21:39
To: Trauma &amp, Critical Care mailing list
Subject: RE: Question for the prehospital experts

Matt,

  I hear totally hear where your coming from with this. If a patient wants
to refuse a board and collor (and can medically do so and documented) a doc
can yell at me till his face turns blue, and its not going to bother me one
bit, i pass on my concerns to the ED staff. If the MOI suggests that I
collor and board someone then I just do it, and not give the option. Heres a
funny story about me...i was in a sports accident last year, I play in a
mens hockey league, I collied with another player, and was knocked
unconcious. my teammates (layman) 

  assisted me off the ice (after about 1-2 mins) and I was walked to the
locker room, where my skates where taken off, and the medics came. (i read
my own runsheet) i had a GCS of 9, combative, signifigant MOI, but I walked
to the locker room?? and I can only recite my paramedic number? do I need a
collor and board? what do you think

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Question for the prehospital experts