Elderly woman fell. No c-spine?

[Fluffpaw38]

I was doing ride time one day. It was a 10 hour shift so i had already gone on 5-6 calls. This was the last call of the night for me. Me being a rider was limited to what i could and could not do. So my too Young EMT-Bs and I were dispatched to a "elderly woman, who has fallen in a doorway." We arrive on scene, its raining, we head into the nursing home and follow a young ladie to a long hall. At the end of the hall we see a pair of elderly legs sticking out of a door. The woman had fallen half in and half out the door. The first thing she was complaining about her hip and her arm, then her neck. Now as a rider i could not direct anyone to do anything, i was there to do what they told me to. The woman was complaining about, hip pain, pain in the left forarm, and neck pain.

So its obvious right!? Get a backboard, Get a collar, check PMS, log roll, cut clothes, asess back and pelvic area, then roll on to backboard right? WROUNG! This idiot doesnt event grab a collar, we log roll her onto the backboard, no collar, no assessment, no pms check.

They strap her to the stretcher, no collar, no padding, no assessment of the pain sites, no PMS check.

We are in the ambulance, on the way to the hospital. No clothes were cut, no physical examination of any kind. All he did was ask questions and get a set of vitals.

Now from what i could see, there was no deformities or swelling or contusions on the forarm. I couldnt assess the hip because her clothes were still on, the woman was in pain the entire ride to the hospital and there was nothing i could do.

=/ this pisses me off. And i think that who ever certified this idiot should be thrown into a pit of fire.

[JPINFV]

I'll be honest a bit here. I'm not really big on back boarding every SNF resident that has a fall. That's because most of the time they've been moved drastically (walking around, moved back to wheel chair, etc). That said, unmoved patients who have a history ALOC/confusion and patients with complaints (neck/back pain, LOC/neuro changes) will be boarded, properly, everytime.

Assuming that the crew is willing to get touchy-feely with their assessment (which it looks like they didn't), I don't honestly feel that every fall needs to come in with their clothes cut to ribbons.

This said, if you are going to back board, do it properly. Especially since if you're going to be back boarding, you can also 'borrow' a sheet from the SNF and sling the hip as well.

[brock8024]

I will agree. I do not backboard every fall. I mean if they have been moved, walked, or anyother thing then i may or may not. I have done standing take down before on a guy from the jail.

[AnthonyM83]

Yeah, she seems like she should have been backboarded. Based on what your description of their assessment, it seems like they did it based on laziness, rather than have a specific reason. Was this a 911 company or did they do non-emergent nursing home transfers only?

I wouldn't usually cut clothes off for these kinds of falls, though. Usually you can shift clothes around to properly inspect and don't need to cut (and leave people with fewer belongings...especially if they're low income or aren't mobile enough to go shopping). Sometimes I'll have to cut a little, though.

If it's major trauma, though, everything comes off.

[ccmedoc]

Without proper physical exam..not necessarily cutting the clothes off, but visualizing the areas of complaint in addition to other possible injury sites, PMS, LOC, etc...the need for c-collar, LBB, and full CID immobilization cannot be assertained. I agree that I do not haul the LBB and assorted toys for every fall, especially from standing, but the lack of proper assessment is reason for concern.

So its obvious right!? Get a backboard, Get a collar, check PMS, log roll, cut clothes, asess back and pelvic area, then roll on to backboard right?

Not so obvious without the aforementioned assessment. Cutting all the clothes are a bit much, maybe the hip area perhaps. This could have been done maintaining privacy.

[JakeEMTP]

I agree with the above 4 posters. Boarding of every fall patient is not always necessary. That being said, a thorough assessment is. Contrary to popular belief, you can assess the pelvis and hips with clothing intact. As advised above, you can secure the hip and pelvis with sheets.

I realise you are doing ride-alongs. I would advise doing it with a different crew though before something really goes askew.

[mediccjh]

If she fell, and is complaining of neck pain, she is getting a board and collar.

[theotherphil]

If she fell, and is complaining of neck pain, she is getting a board and collar.

Is it central bony tenderness? Right/ left sided radiating into trapezius? Any step off? Was the patient knocked out or has a reduced LOC? Any distracting other injuries (I'd argue an ache isn't distracting etc)? Any neuro changes (I suppose a reduced LOC comes into this catagory also)?

Not every patient c/o neck pain needs boarding. Not every trauma patient needs boarding. As other have said, a full examination needs to be done and all the facts considered before deciding on appropriate treatment. Boarding every patient "just in case" isn't appropriate treatment. You can train a monkey to do that.

My concern in this instance is a proper examination wasn't done...not that collar and board was inappropriatly used or not.

[Dustdevil]

Not every patient c/o neck pain needs boarding. Not every trauma patient needs boarding. As other have said, a full examination needs to be done and all the facts considered before deciding on appropriate treatment. Boarding every patient "just in case" isn't appropriate treatment. You can train a monkey to do that.

I actually agree with both of you to some extent. I'm all for SSI, but I don't know how "elderly" this patient was. Her degree of elderliness can contribute to both a sensory deficit and a stoicism that won't allow you to accurately assess her pain. A lot of brittle, elderly women tolerate so much daily pain from arthritis and osteoporosis that they wouldn't even notice the difference if they were to fracture a vertebra. That, of course, would be a factor that precludes SSI. We just don't know enough to definitively judge this particular case, but I am leaning towards immobilising her.

[firedoc5]

To what extent did the nursing home staff assess or treat? Or did they do nothing other than call, which happens all too often. Many elderly patients can not tolerate a board and/or collar due to osteoporosis or other skeletal problems. Immobilize the best you can while at the same time attempt to make comfortable.