Backboards!

[musicislife]

Scenario was a teenage male hit a lip in the sidewalk and went flying off his bike (moderate speed, on flat ground) Helmet was intact, no neck or back pain on palpation, pupils unremarkable, grip and motor skills intact, vitals good, just abrasions to his knee and hands...it all just seemed like a kid who took a spill off his bike.

My planned course of action was to dress the wounds, and transport if the parents decided (which they did).

Leader of my crew decides full spinal immobilization.

Personally, I had no desire to backboard, because no part of this presentation screamed "spinal injury."

he had fallen off the bike and broke his fall with his hands/knees.

to me, the board seemed like overkill..but my decision was over-ruled by the leader of the crew. thoughts?

[Just Plain Ruff]

Well it's the crew leaders call so let the protocol monkey go with it. Did you discuss his decision after the call?

[musicislife]

Well it's the crew leaders call so let the protocol monkey go with it. Did you discuss his decision after the call?

yeah, her reasoning was simply because the bicycle crash.

[Just Plain Ruff]

yeah, her reasoning was simply because the bicycle crash.

Well that would be your first clue she was a protocol monkey. Just bide your time working with her and then move on. I'll bet this isn't the only time she blindly follows protocol. But in her defense, it is protocol so she really didn't do anything wrong.

Now let me turn this around, had you have not boarded and collared this guy and if it was in protocols, would you be in violation and subject to discipline? Do you have the fortitude to go against protocol and buck the establishment? I'm pretty sure this medic on the call was not willing to do that.

So by your admitted judgement would you have broken protocol and not boarded the patient, thus invited a review of your call and possible disciplinary action?? Are you ready to face that music?

Think of me as your Medical director - tell me why with evidence backing up the why, WHY you did not board and collar this patient who sustained a bicycle crash when protocols state he should have been fully immobilized? Your job depends on your defense and whether you convince me.

[musicislife]

Well that would be your first clue she was a protocol monkey. Just bide your time working with her and then move on. I'll bet this isn't the only time she blindly follows protocol. But in her defense, it is protocol so she really didn't do anything wrong.

Now let me turn this around, had you have not boarded and collared this guy and if it was in protocols, would you be in violation and subject to discipline? Do you have the fortitude to go against protocol and buck the establishment? I'm pretty sure this medic on the call was not willing to do that.

So by your admitted judgement would you have broken protocol and not boarded the patient, thus invited a review of your call and possible disciplinary action?? Are you ready to face that music?

Think of me as your Medical director - tell me why with evidence backing up the why, WHY you did not board and collar this patient who sustained a bicycle crash when protocols state he should have been fully immobilized? Your job depends on your defense and whether you convince me.

well, our protocols do not specify MOI, except in the case of MVA or GSW i believe..they only specify signs/symptoms of spinal injury

anyway I found that PT had no neuro deficit, palpating the spine revealed no pain, and the pt was not complaining of head, neck, or back pain. he was fully alert and oriented, he was not intoxicated/under the influence of anything, nor did he show any signs of being under the influence, and had only minor injuries (3 small abrasions to knee and hands), and the PT stated his head did not even hit the ground (and there was no damage to his helmet).

from this i would say the likelihood of spinal injury is very, very low, as no signs or symptoms were present.

that would be my defense of my treatment plan.

[Just Plain Ruff]

but isn't this technically a vehicle accident? he was operating a moving vehicle? (devils advocate). Describe Moderate speed? how fast is moderate? 10 MPH? 20 MPH? 30?

[island emt]

Do you have a selective spinal immobilization protocol option?

This would allow you to do the spinal / neuro exam and properly rule out the need for full immobilization.

If you do then it could have been used.

If you don't , then do some research on the NEXUS study.

Many states now have the ability to make this determination, by following a protocol that was first developed by the wilderness medicine folks and then followed up by the NEXUS study.

We have been using it since the early 1990's

Edited July 30, 2014 by island emt

[musicislife]

but isn't this technically a vehicle accident? he was operating a moving vehicle? (devils advocate). Describe Moderate speed? how fast is moderate? 10 MPH? 20 MPH? 30?

He said he was just casually riding his bike home..I have tried to go as fast as I can on flat ground and only hit 20 mph. My best guess is 10 mph or less

Do you have a selective spinal immobilization protocol option?

This would allow you to do the spinal / neuro exam and properly rule out the need for full immobilization.

If you do then it could have been used.

If you don't , then do some research on the NEXUS study.

Many states now have the ability to make this determination, by following a protocol that was first developed by the wilderness medicine folks and then followed up by the NEXUS study.

We have been using it since the early 1990's

Ive done a lot of nexus research..however I doubt our great state of NJ is that progressive with EMS. I will have to look into NJOEMS

[paramedicmike]

Ive done a lot of nexus research..however I doubt our great state of NJ is that progressive with EMS. I will have to look into NJOEMS

I don't know if you've mentioned your location before. If you have I've just plain missed it.

You've recently asked a lot of good questions. However, the fact that you're in New Jersey is part of the problem you're facing. In fact, I'd go so far as to say it is a HUGE part of your problem. New Jersey does something right. I like that they require ALS to be hospital based. After all, this is medicine. The First Aid Council full of jolly volly good ole boys running the BLS side of things, however, is an example of what not to do.

Things are starting to make more sense now.

[island emt]

as Mike just posted: The Fact that you are in Joisey makes a lot of what you post make sense.

You are correct Nj does not have a ssi protocol. They are vastly behind in many areas and limit what their non ALS providers can do.

Thats part of the First Aid Squad mentality, with little fifedoms that control power in their individual burgs.

This is not aimed at you personally Musiclife , just common knowledge of how the system works in the garbage state.