I nead your opinions on a MVA call that I went on.Thankx

[akflightmedic]

Much better, thank you.

I am of the same thoughts as you. I would have let rescue pop the door for several reasons.

1. Mechanism of injury/starred windshield,etc.

2. Why not? Let the ricky rescues play every now and then. I rather them practice on "non emergencies" and be proficient rather them trying to figure it out when I really need them.

3. There was no rush so why risk further injury when the others are on the way.

You were responsible on this call. You voiced your concerns only to have them ignored. As the junior man that sometimes happens and it is not always right. Howeveri f it were me and he refused to do what I felt was absolutely right and it could potentially harm the pt, I would have called the supervisor on the radio or advised the ALS unit of the situation. I certainly would not ride this pt in or do the report as my name would not be attached other than as an assistant on scene. I would insist if he continues with the method he chose, he does the ride in and report. At least should any adverse legal procedings take place, you can say you did all you could.

I also would have downgraded the responding units to nonemergency mode.

[WelshMedic]

What was the mechanism of injury? how fast was the car travelling? Did she wear a seatbelt? How much damage was done to the rest of the car? These are all factors that play a role here. However, she was alert and orientated and WASN'T complaining of pain. I realise that within the claim culture that exists in the US, there's a potential for over-treating someone but surely we can think for ourselves, can't we? I don't think the roof would have come off with me as it would be a waste of time and resources as well as potentially wrecking an otherwise perfectly good car.

Can't someone sue you for wrecking the car if they find out they have no lasting C-spine injury? (A genuine question?)

Carl.

[akflightmedic]

"drivers of the vehichles. One of them was up and about, no problem, his vehichle didnt have any damage. The other vehichle had smashed into a light pole. The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain. "

Sounds lke the car door was already wasted, waiting for it to be popped open is no big deal. Roof flap, maybe , maybe not I wasnt there. Starred the windshield so that answers the seatbelt question, doesnt remember the accident, hmmmm. Over treating, I dont think so. She is stable but why pull her up and over and make her lift herself up? If you are going to do this, why backboard at all?

[BushyFromOz]

Well, i think ill use this opportunity to pose a question to yall....

At the race meets i cover we routinely extricate the driver through the passenger side, though we open the drivers side door to do it....

We find it is much smoother than going out the drivers door, it also mean we can have them on the spine board and strapped down before we even remove it from the vehicle, find its much easier to get their legs out from under the steering wheel this way

Any thoughts?

[akflightmedic]

I have done that many times and it is a great idea, except when there is a center console that requires you to llift the patient or a gearshifter in the way.

Other than that, it works great especially for the reason you mentioned.

[AnthonyM83]

Howeveri f it were me and he refused to do what I felt was absolutely right and it could potentially harm the pt, I would have called the supervisor on the radio or advised the ALS unit of the situation.

See, I feel this is easier said than done. There are many things that could potentially harm the pt. Like the 2nd victim in his scenario who was already walking around and minimum damage to their car...not putting on a c-spine could potentially harm. Also, it's very likely that the way they extracted the primary pt out of the car worked perfectly fine.

I find it extremely difficult as a junior to intervene with pt care UNLESS it's really clear cut that it would hurt the pt. And in those cases, I would never have to (I'd think) b/c if it's clear cut, then they wouldn't be taking the risk either. Straight out of school, if you asked me whether you should c-spine someone, I'd give the standard, yes, any head injury could potentially be a c-spine injury, so immobilize, thus I would step in and stop it or handoff the paperwork to the person who made the decision. BUT once I started working, I realized you don't actually c-spine every head injury.

So, it makes me think, what other things do I think would harm the pt, but really it's just lack of experience that makes me think that...and would I risk my career/standing on making a big deal out of it, when it was only potential harm.

[whit72]

Your a pt advocate, if you see something you feel will exacerbate the situation, then you need to speak up.

This I feel is just a judgement call, over the center console. Popping the door, rolling the roof back seems a bit extreme. Whatever, its preference.

Pick you fights wisely as a rookie. If you look like a know-it all over and extrication decision on a stable pt, you could alienate yourself later,

when you really need to step in and question the way something is being performed.

Good luck

[Neuropathy]

This I feel is just a judgement call,

Famous last words..

he then stuck the board in, over the console, he then asked for her to lift herself up by standing up a little

Thats pretty poor judgement

If you look like a know-it all over and extrication decision on a stable pt

ummmmm....

The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain.

This is not an "Extrication Decsision", this is an idiot who obviously does not understand the importance if spinal immobilisation and extrication techiniques

asked for her to lift herself up by standing up a little

See, an idiot

[Coach Hohman]

Famous last words..

Thats pretty poor judgement

ummmmm....

This is not an "Extrication Decsision", this is an idiot who obviously does not understand the importance if spinal immobilisation and extrication techiniques

See, an idiot

Yeah.....what Neuropathy said...+10 for Idiot...Ghurty, where do you live? I'd like to try to avoid it while this guy is on duty.

[whit72]

Oh I see the EMT told her to lift herself up to get on the board. Got it now.

An neuropathy 95% of this job is judgement calls.

Or do you just board everyone.

Put everyone on oxygen

Start an IV on everyone

Place them on a monitor

Put traction on every femur fx.

In that case you have all your bases covered and you have nothing to worry about.

Most on the other hand treat people based on assessment.

My feeling is people who over treat, are lacking good assessment skills. They over treat to compensate for their insecurities as a provider.

Judgement calls are also known as a decisions. And yes I make them everyday.