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

[allison20]

To the original poster,I to had a similar incident at a MVA. Patient was a 78 year old with poss leg fractures and the medic " her highness" had decided to call off the rescue truck, as they were pulling up on scene, and yank him thru the passenger door. When I tried to ask "why not open the door" I was cut off, reminded that she was in PARAMEDIC in charge and how dare I question her. So instead of waiting 5 minutes for the rescue to pop the door, she did a half ass job of yanking him thru the passenger door. I know what she did was wrong, but in this county, there is not a damm thing you can do about it.

[Dustdevil]

I know what she did was wrong, but in this county, there is not a damm thing you can do about it.

Then do nothing. That's right. Stand back with your hands in your pocket and say, "Go for it, dude" when your partner says he is going to do something that is wrong. You are not obligated to participate. If he asked you to defibrillate a conscious, alert, oriented, non-distressed patient, would you do it? Hell no. So why would you willingly participate in any other form of inappropriate patient care? The answer is, you shouldn't. And if you do, you are just as wrong as he is.

So what happens? He reports you for not helping him, and you in turn report him for inappropriate patient care? Yes, I know that when he complains, you will be the one that the supervisor or manager makes out to be in the wrong. That is why it is important for you to be the first one to complain. First rule of EMS survival: he who gets his story in first is right. While he is trying to single-handedly extricate this person, you get on the radio to request a supervisor.

[Dustdevil]

Nexus criteria is a in hospital scale used for radiography. Not a criteria for pre hospital immobilization.

Tell that to your medical director, then get back to us from the unemployment line!

Actually, Whit, you have a half-way valid point there. In fact, I have argued that very point here on several occasions. I have argued it with Dr. Bledsoe to the point that he wanted to physically hurt me. You are absolutely correct in the purpose of the NEXUS criteria. However, the reason that I and others find the NEXUS criteria of dubious value in the field is because it is not specific enough for field use. That means, there are some people who are cleared in the field by NEXUS who will still have SCI. That is both a medical and a legal pitfall of NEXUS. However, the same cannot be said about those who the criteria says should be immobilised. In other words, NEXUS is LESS restrictive than previously taught and accepted spinal protocols. Before NEXUS, EVERYBODY with a suspicious MOI got full spinal precautions. So if NEXUS says you get spinal precautions, then every other protocol would have also said so. Therefore, whining about NEXUS not being a field-applicable protocol doesn't get you any points here. NEXUS or no NEXUS, the patient in question is due full spinal precautions.

I actually was taken out a hatchback immobilised, the emphasis is on competent immobilisation, not the route in which extricated.

I'm still perplexed as to why you believe it is an either-or proposition. Why are not BOTH of those factors to be considered? Are you incapable of balancing more than one decision at a time? Are you incapable of walking and chewing gum at the same time? I sure hope you don't ever have patients with both chest pain AND shortness of breath! What are you going to do then, give them Nitro and ignore the dyspnea because two factors are too overwhelming for you? Seriously dude, I once thought you were a relatively smart guy, but you're just digging yourself very deeply into a bottomless pit of incredibility.

As far as the NIMROD comment, I would expect nothing less from a pushy self proclaimed EMS expert.

Please point me to any quote on this forum where I even came close to making any such claim. Obviously, your powers of character judgement are as inadequate as your medical judgement.

[Malignant-Hyperthermia]

That means, there are some people who are cleared in the field by NEXUS who will still have SCI. That is both a medical and a legal pitfall of NEXUS. However, the same cannot be said about those who the criteria says should be immobilised. In other words, NEXUS is LESS restrictive than previously taught and accepted spinal protocols. Before NEXUS, EVERYBODY with a suspicious MOI got full spinal precautions

Ahh i stuffed up as well, i should have explained this because i have also "debated" this with others

We are taught that NEXUS should be used, but suspect MOI ALWAYS overrides it.

No suspect MOI but fails NEXUS = immobilise (thats generalsied i know, but i couldn't be arsed explaining [insert scenario here + common sense here])

Passes NEXUS but suspect MOI = immobilise

Pass NEXUS and no suspect MOI = free to pass go and collect $200

[Dustdevil]

No suspect MOI but fails NEXUS = immobilise (thats generalsied i know, but i couldn't be arsed explaining [insert scenario here + common sense here])

Passes NEXUS but suspect MOI = immobilise

Pass NEXUS and no suspect MOI = free to pass go and collect $200

Of course, that means that nothing has really changed with the introduction of NEXUS, since pretty much anybody who fails NEXUS is going to have MOI.

[whit72]

I might need to clarify my self here.

My partner reviewed this topic, and stated to me sometimes I don't always get the point across im trying to make, in the fashion I am intending.

Which is a valid point. I will admit this. I apologize (she made me type that.) LOL

The fact of the matter is I don't believe this conversation was ever about immobilisation, We all agree the pt warranted it on MOI alone.

As far as the NEXUS criteria, the fact that it dosent factor in MOI, is the sole reason I believe medical directors wouldn't endorse it.

I would hope that most ems personnel would be able to factor in force needed to cause significant intrusion and minor, moderate and heavy damage. Regardless of a negative NEXUS finding.

Although it is a helpful tool in assessment.

Sorry dust you were speaking of my nimrod partners. She didn't like that comment, nor does she resemble it.

Although I can usually decipher the meaning of your posts from you usual chest beating banter.

I apologize to malignent for the rash og bull Sh#@ I directed towards you for the medicine practise comment. I will state that the practise of medicine comments do bother me. I have a close friend who sacrificed her entire twenties to obtain her MD/phd. For me to assume that I practise medicine would be an insult to her over a decade of education.

Although she has made the comment that if you were to drop dead, you would have a better chance of survival if you did it at an EMS convention opposed to a physicians convention.

God I feel I just left confession.

Later

[Malignant-Hyperthermia]

Although she has made the comment that if you were to drop dead, you would have a better chance of survival if you did it at an EMS convention opposed to a physicians convention.

No doubt....so in this case who is the better medical practitioner? the Physician or the Paramedic?

I love these fruitful debates that end in a backhanded comment........ leaves a very sour taste

However, this is what these forums are all about, and a good joust like this not only sears at your synapses, it brings out the best information people have to offer

Good show ol'e chap!

[Dustdevil]

The fact of the matter is I don't believe this conversation was ever about immobilisation, We all agree the pt warranted it on MOI alone.

I wouldn't go that far. There are some strict NEXUS-ists here at The City who would dispute that. I, of course, am not one of them. But yes, this conversation IS about immobilisation. The concept of immobilisation encompasses everything you do to immobilise the patient's spine from first contact until you deliver them to the ER table. Immobilisation does not end when they are in the collar, in the KED, or on the board. Your means of extrication DOES matter. It is the continuation of the immobilisation process. That means you can't just package the patient, then jerk them about the vehicle during extrication without any regard to how much movement and stress is being placed on the patient. That is called "half-arsing" the job, which we have already established is wholly inappropriate. And until you understand this (even if you choose not to publicly admit it), you are missing an extremely serious point of patient care, and will continue to receive the distrust of those many educated and experienced medics here who remain perplexed that you just don't seem to get it.

As far as the NEXUS criteria, the fact that it dosent factor in MOI, is the sole reason I believe medical directors wouldn't endorse it.

I would hope that most ems personnel would be able to factor in force needed to cause significant intrusion and minor, moderate and heavy damage. Regardless of a negative NEXUS finding.

Although it is a helpful tool in assessment.

See! When you say things like this, I find myself saying, "Hey, he's not a complete idiot! That's a fairly intelligent thought which a lot of other intelligent people never even seem to realise!" I applaud you for that thought process. We are in total agreement on it. And it's not the first really impressive thing I have seen you say around here. That's why I am frankly stumped by your position on the immobilisation and extrication issue. You do seem sharp enough to know better.

Sorry dust you were speaking of my nimrod partners. She didn't like that comment, nor does she resemble it.

If she's hott (and doesn't have a wicked Boston accent), please give her my apologies and my e-mail address.

[Malignant-Hyperthermia]

As far as the NEXUS criteria, the fact that it dosent factor in MOI, is the sole reason I believe medical directors wouldn't endorse it.

I would hope that most ems personnel would be able to factor in force needed to cause significant intrusion and minor, moderate and heavy damage. Regardless of a negative NEXUS finding.

Although it is a helpful tool in assessment.

There it is! Right there! THAT is what this place is all about!

[Asysin2leads]

Okay, okay, okay, the adults have talked too much and now I'm really confused. Dust, I'm curious, if a person can be safely KEDed in the driver's seat, and a backboard can be stabilized running from the passenger's set across the console to under the patient, and the patient can be safely rotated onto the backboard and secured without opening the driver's side door, what in terms of physics causes the patient detriment? I'm not trying to be a wiseass or challenging you, I really am curious, is there some sort of stress this technique would cause that I'm not aware of?

I can see your point about going through the roof, even if everything is tight, you still can place strain on the hips and neck if you are yanked upwards from a sitting position,I can see your point. But can you fill me in on the difference between transferring someone onto a backboard with a

KED in place towards the driver's side versus the passenger's side?