first real call

[medic001918]

That post was a little better, but there's till much room for improvement. It's written in a lot of short hand and still without punctuation. If you want to be taken seriously, a well constructed post goes a long way towards that goal. On a forum such as EMTCity or any other forum your written word is as good as your spoken word and people are forming opinions based on how your post is formed. Keep that in mind when you put together your posts, and you'll find that people respond much better to your posts, even when they disagree with you.

Now on to the call itself. Regardless of someone is only claming a "cut" head, as an EMT-B you should not have been the one to decide if c-spine precautions were not warranted or not unless that's specifically in your protocol? From reading your post, it doesn't sound as though it's protocol for you to not immobilize a patient with that kind of mechanism of injury.

Remember your kinematics of trauma lecture from class? Rollover MVC's can have one of the highest rates of unpredictable injuries due to the fact that you can't determine where all of the forces came from in the impacts that occur. There are a number of things that come into play when a provider decides to immobilize, or decides not to immobilize a patient. From your description of the events it doesn't sound as though many of those things were weighed into your decision. I can also tell you that as a paramedic, if I showed up and you didn't have c-spine being held on this patient or at least form of doing something being done; that we would be having words or I would be speaking with your chief and/or training officer. Regardless of the damage to the vehicle, this is a patient that was in a motor vehicle that was flipped over at least once (to get it on it's roof). Seat belts today do not offer the best protection against a roll over style crash, and there are a number of things the patient may have struck their head on to in order to get that laceration.

Unfortunately, this is part of the learning process. We've all learned by making mistakes. It's just the nature of the job. Hopefully someone will be there to help stop you from making big mistakes when it matters. And hopefully this call will be reviewed by you with someone from your service to ensure that proper protocols and treatments are carried out the next time. Good luck.

Shane

NREMT-P

[JPINFV]

Quick question for ya.

Besides requesting a little first aid for the cut, was the patient refusing/declining transport?

[Cookie]

Pt. walking around, you still can take manual control of C spine. IE stand behind pt. and place hands in proper place for c spine control. Two when unit arrives that has all the c collars and back boards, you still maintain control of c spine while they put a collar on, and place a backboard behind standing pt. Then you do a standing takedown of the patient, all while maintaining c spine. After head blocks in place and pt. strapped properly to backboard and then others who are transporting can take over from you. That is what I would do and we do all the time when we have the walking wounded from a roll over.

Car upside down is a significant MOI, even if the pt was strapped in.

You never know what happened to the organs, specifically the brain and the spine being bounced about in a roll over, and when the pt. extricates themselves, hummm. They are strapped in, car upside down, think about it. Think about the MOI, think about the possibilities.

[rocketjaw]

NickD - I too am a student about 3/4 through the class. I'd have to agree with what you said. They give us lots of scenario questions on the tests that talk about almost this exact same incident, where theres a mva (significant MOI) and when you arrive on scene the patient is up and walking around. The correct answer is ALWAYS the most cautious one - to take c spine precautions anyways.

ps - we use that same book too, Brady's prehospital emergency care. I wonder if all EMT's in the U.S. learn from that book...

[thecroc]

we did not use the brady book for the class so not every use brady books.

not every rollover is the same. in this case it was less sever than most slow speed no eoth seat belt was on for rollovers this one

was not as bad as most

as for no c spine in hind site i most likely should of done more to try to get him to get back boarded but he did not any help so we could not do much

[medic001918]

So a less severe roll over has the potential for less injury? True to some extent, however in any rollover there is a potential for injury due to the unpredictability of the pattern. My suggestion is to read up on some kinematics of trauma. It might change your views slightly.

Hindsight is 20/20. And in this case, you absolutely should have been holding some form of c-spine. Anything less is unacceptable.

And as was mentioned before, brushing up on the construction of your posts will go a long way towards your credibility as a poster, and in some ways a provider when on the forums. Food for thought.

Shane

NREMT-P

[Mastabattas]

My understanding of the US structure of EMS is that the EMT-B is a loose equivalent of the EMR in Alberta.

That being said my only questions is this: Is it within the scope of an EMT-B to rule out C-spine?

In Alberta it is NOT within the scope of an EMR.

[rocketjaw]

I don't believe it is in our scope to rule out c - spine. They teach us that WHENEVER there is a significant MOI to ALWAYS take c - spine precautions

[mark]

we did not use the brady book for the class so not every use brady books.

not every rollover is the same. in this case it was less sever than most slow speed no eoth seat belt was on for rollovers this one

was not as bad as most

as for no c spine in hind site i most likely should of done more to try to get him to get back boarded but he did not any help so we could not do much

No offense here Croc, but when someone types a post poorly, it makes them seem unintelligent and it drives me nuts. So, I'm going to do us both a favor and critique your post before I respond to it.

Let's begin:

-The beginning of a new sentence should always start with a capital letter.

-The word "I" should always be capitalized as well.

-Never underestimate the importance of a comma. A comma turns "Eats shoots and leaves" into "Eats, shoots, and leaves". See the difference?

-Make sure you have correct spelling in your post. "Sever" means to separate from the whole, while "Severe" means harsh or unnecessarily extreme.

-Correct grammar, spelling, and flow are very important when it comes to call documentation as well as everyday communication.

Now, onto the call...

First off, you're right. Not every rollover is the same, but keep in mind how much force it takes to flip a car off of its wheels and onto its roof. Even in the best case scenario, that's an awful lot of force to flipthat much weight. It's been said before, and I'll say it again. Seatbelts strap you into the seat. That's it. They do not protect against any motion other than forward and backward, and your head and neck can still bounce around like a bobblehead doll. Also. in rollovers, there are a lot more directions to go than just forward and backward. You also say that he didn't want any help, but ended up being transported by the local service. What happened to change his mind?

You seem to be quite new at all of this, so the best advice I can offer you is if something seems like it's getting out of control...or you think something might be too much for you to handle...just step back for a second for a second, calm yourself down, and remember your training. You can't go wrong if you go by your training. Best of luck as you start out in this field.

[CodeBlueEMT]

It's been my experience that not all patients will allow C-spine immobilization. I've responded to horrific MVA's with a victim already out of the vehicle upon arrival. If a patient refuses treatment, I do my best to explain what's in their best interest. Every call can present difficult situations. Do any of you just grab a patient and hold C-spine? The classroom and reality are two different arenas. If you've been doing this job long enough, you know what I mean. Anybody remember their first call? Did you have to respond alone? Think about it.

Shayne