Fire based EMS

[StickEm]

For the most part, the FFs we deal with are great about getting the PT ready for us and even driving to the ER.

There was that one time, however that a guy with NO HELMET went over a moving car on his four-wheeler, broke both the front and rear windows out with his body, and slid down the back side of it, leaving a bloody trail. He looked like s***, and had cuts and scrapes everywhere. Now due to the MOI, the most important thing is immobilization, and here we had 6 FFs, (one of which was a "paramedic",) standing around, while the guy held himself up on the fender of the four wheeler. They are asking him questions and he's answering by NODDING HIS HEAD FROM SIDE TO SIDE AND UP AND DOWN!!! No c-spine, no long board, nothing. He was found to have a brain bleed later, which disrupted his functions and rendered him a veg. Now, he was C&A for the whole ride in to Grady and VS were stable. Here we thought he was lucky...

One other time, the FFs gave us some "anomylous" BP readings, and were downplaying this woman's CC of tingling, facial drooping, and high BP, saying it wasn't a stroke, and they even had us slow our response. All we had was what dispatch told us with a woman CO feeling faint until we got there and assessed her.

-Dumba$$es.

[CBEMT]

Now due to the MOI, the most important thing is immobilization,

I thought we had grown out of that.

They are asking him questions and he's answering by NODDING HIS HEAD FROM SIDE TO SIDE AND UP AND DOWN!!! No c-spine, no long board, nothing. He was found to have a brain bleed later, which disrupted his functions and rendered him a veg.

Ah- but he didn't have a cervical injury, did he!

[StickEm]

CB, I assume you are being sarcastic.

In actuality, he did have a basal fracture, and this is what rendered him braindead by the afternoon. Whether or not c-spine immobilization would have helped, it is still SOP for any possible head/neck injury or MVA. LOL we outgrew that...

[kristo]

Doesn't need to be standard practise. There is some very convincing evidence that shows that if there is no tenderness or palpable abnormalities in the vertebrae, and the patient can move and feel their extremities (feel the difference between sharp and soft touch), it can be assumed that there is no need for spinal immobilization.

Contraindications for this kind of assessment would be an altered LOC, overwhelming pain elsewhere or any back pains or tenderness.

[StickEm]

Yeah, ok. You do that. As for me and mines, we will do a full meal-deal on any significant MOI and stay out of court.

Unless you have x-ray vision, or CAT scan vision, you can't say if it is or is not a fracture.

Better to err on the side of caution in this litigious age.

If your Pt. turns around and sues for sciatic pain later on down the road, then some lawyer will ask the question, "What is the AAOS' and NREMT's protocol for transporting a Pt involved in an MVC with significant MOI like this four-wheeler, head-on versus a car? Did you provide an adequate standard of care? What if we ask four other paramedics/EMTs what that level of care is and they all say, "full immoblization."? You have neglected your Pts needs by deviation from an acceptable standard of care, and since we found that level of care described by your state's medical director in YOUR SOP manual, you are wrong. I rest my case, your honor."

Your company pays, you get fired and lose your license.

[StickEm]

I know of very few F.D.'s that have a successful EMS program. Again, usually it is because what has been mentioned previously. Unfortunately, I am beginning to see and witness more and more of the same attitudes in EMS. The .. "I am here to save a life, otherwise don't bother me" .. type. Yes, some of those are awaiting to be able to get on a F.D.

Until EMS can prove to the public, the powers to be, that we should be an individual service, nothing will change. It will definitely not change with the current education level, the current attitude and activity of the majority of EMS personnel.

Same old song.. and same old verse...

R/r 911

Yup, I agree.

Let me make mention of the one thing FDs have that we don't, and it probably seals deals for them in most cases:

A Union.

Ugh, I said the "U" word...

[paraloco]

agrees with stick'em. the things going on where I am would not be taken quietly by IAFF if the firemen were running EMS

[CBEMT]

Yeah, ok. You do that. As for me and mines, we will do a full meal-deal on any significant MOI and stay out of court.

Unless you have x-ray vision, or CAT scan vision, you can't say if it is or is not a fracture.

Better to err on the side of caution in this litigious age.

Treat the patient not the lawyer.

If your Pt. turns around and sues for sciatic pain later on down the road, then some lawyer will ask the question, "What is the AAOS' and NREMT's protocol for transporting a Pt involved in an MVC with significant MOI like this four-wheeler, head-on versus a car? Did you provide an adequate standard of care? What if we ask four other paramedics/EMTs what that level of care is and they all say, "full immoblization."? You have neglected your Pts needs by deviation from an acceptable standard of care, and since we found that level of care described by your state's medical director in YOUR SOP manual, you are wrong. I rest my case, your honor."

That's when my expert gets up and gives us the evidence-based medicine showing MOI is a piss-poor method of assessment. Oh, and he'll give us a nice dissertation on SSI research as well.

As for my medical director's SOP, those tell me to "consider" spinal immobilization.

[flight-lp]

Yeah, ok. You do that. As for me and mines, we will do a full meal-deal on any significant MOI and stay out of court.

Unless you have x-ray vision, or CAT scan vision, you can't say if it is or is not a fracture.

Better to err on the side of caution in this litigious age.

If your Pt. turns around and sues for sciatic pain later on down the road, then some lawyer will ask the question, "What is the AAOS' and NREMT's protocol for transporting a Pt involved in an MVC with significant MOI like this four-wheeler, head-on versus a car? Did you provide an adequate standard of care? What if we ask four other paramedics/EMTs what that level of care is and they all say, "full immoblization."? You have neglected your Pts needs by deviation from an acceptable standard of care, and since we found that level of care described by your state's medical director in YOUR SOP manual, you are wrong. I rest my case, your honor."

Your company pays, you get fired and lose your license.

Ther are many agencies out there that have selective spinal motion restriction protocols. It is becoming quite common, so your "standard of practice comment" may not hold water in some areas. I really think you are over doing your fictitious courtroom drama. NREMT is a testing agency and certification registry only, nothing more. They do not have "protocols", only the skill sets that are required for their test. Nor does AAOS have any input, regulation, or authority over anything that I do as a medic. I've been on the stand at both ends on numerous occasions and I've never heard either agency mentioned...................

As others have mentioned, you can cement someone to a backboard and staple their head to it all day long, you still are going to do nothing for a head bleed. So a lack of SMR would not have had any detrimental effect or change in the patient's condition. Dumbass should have been wearing a helmet.......................

[pshep2134]

This study was conducted by three individuals who are directors in Dallas, LA and W. Palm Beach. Huge areas. They take into account the large cites. These are places with over 250,000 people or up to 5 times that much. They do not account for the smaller cities or towns or even the smaller counties that have many volunteer agencies within them. I would think this to be a majority of the population. Volunteers for their FD and for their BLS. By this account, this whole study is hogwash. In the grand scheme of things, in the larger cities this may be accurate, but not for everywhere America.

Philip Shepherd NREMT-P