Re: backboarding an osteoarthritis fall vic

[Guest guest]

In a message dated 5/14/2003 5:18:14 PM Eastern Standard Time,

clampson@... writes:

> QUESTION WHAT WOULD YOU HAVE DONE IN MY PLACE?

Honestly, now this is coming from an EMT...I would not have board and

collared her. I have not boarded and collared pts that old. I know we are

supposed to. But come one. She is 80+ yr old. She has a hump. She is

going to be uncomfortable. I would just take her to the hospital w/out board

and collar. Tell the hospital that she fell from unknown. In fact, not to

long ago had an 88 y/o got her feet tangled up in the phone cord and tripped.

She had a lac on her nose. Well, she is on cumadin. HELLO! Blood

EVERYWHERE. I decided NOT to board and collar her b/c of her age and her

complaint. Had it been someone younger, then yes. But board and collar are

uncomfortable as is, when your that old, with a hump..think about it. Bad

circulation..I assume your pt's nose was bleeding b/c of possible break,

correct? Well, she is going to be swallowing a lot of blood...yeah I would

not have board and collared. Just my 2 cents...whether it is wrong or

right...~Dawn~

[Guest guest]

I would have done similarly. I would have assessed her very carefully and

once convinced that she had no apparent spinal injury would have transported

her without the spineboard.

Gene

[Guest guest]

I would have done similarly. I would have assessed her very carefully and

once convinced that she had no apparent spinal injury would have transported

her without the spineboard.

Gene

[Guest guest]

You did good.........first do no harm.......

Terry Dinerman EMTP

[Guest guest]

We have always used a evac-u-splint on top of a backboard for those folks who

are elderly that we suspect of spinal injuries--it seems more comfortable to

them than just the board.

[Guest guest]

I saw the padded backboard somewhere around Houston, ... Some guy with

an animal nickname....

-Wes Ogilvie

[Guest guest]

I'm with Terry on this one.

I too think you did good. These are educated judgement calls that you MUST

be able to make on the scene. Today you did it this way, tomorrow the

circumstances may be just different enough that you would choose something

else.

backboarding an osteoarthritis fall vic

> 80 y/0 female upon arrival pt found on the floor with nursing home

> employees. pt was about 6ft away from be on her back pillow under

> head a blanket covering her. unwitnessed fall. one employee stated

> she fell from bed but i observed the rails were up on the bed,

> another employee stated she fell from a standing position. she has

> a laceration over lt eyebrow and a possible broken nose. after doing

> a head to toe the only complaint she had was pain in left shoulder.

> we went to log roll her, she was put on the backboard, she had a

> 4inch gap between board and her lower back and a hump on her upper

> back. i had to put a folded towel under her head to keep it from

> being hyperextended. she was very thin with no muscle, pretty much

> bones with skin pulled over. on the backboard she started wiggling

> around and drawing up her knees. she started complaining of her

> legs going numb an pain in the buttocks area where she was on the

> board. i have heard this a million times before but i checked

> anyway. besides the 4inch gap between the board and her lower back

> she was directly on her tailbone - no meat to pad. i had her c-

> collar on and c-spine secured. i decided to put her on the stretcher

> from the backboard by log rolling her onto the stretcher and c-spine

> her to the stretcher. remember she had no complaints except

> shoulder pain. we have very bumpy streets between the nursing home

> and the hospital. not wanted to hurt her anymore and thinking it

> would cause more damage than good left her on the stretcher with the

> c-spine, head blocked, shoulders straped down where she couldnt move

> anything from the waist up. then transported to hospital with iv,

> monitor etc. at hospital we were met by the dr. in the trauma room.

> i explained to him what i did and why, he cleared her from the c-

> spine and never gave me a funny look or questioned my decession to

> do this.

>

> QUESTION WHAT WOULD YOU HAVE DONE IN MY PLACE?

>

>

>

>

>

>

[Guest guest]

Buy a backboard that pads the coxyx.

backboarding an osteoarthritis fall vic

> 80 y/0 female upon arrival pt found on the floor with nursing home

> employees. pt was about 6ft away from be on her back pillow under

> head a blanket covering her. unwitnessed fall. one employee stated

> she fell from bed but i observed the rails were up on the bed,

> another employee stated she fell from a standing position. she has

> a laceration over lt eyebrow and a possible broken nose. after doing

> a head to toe the only complaint she had was pain in left shoulder.

> we went to log roll her, she was put on the backboard, she had a

> 4inch gap between board and her lower back and a hump on her upper

> back. i had to put a folded towel under her head to keep it from

> being hyperextended. she was very thin with no muscle, pretty much

> bones with skin pulled over. on the backboard she started wiggling

> around and drawing up her knees. she started complaining of her

> legs going numb an pain in the buttocks area where she was on the

> board. i have heard this a million times before but i checked

> anyway. besides the 4inch gap between the board and her lower back

> she was directly on her tailbone - no meat to pad. i had her c-

> collar on and c-spine secured. i decided to put her on the stretcher

> from the backboard by log rolling her onto the stretcher and c-spine

> her to the stretcher. remember she had no complaints except

> shoulder pain. we have very bumpy streets between the nursing home

> and the hospital. not wanted to hurt her anymore and thinking it

> would cause more damage than good left her on the stretcher with the

> c-spine, head blocked, shoulders straped down where she couldnt move

> anything from the waist up. then transported to hospital with iv,

> monitor etc. at hospital we were met by the dr. in the trauma room.

> i explained to him what i did and why, he cleared her from the c-

> spine and never gave me a funny look or questioned my decession to

> do this.

>

> QUESTION WHAT WOULD YOU HAVE DONE IN MY PLACE?

>

>

>

>

>

>

[Guest guest]

>that would be great if the service i work for had them.

Buy a backboard that pads the coxyx.

> backboarding an osteoarthritis fall vic

>

>

> > 80 y/0 female upon arrival pt found on the floor with nursing

home

> > employees. pt was about 6ft away from be on her back pillow under

> > head a blanket covering her. unwitnessed fall. one employee

stated

> > she fell from bed but i observed the rails were up on the bed,

> > another employee stated she fell from a standing position. she

has

> > a laceration over lt eyebrow and a possible broken nose. after

doing

> > a head to toe the only complaint she had was pain in left

shoulder.

> > we went to log roll her, she was put on the backboard, she had a

> > 4inch gap between board and her lower back and a hump on her

upper

> > back. i had to put a folded towel under her head to keep it from

> > being hyperextended. she was very thin with no muscle, pretty

much

> > bones with skin pulled over. on the backboard she started

wiggling

> > around and drawing up her knees. she started complaining of her

> > legs going numb an pain in the buttocks area where she was on the

> > board. i have heard this a million times before but i checked

> > anyway. besides the 4inch gap between the board and her lower

back

> > she was directly on her tailbone - no meat to pad. i had her c-

> > collar on and c-spine secured. i decided to put her on the

stretcher

> > from the backboard by log rolling her onto the stretcher and c-

spine

> > her to the stretcher. remember she had no complaints except

> > shoulder pain. we have very bumpy streets between the nursing

home

> > and the hospital. not wanted to hurt her anymore and thinking it

> > would cause more damage than good left her on the stretcher with

the

> > c-spine, head blocked, shoulders straped down where she couldnt

move

> > anything from the waist up. then transported to hospital with iv,

> > monitor etc. at hospital we were met by the dr. in the trauma

room.

> > i explained to him what i did and why, he cleared her from the c-

> > spine and never gave me a funny look or questioned my decession

to

> > do this.

> >

> > QUESTION WHAT WOULD YOU HAVE DONE IN MY PLACE?

> >

> >

> >

> >

> >

> >

[Guest guest]

but then someone would just steal it!!! oops....here we go again..

backboarding an osteoarthritis fall vic

>

>

> > 80 y/0 female upon arrival pt found on the floor with nursing home

> > employees. pt was about 6ft away from be on her back pillow under

> > head a blanket covering her. unwitnessed fall. one employee stated

> > she fell from bed but i observed the rails were up on the bed,

> > another employee stated she fell from a standing position. she has

> > a laceration over lt eyebrow and a possible broken nose. after doing

> > a head to toe the only complaint she had was pain in left shoulder.

> > we went to log roll her, she was put on the backboard, she had a

> > 4inch gap between board and her lower back and a hump on her upper

> > back. i had to put a folded towel under her head to keep it from

> > being hyperextended. she was very thin with no muscle, pretty much

> > bones with skin pulled over. on the backboard she started wiggling

> > around and drawing up her knees. she started complaining of her

> > legs going numb an pain in the buttocks area where she was on the

> > board. i have heard this a million times before but i checked

> > anyway. besides the 4inch gap between the board and her lower back

> > she was directly on her tailbone - no meat to pad. i had her c-

> > collar on and c-spine secured. i decided to put her on the stretcher

> > from the backboard by log rolling her onto the stretcher and c-spine

> > her to the stretcher. remember she had no complaints except

> > shoulder pain. we have very bumpy streets between the nursing home

> > and the hospital. not wanted to hurt her anymore and thinking it

> > would cause more damage than good left her on the stretcher with the

> > c-spine, head blocked, shoulders straped down where she couldnt move

> > anything from the waist up. then transported to hospital with iv,

> > monitor etc. at hospital we were met by the dr. in the trauma room.

> > i explained to him what i did and why, he cleared her from the c-

> > spine and never gave me a funny look or questioned my decession to

> > do this.

> >

> > QUESTION WHAT WOULD YOU HAVE DONE IN MY PLACE?

> >

> >

> >

> >

> >

> >

[Guest guest]

--these are great suggestions, but i wanted to bounce it off some of

you guys because my boss has threatened to report me to the state. i

was hoping maybe a dr would give his opinion or at lest a person

that works in an er and has an opinion

- In , nails504@a... wrote:

> We have always used a evac-u-splint on top of a backboard for

those folks who

> are elderly that we suspect of spinal injuries--it seems more

comfortable to

> them than just the board.

>

>

>

[Guest guest]

Yes, a large cat. Definitely not a housecat. Probably not even litter-box

trained.

-Wes

[Guest guest]

In a message dated 05/15/2003 11:24:44 AM Eastern Daylight Time,

Etlaesium@... writes:

> or I would have padded it well enough to make

> it comparable to the cushion on the stretcher (who knows, maybe I would

> have log rolled her onto the stretcher cushion while it was on the back

> board?!?!?!)

what about on a reeves?? place the pt on a reeves, then to the litter

(stretcher). ~Dawn~

[Guest guest]

In a message dated 05/15/2003 11:24:44 AM Eastern Daylight Time,

Etlaesium@... writes:

> or I would have padded it well enough to make

> it comparable to the cushion on the stretcher (who knows, maybe I would

> have log rolled her onto the stretcher cushion while it was on the back

> board?!?!?!)

what about on a reeves?? place the pt on a reeves, then to the litter

(stretcher). ~Dawn~

[Guest guest]

Was it a type of cat?????

Re: backboarding an osteoarthritis fall vic

> I saw the padded backboard somewhere around Houston, ... Some guy

with

> an animal nickname....

>

> -Wes Ogilvie

>

>

>

[Guest guest]

Ok, in wades the attorney...

The question is simple, it's the answer that's less than clear. The question

is whether the medic is negligent in not restricting the patient's movement

by placing them on a backboard. Negligence, in the most basic terms, is a

deviation from the standard of care that a reasonable person (or medic, in

this case) would provide.

Simply put, the plaintiff will need to present evidence that the medic's

failure to place the patient is not acceptable under the current standards of

EMS. The defendant will of course produce evidence to the contrary. In other

words, it's going to end up being a battle between expert witnesses. Who

will win? Folks, that's a question for the jury.

As for the medical director and your workplace, it's the medical director's

call. If you deviate from the protocols, you're opening yourself up to HUGE

trouble.

-Wes Ogilvie

P.S. - Of course, I'm not providing legal advice, but rather, just discussing

the issue like the rest of you. My perspective just happens to be different.

[Guest guest]

Ok, in wades the attorney...

The question is simple, it's the answer that's less than clear. The question

is whether the medic is negligent in not restricting the patient's movement

by placing them on a backboard. Negligence, in the most basic terms, is a

deviation from the standard of care that a reasonable person (or medic, in

this case) would provide.

Simply put, the plaintiff will need to present evidence that the medic's

failure to place the patient is not acceptable under the current standards of

EMS. The defendant will of course produce evidence to the contrary. In other

words, it's going to end up being a battle between expert witnesses. Who

will win? Folks, that's a question for the jury.

As for the medical director and your workplace, it's the medical director's

call. If you deviate from the protocols, you're opening yourself up to HUGE

trouble.

-Wes Ogilvie

P.S. - Of course, I'm not providing legal advice, but rather, just discussing

the issue like the rest of you. My perspective just happens to be different.

[Guest guest]

Absolutely. Without any harm to the patient, there's no cause of action. I

was just taking it a step further, to go into what would happen had the

patient later come back and complained of harm.

-Wes Ogilvie

[Guest guest]

OK...I'm not a doctor, but I do work in an E.R. as well as for a large urban

EMS department. We recently revised our standards and for all practical

purposes, mechanism of injury is no longer a driving criteria for automatic

spinal movement restriction. Mechanism is a driving consideration for

evaluation of the need for SMR. We break the evaluation down to four basic

questions:

1. Is there pain along the spinal column or the paraspinal musculature?

2. Is there any neurological deficit?

3. Are there any distracting injuries (physical or emotional)?

4. Is the patient reliable (meaning can the patient participate adequately

enough in providing a SAMPLE history to allow you to make an educated

decision)? (I can already hear Gene's fingers typing a reply to this

criteria).

If the answer to any one of these questions is " yes " , SMR should be

implemented. That is the EMS perspective.

Our system has always sought consensus approval from the local medical

community before implementing substantial changes in our standards of care,

so from the E.R. side, the physician's groups support this decision

algorithm. Given the information you provided about your patient, unless

the shoulder pain could be considered too distracting to allow her to be

aware of any back pain, our medics would not be required to place her into

SMR.

Hope this helps.

Ed Strout, RN, CEN, LP

Clinical Practice Coordinator

Austin- County EMS

517 S. Pleasant Valley Rd.

Austin, Tx. 78741

Office

Pager

Fax

e-mail: ed.strout@...

Re: backboarding an osteoarthritis fall vic

--these are great suggestions, but i wanted to bounce it off some of

you guys because my boss has threatened to report me to the state. i

was hoping maybe a dr would give his opinion or at lest a person

that works in an er and has an opinion

- In , nails504@a... wrote:

> We have always used a evac-u-splint on top of a backboard for

those folks who

> are elderly that we suspect of spinal injuries--it seems more

comfortable to

> them than just the board.

>

>

>

[Guest guest]

I would gladly take the opportunity to present my case to those that are

in charge of policy. As a matter of fact, this being a TDH sponsored

message group, you have just announced it to the State (I believe this

is a TDH sponsored group, at least. if not, then my bad, but I know they

read it). But, with the overwhelming response to the issue as it is, I

would feel quite comfortable in the fact that you are a " thinking medic "

and not all calls present in the textbook version.

I say kudos to you for seeking input from your peers instead of trying

to hide it under the carpet in the break room. Before it comes to the

State's involvement, I would seek out your Medical Director and ask his

opinion. Take what he says and learn from it (even if you acted totally

appropriate). If it comes to the State's involvement, print out the

responses here and include the discussion with your Medical Director and

hang on to it if needed. Remember, you will be assessed by your peers

and the standard is the standard at which your peers would have

performed given the same amount of training and the same circumstance

(Wes, you could help me out on that one).

And, for the record, even if you didn't suspect a spinal injury, but

there were issues that might have been questionable, the standard now is

" Spinal Movement Restriction " . I fear that the patient would have

attempted more movement while on the board to gain comfort, thus

possibly causing more harm than good. Now, I can't say with 100%

certainty what I would have done (without all the facts), but it is safe

to say that I would have not used the long spine board to restrict

movement of this patient, or I would have padded it well enough to make

it comparable to the cushion on the stretcher (who knows, maybe I would

have log rolled her onto the stretcher cushion while it was on the back

board?!?!?!). But, again, I can't say for sure.

What innovative creatures we can be.

Schadone, NREMT-Paramedic

City of Austin

Austin/ County EMS

Medic 12 / Medic 24

@...

Re: backboarding an osteoarthritis fall vic

--these are great suggestions, but i wanted to bounce it off some of

you guys because my boss has threatened to report me to the state. i

was hoping maybe a dr would give his opinion or at lest a person

that works in an er and has an opinion

- In , nails504@a... wrote:

> We have always used a evac-u-splint on top of a backboard for

those folks who

> are elderly that we suspect of spinal injuries--it seems more

comfortable to

> them than just the board.

>

>

>

[Guest guest]

Wes-

I fail to see the actionable issue in this case study. I have always been

taught that an injury must have been inflicted or some other loss must have

occurred for a finding of negligence to be laid.

In this case, the Medic attempted to apply a Protocol, found it insufficient to

cover the situation, and improvised a solution that got the patient to the ER

intact.

Now, the only way I could find fault with the Medic is if it specifically states

in his protocol that he must call medical control prior to deviating from such

instructions.

I am fortunate to work under a Medical Director that writes Protocols as

" ....suggested treatment modalities for common medical conditions.... " . He

suggests treatments for the usual range of issues and expects that most cases

will fall under such guides. But he also expects us to exercise independent

judgment if the recommended treatment is inadequate to the task at hand or may

in fact create iatrogenic injury.

This does not, however relieve the attending Medic from the responsibility of

supporting his choices when the run is reviewed. Deviations from Protocol are

often the foundations for revisions of the inadequate protocol and all

deviations should be well documented and reviewed.

I hope this Medics Administrator holds similar views and does not pillory a

thinking, adaptive EMT.

Regards-

TD

Re: backboarding an osteoarthritis fall vic

Ok, in wades the attorney...

The question is simple, it's the answer that's less than clear. The question

is whether the medic is negligent in not restricting the patient's movement

by placing them on a backboard. Negligence, in the most basic terms, is a

deviation from the standard of care that a reasonable person (or medic, in

this case) would provide.

Simply put, the plaintiff will need to present evidence that the medic's

failure to place the patient is not acceptable under the current standards of

EMS. The defendant will of course produce evidence to the contrary. In other

words, it's going to end up being a battle between expert witnesses. Who

will win? Folks, that's a question for the jury.

As for the medical director and your workplace, it's the medical director's

call. If you deviate from the protocols, you're opening yourself up to HUGE

trouble.

-Wes Ogilvie

P.S. - Of course, I'm not providing legal advice, but rather, just discussing

the issue like the rest of you. My perspective just happens to be different.

[Guest guest]

Wes-

I fail to see the actionable issue in this case study. I have always been

taught that an injury must have been inflicted or some other loss must have

occurred for a finding of negligence to be laid.

In this case, the Medic attempted to apply a Protocol, found it insufficient to

cover the situation, and improvised a solution that got the patient to the ER

intact.

Now, the only way I could find fault with the Medic is if it specifically states

in his protocol that he must call medical control prior to deviating from such

instructions.

I am fortunate to work under a Medical Director that writes Protocols as

" ....suggested treatment modalities for common medical conditions.... " . He

suggests treatments for the usual range of issues and expects that most cases

will fall under such guides. But he also expects us to exercise independent

judgment if the recommended treatment is inadequate to the task at hand or may

in fact create iatrogenic injury.

This does not, however relieve the attending Medic from the responsibility of

supporting his choices when the run is reviewed. Deviations from Protocol are

often the foundations for revisions of the inadequate protocol and all

deviations should be well documented and reviewed.

I hope this Medics Administrator holds similar views and does not pillory a

thinking, adaptive EMT.

Regards-

TD

Re: backboarding an osteoarthritis fall vic

Ok, in wades the attorney...

The question is simple, it's the answer that's less than clear. The question

is whether the medic is negligent in not restricting the patient's movement

by placing them on a backboard. Negligence, in the most basic terms, is a

deviation from the standard of care that a reasonable person (or medic, in

this case) would provide.

Simply put, the plaintiff will need to present evidence that the medic's

failure to place the patient is not acceptable under the current standards of

EMS. The defendant will of course produce evidence to the contrary. In other

words, it's going to end up being a battle between expert witnesses. Who

will win? Folks, that's a question for the jury.

As for the medical director and your workplace, it's the medical director's

call. If you deviate from the protocols, you're opening yourself up to HUGE

trouble.

-Wes Ogilvie

P.S. - Of course, I'm not providing legal advice, but rather, just discussing

the issue like the rest of you. My perspective just happens to be different.

[Guest guest]

" OHHHHH! That's different then. Never mind. " Lotilla

Re: backboarding an osteoarthritis fall vic

Absolutely. Without any harm to the patient, there's no cause of action. I

was just taking it a step further, to go into what would happen had the

patient later come back and complained of harm.

-Wes Ogilvie

[Guest guest]

I think these criteria make great sense, and I completely agree with them.

Immobilization based solely on MOI is not only irrational but potentially

harmful.

As to whether or not it is defensible not to board a patient like the one

described in the original scenario to this thread, it is.

The ultimate question for the jury is whether or not your actions were those

of a reasonable and prudent practitioner at your level.

Given the facts of the scenario, in my judgment the decision not to board

the patient is reasonable, prudent, and defensible. You will have NO

difficulty in finding a board certified ER physician to serve as your expert.

Finally, there can be no successful litigation arising from this incident

because there was no injury or damage to the patient.

I would hope that nobody in a management position would blindly attempt to

discipline a medic for failing to board this patient. That would be a

triumph of form over substance. If there were to be any action taken

resulting from this case it should be a reevaluation of protocols, some

thoughtful discussions between medical director, medics, and management, and

a review of the current literature which supports movement away from rigid

spineboard protocols.

Gene

In a message dated 5/15/2003 11:03:10 AM Central Daylight Time,

ed.strout@... writes:

> OK...I'm not a doctor, but I do work in an E.R. as well as for a large urban

> EMS department. We recently revised our standards and for all practical

> purposes, mechanism of injury is no longer a driving criteria for automatic

> spinal movement restriction. Mechanism is a driving consideration for

> evaluation of the need for SMR. We break the evaluation down to four basic

> questions:

>

> 1. Is there pain along the spinal column or the paraspinal musculature?

> 2. Is there any neurological deficit?

> 3. Are there any distracting injuries (physical or emotional)?

> 4. Is the patient reliable (meaning can the patient participate adequately

> enough in providing a SAMPLE history to allow you to make an educated

> decision)? (I can already hear Gene's fingers typing a reply to this

> criteria).

>

> If the answer to any one of these questions is " yes " , SMR should be

> implemented. That is the EMS perspective.

>

> Our system has always sought consensus approval from the local medical

> community before implementing substantial changes in our standards of care,

> so from the E.R. side, the physician's groups support this decision

> algorithm. Given the information you provided about your patient, unless

> the shoulder pain could be considered too distracting to allow her to be

> aware of any back pain, our medics would not be required to place her into

> SMR.

>

> Hope this helps.

>

> Ed Strout, RN, CEN, LP

> Clinical Practice Coordinator

> Austin- County EMS

> 517 S. Pleasant Valley Rd.

> Austin, Tx. 78741

> Office

> Pager

> Fax

> e-mail: ed.strout@...

>

> Re: backboarding an osteoarthritis fall vic

>

> --these are great suggestions, but i wanted to bounce it off some of

> you guys because my boss has threatened to report me to the state. i

> was hoping maybe a dr would give his opinion or at lest a person

> that works in an er and has an opinion

>

>

>

> - In , nails504@a... wrote:

> >We have always used an evac-u-splint on top of a backboard for

> those folks who

> >are elderly that we suspect of spinal injuries--it seems more

> comfortable to

> >them than just the board.

> >

> >

> >