Guest guest Posted February 14, 2005 Report Share Posted February 14, 2005 Would you immobilize somebody who could not give a clear history, has severe head and neck pain, and fever? E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care You said it better than I could . Great post. -Alfonso R. Ochoa > The standard of care is to immobilize anybody who has neck pain. While there > are cases of fx c-spine w/o pain, they are rare enough to be able to exclude > them from including them in the standard of care for neck injury in a case > w/o mechanism of injury. > > I'm confused.....are you saying that people should NOT package the ones with > neck pain from minor accidents? > > I have made exceptions....rare ones....where I have transported somebody to > the ED w/o complaints and didn't immobilize them, but as general practice, > if you insist on being transported to the ED in the absence of any complaint > in order to buff up your lawsuit over the TA, you are the kind of person who > will try to sue me later when your no pain neck injury turns out to be > debilitating for life, according to your chiropractor, and you are going to > get trussed up like a Christmas turkey before you get in my rig. > > Hey, I didn't just have a car wreck, I hit the lottery! Somebody call Jim > Adler! > magnetass sends > Standard of Care > > > > > > so today in medic school the instructor brought up what i thought was a > > good point. > > > > as things are now, if we are called to a MVC that is minor, very little or > > no damage at all, and one passanger complains of insurance pain, so we > > package them fully to CYA, if their back didnt hurt, it will by the time > > they have gotten to the hospital, had X-rays and are cleared to be > > released from being packaged. as it is now, that is the standard of care, > > you put a medic on the stand in court and he/she will say yeah, id > > do that. > > > > well, if we all collectively decide to NOT package the people from these > > minor accidents, then we cannot be sued because it is not outside of the > > standard of care. > > > > obviously significant MOIs should be packaged, but im talking about the BS > > calls where all it is is an insurance convention. > > > > what are ya'lls thoughts? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2005 Report Share Posted February 14, 2005 Would you immobilize somebody who could not give a clear history, has severe head and neck pain, and fever? E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care You said it better than I could . Great post. -Alfonso R. Ochoa > The standard of care is to immobilize anybody who has neck pain. While there > are cases of fx c-spine w/o pain, they are rare enough to be able to exclude > them from including them in the standard of care for neck injury in a case > w/o mechanism of injury. > > I'm confused.....are you saying that people should NOT package the ones with > neck pain from minor accidents? > > I have made exceptions....rare ones....where I have transported somebody to > the ED w/o complaints and didn't immobilize them, but as general practice, > if you insist on being transported to the ED in the absence of any complaint > in order to buff up your lawsuit over the TA, you are the kind of person who > will try to sue me later when your no pain neck injury turns out to be > debilitating for life, according to your chiropractor, and you are going to > get trussed up like a Christmas turkey before you get in my rig. > > Hey, I didn't just have a car wreck, I hit the lottery! Somebody call Jim > Adler! > magnetass sends > Standard of Care > > > > > > so today in medic school the instructor brought up what i thought was a > > good point. > > > > as things are now, if we are called to a MVC that is minor, very little or > > no damage at all, and one passanger complains of insurance pain, so we > > package them fully to CYA, if their back didnt hurt, it will by the time > > they have gotten to the hospital, had X-rays and are cleared to be > > released from being packaged. as it is now, that is the standard of care, > > you put a medic on the stand in court and he/she will say yeah, id > > do that. > > > > well, if we all collectively decide to NOT package the people from these > > minor accidents, then we cannot be sued because it is not outside of the > > standard of care. > > > > obviously significant MOIs should be packaged, but im talking about the BS > > calls where all it is is an insurance convention. > > > > what are ya'lls thoughts? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2005 Report Share Posted February 14, 2005 Would you immobilize somebody who could not give a clear history, has severe head and neck pain, and fever? E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care You said it better than I could . Great post. -Alfonso R. Ochoa > The standard of care is to immobilize anybody who has neck pain. While there > are cases of fx c-spine w/o pain, they are rare enough to be able to exclude > them from including them in the standard of care for neck injury in a case > w/o mechanism of injury. > > I'm confused.....are you saying that people should NOT package the ones with > neck pain from minor accidents? > > I have made exceptions....rare ones....where I have transported somebody to > the ED w/o complaints and didn't immobilize them, but as general practice, > if you insist on being transported to the ED in the absence of any complaint > in order to buff up your lawsuit over the TA, you are the kind of person who > will try to sue me later when your no pain neck injury turns out to be > debilitating for life, according to your chiropractor, and you are going to > get trussed up like a Christmas turkey before you get in my rig. > > Hey, I didn't just have a car wreck, I hit the lottery! Somebody call Jim > Adler! > magnetass sends > Standard of Care > > > > > > so today in medic school the instructor brought up what i thought was a > > good point. > > > > as things are now, if we are called to a MVC that is minor, very little or > > no damage at all, and one passanger complains of insurance pain, so we > > package them fully to CYA, if their back didnt hurt, it will by the time > > they have gotten to the hospital, had X-rays and are cleared to be > > released from being packaged. as it is now, that is the standard of care, > > you put a medic on the stand in court and he/she will say yeah, id > > do that. > > > > well, if we all collectively decide to NOT package the people from these > > minor accidents, then we cannot be sued because it is not outside of the > > standard of care. > > > > obviously significant MOIs should be packaged, but im talking about the BS > > calls where all it is is an insurance convention. > > > > what are ya'lls thoughts? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2005 Report Share Posted February 15, 2005 PHTLS has a flowchart that teaches " Indications " for spinal immobilization. It is in the 5th edition provider text. Lee Re: Standard of Care You said it better than I could . Great post. -Alfonso R. Ochoa > The standard of care is to immobilize anybody who has neck pain. While there > are cases of fx c-spine w/o pain, they are rare enough to be able to exclude > them from including them in the standard of care for neck injury in a case > w/o mechanism of injury. > > I'm confused.....are you saying that people should NOT package the ones with > neck pain from minor accidents? > > I have made exceptions....rare ones....where I have transported somebody to > the ED w/o complaints and didn't immobilize them, but as general practice, > if you insist on being transported to the ED in the absence of any complaint > in order to buff up your lawsuit over the TA, you are the kind of person who > will try to sue me later when your no pain neck injury turns out to be > debilitating for life, according to your chiropractor, and you are going to > get trussed up like a Christmas turkey before you get in my rig. > > Hey, I didn't just have a car wreck, I hit the lottery! Somebody call Jim > Adler! > magnetass sends > Standard of Care > > > > > > so today in medic school the instructor brought up what i thought was a > > good point. > > > > as things are now, if we are called to a MVC that is minor, very little or > > no damage at all, and one passanger complains of insurance pain, so we > > package them fully to CYA, if their back didnt hurt, it will by the time > > they have gotten to the hospital, had X-rays and are cleared to be > > released from being packaged. as it is now, that is the standard of care, > > you put a medic on the stand in court and he/she will say yeah, id > > do that. > > > > well, if we all collectively decide to NOT package the people from these > > minor accidents, then we cannot be sued because it is not outside of the > > standard of care. > > > > obviously significant MOIs should be packaged, but im talking about the BS > > calls where all it is is an insurance convention. > > > > what are ya'lls thoughts? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2005 Report Share Posted February 15, 2005 PHTLS has a flowchart that teaches " Indications " for spinal immobilization. It is in the 5th edition provider text. Lee Re: Standard of Care You said it better than I could . Great post. -Alfonso R. Ochoa > The standard of care is to immobilize anybody who has neck pain. While there > are cases of fx c-spine w/o pain, they are rare enough to be able to exclude > them from including them in the standard of care for neck injury in a case > w/o mechanism of injury. > > I'm confused.....are you saying that people should NOT package the ones with > neck pain from minor accidents? > > I have made exceptions....rare ones....where I have transported somebody to > the ED w/o complaints and didn't immobilize them, but as general practice, > if you insist on being transported to the ED in the absence of any complaint > in order to buff up your lawsuit over the TA, you are the kind of person who > will try to sue me later when your no pain neck injury turns out to be > debilitating for life, according to your chiropractor, and you are going to > get trussed up like a Christmas turkey before you get in my rig. > > Hey, I didn't just have a car wreck, I hit the lottery! Somebody call Jim > Adler! > magnetass sends > Standard of Care > > > > > > so today in medic school the instructor brought up what i thought was a > > good point. > > > > as things are now, if we are called to a MVC that is minor, very little or > > no damage at all, and one passanger complains of insurance pain, so we > > package them fully to CYA, if their back didnt hurt, it will by the time > > they have gotten to the hospital, had X-rays and are cleared to be > > released from being packaged. as it is now, that is the standard of care, > > you put a medic on the stand in court and he/she will say yeah, id > > do that. > > > > well, if we all collectively decide to NOT package the people from these > > minor accidents, then we cannot be sued because it is not outside of the > > standard of care. > > > > obviously significant MOIs should be packaged, but im talking about the BS > > calls where all it is is an insurance convention. > > > > what are ya'lls thoughts? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Of all the criteria for trauma center usage, helicopter usage, " load and go " criteria, mechanism of injury seems to be the most inaccurate and does not have literature support for use. For example, death of occupant in the same vehicle does not in any way imply that others in the vehicle are seriously injured. Just like " ejection of occupant from the vehicle " means that the ejected person was not restrained and tells you nothing about restraint status of the other people in the car, The only reliable criteria are physiologic status (i.e., pulse, BP, GCS, RTS). BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care MOI plays a role in your " educated " treatment as well as your protocol. How many of us have seen an old impala with minimum damage with a fatal injuries to the occupants. However, a new impala with severe damage with no injuries. It is my belief that we treat the same. I do know that we are faced with less than obvious gross trauma, however, ever heard of the boy who cried wolf? I do think there will come a time where EMS in general can rule out injuires, but until the order for the " portable, deluxe, turbo modelx-ray machine " comes in.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Of all the criteria for trauma center usage, helicopter usage, " load and go " criteria, mechanism of injury seems to be the most inaccurate and does not have literature support for use. For example, death of occupant in the same vehicle does not in any way imply that others in the vehicle are seriously injured. Just like " ejection of occupant from the vehicle " means that the ejected person was not restrained and tells you nothing about restraint status of the other people in the car, The only reliable criteria are physiologic status (i.e., pulse, BP, GCS, RTS). BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care MOI plays a role in your " educated " treatment as well as your protocol. How many of us have seen an old impala with minimum damage with a fatal injuries to the occupants. However, a new impala with severe damage with no injuries. It is my belief that we treat the same. I do know that we are faced with less than obvious gross trauma, however, ever heard of the boy who cried wolf? I do think there will come a time where EMS in general can rule out injuires, but until the order for the " portable, deluxe, turbo modelx-ray machine " comes in.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Of all the criteria for trauma center usage, helicopter usage, " load and go " criteria, mechanism of injury seems to be the most inaccurate and does not have literature support for use. For example, death of occupant in the same vehicle does not in any way imply that others in the vehicle are seriously injured. Just like " ejection of occupant from the vehicle " means that the ejected person was not restrained and tells you nothing about restraint status of the other people in the car, The only reliable criteria are physiologic status (i.e., pulse, BP, GCS, RTS). BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Standard of Care MOI plays a role in your " educated " treatment as well as your protocol. How many of us have seen an old impala with minimum damage with a fatal injuries to the occupants. However, a new impala with severe damage with no injuries. It is my belief that we treat the same. I do know that we are faced with less than obvious gross trauma, however, ever heard of the boy who cried wolf? I do think there will come a time where EMS in general can rule out injuires, but until the order for the " portable, deluxe, turbo modelx-ray machine " comes in.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Dr. Bledsoe, Is there literature to support the premise that patients presenting an " index of suspicion " or " mechanism of injury " benefit from being evaluated by a trauma surgeon within a short period of arrival? I've seen several instances where a patient is transported to the regional trauma center rather than a " regular " emergency room solely because " trauma criteria " were met. Thank you, Wes Ogilvie, MPA, JD, EMT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Dr. Bledsoe, Is there literature to support the premise that patients presenting an " index of suspicion " or " mechanism of injury " benefit from being evaluated by a trauma surgeon within a short period of arrival? I've seen several instances where a patient is transported to the regional trauma center rather than a " regular " emergency room solely because " trauma criteria " were met. Thank you, Wes Ogilvie, MPA, JD, EMT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Dr. Bledsoe, Is there literature to support the premise that patients presenting an " index of suspicion " or " mechanism of injury " benefit from being evaluated by a trauma surgeon within a short period of arrival? I've seen several instances where a patient is transported to the regional trauma center rather than a " regular " emergency room solely because " trauma criteria " were met. Thank you, Wes Ogilvie, MPA, JD, EMT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 Rob, Blood sucking lawyers read this list. You've just given them a new idea. " Have you or a loved one sufferred excruciating pain, skin ulcerations, respiratory distress, or claustrophobia from having been needlessly strapped to an unpadded spine board by an EMS Service? " " Call the law firm of Beatum, Cheatum, and Howe, immediately. You pay nothing unless we recover damages. " And Rob, the standard is CHANGING. Read the literature, please. Otherwise,..........who knows? It's not always good to be the 1st in everything. E.(Gene) Gandy POB 1651 Albany, TX 76430 wegandy1938@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 Rob, Blood sucking lawyers read this list. You've just given them a new idea. " Have you or a loved one sufferred excruciating pain, skin ulcerations, respiratory distress, or claustrophobia from having been needlessly strapped to an unpadded spine board by an EMS Service? " " Call the law firm of Beatum, Cheatum, and Howe, immediately. You pay nothing unless we recover damages. " And Rob, the standard is CHANGING. Read the literature, please. Otherwise,..........who knows? It's not always good to be the 1st in everything. E.(Gene) Gandy POB 1651 Albany, TX 76430 wegandy1938@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 Rob, Blood sucking lawyers read this list. You've just given them a new idea. " Have you or a loved one sufferred excruciating pain, skin ulcerations, respiratory distress, or claustrophobia from having been needlessly strapped to an unpadded spine board by an EMS Service? " " Call the law firm of Beatum, Cheatum, and Howe, immediately. You pay nothing unless we recover damages. " And Rob, the standard is CHANGING. Read the literature, please. Otherwise,..........who knows? It's not always good to be the 1st in everything. E.(Gene) Gandy POB 1651 Albany, TX 76430 wegandy1938@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 My 76 year-old mother-in-law was recently in a head-on collision then received a secondary T-bone impact. The responding agency, I think, was more than justified in their desire to maintain spinal stabilization. However, from her side, she told them that she was claustrophobic and didn't want " the collar thing " and that it hurt her to lay flat. Instead of exploring options, short-board or K.E.D., she was told that it was all or nothing, and " had " to sign a refusal. She had chest pain and a " seatbelt bruise " across the abdomen. Again, while I don't doubt her, this was only her side of the event. For my patients, I try to stress that it is not just my job, but my desire to transport anyone with suspected injury so if something else appears, I can treat problems as they occur. We have the ability, to allow a patient to refuse any specific treatment or refuse all treatment and allow transport only. After an informed refusal. I'll admit it's not the ideal situation, but it allows me to monitor the patient and lets me know I got them to the hospital for further evaluation. It also takes some of the legal burden off me. Could I still get sued for not C-spining? Pretty sure the answer is yes. But I think I'd rather fight that from a well documented run record including them declining treatment, than leaving the scene with them there and having them drop like a box of rocks. Sorry this was so wordy. Have a great weekend. Joe T. Kiff, EMT-LP, EMSI Cy-Fair Volunteer Fire Department Houston, Texas ________________________________________________________________ Sent via the WebMail system at cyfairvfd.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 My 76 year-old mother-in-law was recently in a head-on collision then received a secondary T-bone impact. The responding agency, I think, was more than justified in their desire to maintain spinal stabilization. However, from her side, she told them that she was claustrophobic and didn't want " the collar thing " and that it hurt her to lay flat. Instead of exploring options, short-board or K.E.D., she was told that it was all or nothing, and " had " to sign a refusal. She had chest pain and a " seatbelt bruise " across the abdomen. Again, while I don't doubt her, this was only her side of the event. For my patients, I try to stress that it is not just my job, but my desire to transport anyone with suspected injury so if something else appears, I can treat problems as they occur. We have the ability, to allow a patient to refuse any specific treatment or refuse all treatment and allow transport only. After an informed refusal. I'll admit it's not the ideal situation, but it allows me to monitor the patient and lets me know I got them to the hospital for further evaluation. It also takes some of the legal burden off me. Could I still get sued for not C-spining? Pretty sure the answer is yes. But I think I'd rather fight that from a well documented run record including them declining treatment, than leaving the scene with them there and having them drop like a box of rocks. Sorry this was so wordy. Have a great weekend. Joe T. Kiff, EMT-LP, EMSI Cy-Fair Volunteer Fire Department Houston, Texas ________________________________________________________________ Sent via the WebMail system at cyfairvfd.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 My 76 year-old mother-in-law was recently in a head-on collision then received a secondary T-bone impact. The responding agency, I think, was more than justified in their desire to maintain spinal stabilization. However, from her side, she told them that she was claustrophobic and didn't want " the collar thing " and that it hurt her to lay flat. Instead of exploring options, short-board or K.E.D., she was told that it was all or nothing, and " had " to sign a refusal. She had chest pain and a " seatbelt bruise " across the abdomen. Again, while I don't doubt her, this was only her side of the event. For my patients, I try to stress that it is not just my job, but my desire to transport anyone with suspected injury so if something else appears, I can treat problems as they occur. We have the ability, to allow a patient to refuse any specific treatment or refuse all treatment and allow transport only. After an informed refusal. I'll admit it's not the ideal situation, but it allows me to monitor the patient and lets me know I got them to the hospital for further evaluation. It also takes some of the legal burden off me. Could I still get sued for not C-spining? Pretty sure the answer is yes. But I think I'd rather fight that from a well documented run record including them declining treatment, than leaving the scene with them there and having them drop like a box of rocks. Sorry this was so wordy. Have a great weekend. Joe T. Kiff, EMT-LP, EMSI Cy-Fair Volunteer Fire Department Houston, Texas ________________________________________________________________ Sent via the WebMail system at cyfairvfd.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 1. I am quite sure there are a lot of things you (or I) haven't seen YET! This doesn't mean that we do not treat them or take precautions. Yes, broken bones are usually easier to tentatively rule out in the field to a point than spinal fractures are but there are mechanisms in existence to do the same with spinal fractures. 2. I had the pleasure last night of transporting a gentleman who informed me that his cardiac condition and pacemaker were caused by a medication that was given to him several years ago and that he wished to be transported to a hospital other than the closest one because they closest hospital had misdiagnosed himself and his wife (a broken leg) several times. He then proceeds to tell me that he is a medical malpractice attorney. When I tell him, jokingly, " OH MY GAWD " , he informs me that he doesn't sue people and never has. So, I would hesitate to say that it is the lawyers that are blood sucking but the people who engage their services. Also, I think Gene has mentioned before, injuries AND lawsuits over just that, the misuse of the long spine board. We treat to our standard of care, we document appropriately and we let our care stand up for itself if needed. Chambers, LP, AAS, sometimes ASS -- Re: Standard of Care hire-Pattison EMS says: > > We wouldn't splint an arm is there were no signs or symptoms of > injury, so why do we think we should splint a back when there are > no signs or symptoms of injury? Two reasons: 1. Because I have seen asymptomatic/non-complaining c-spinal fractures. I have not ever seen an asymptomatic/non-complaining arm fracture. 2. Because the blood sucking lawyers sue over not taking such precautions. I have not ever seen a blood sucking lawyer sue over the discomfort of a long board. Neither of the above situations are likely to ever change, therefore, this entire discussion is little more than academic. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 1. I am quite sure there are a lot of things you (or I) haven't seen YET! This doesn't mean that we do not treat them or take precautions. Yes, broken bones are usually easier to tentatively rule out in the field to a point than spinal fractures are but there are mechanisms in existence to do the same with spinal fractures. 2. I had the pleasure last night of transporting a gentleman who informed me that his cardiac condition and pacemaker were caused by a medication that was given to him several years ago and that he wished to be transported to a hospital other than the closest one because they closest hospital had misdiagnosed himself and his wife (a broken leg) several times. He then proceeds to tell me that he is a medical malpractice attorney. When I tell him, jokingly, " OH MY GAWD " , he informs me that he doesn't sue people and never has. So, I would hesitate to say that it is the lawyers that are blood sucking but the people who engage their services. Also, I think Gene has mentioned before, injuries AND lawsuits over just that, the misuse of the long spine board. We treat to our standard of care, we document appropriately and we let our care stand up for itself if needed. Chambers, LP, AAS, sometimes ASS -- Re: Standard of Care hire-Pattison EMS says: > > We wouldn't splint an arm is there were no signs or symptoms of > injury, so why do we think we should splint a back when there are > no signs or symptoms of injury? Two reasons: 1. Because I have seen asymptomatic/non-complaining c-spinal fractures. I have not ever seen an asymptomatic/non-complaining arm fracture. 2. Because the blood sucking lawyers sue over not taking such precautions. I have not ever seen a blood sucking lawyer sue over the discomfort of a long board. Neither of the above situations are likely to ever change, therefore, this entire discussion is little more than academic. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 1. I am quite sure there are a lot of things you (or I) haven't seen YET! This doesn't mean that we do not treat them or take precautions. Yes, broken bones are usually easier to tentatively rule out in the field to a point than spinal fractures are but there are mechanisms in existence to do the same with spinal fractures. 2. I had the pleasure last night of transporting a gentleman who informed me that his cardiac condition and pacemaker were caused by a medication that was given to him several years ago and that he wished to be transported to a hospital other than the closest one because they closest hospital had misdiagnosed himself and his wife (a broken leg) several times. He then proceeds to tell me that he is a medical malpractice attorney. When I tell him, jokingly, " OH MY GAWD " , he informs me that he doesn't sue people and never has. So, I would hesitate to say that it is the lawyers that are blood sucking but the people who engage their services. Also, I think Gene has mentioned before, injuries AND lawsuits over just that, the misuse of the long spine board. We treat to our standard of care, we document appropriately and we let our care stand up for itself if needed. Chambers, LP, AAS, sometimes ASS -- Re: Standard of Care hire-Pattison EMS says: > > We wouldn't splint an arm is there were no signs or symptoms of > injury, so why do we think we should splint a back when there are > no signs or symptoms of injury? Two reasons: 1. Because I have seen asymptomatic/non-complaining c-spinal fractures. I have not ever seen an asymptomatic/non-complaining arm fracture. 2. Because the blood sucking lawyers sue over not taking such precautions. I have not ever seen a blood sucking lawyer sue over the discomfort of a long board. Neither of the above situations are likely to ever change, therefore, this entire discussion is little more than academic. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 I don't know Joe....I think if you ask the " Judgement Question " then you'll be OK. :-) magnetass sends Re: Re: Standard of Care > > My 76 year-old mother-in-law was recently in a head-on collision then > received a secondary T-bone impact. The responding agency, I think, was > more than justified in their desire to maintain spinal stabilization. > However, from her side, she told them that she was claustrophobic and > didn't want " the collar thing " and that it hurt her to lay flat. Instead > of exploring options, short-board or K.E.D., she was told that it was all > or nothing, and " had " to sign a refusal. She had chest pain and a > " seatbelt bruise " across the abdomen. Again, while I don't doubt her, > this was only her side of the event. > > For my patients, I try to stress that it is not just my job, but my desire > to transport anyone with suspected injury so if something else appears, I > can treat problems as they occur. > We have the ability, to allow a patient to refuse any specific treatment > or refuse all treatment and allow transport only. After an informed > refusal. I'll admit it's not the ideal situation, but it allows me to > monitor the patient and lets me know I got them to the hospital for > further evaluation. It also takes some of the legal burden off me. Could > I still get sued for not C-spining? Pretty sure the answer is yes. But I > think I'd rather fight that from a well documented run record including > them declining treatment, than leaving the scene with them there and > having them drop like a box of rocks. > > Sorry this was so wordy. Have a great weekend. > > Joe T. Kiff, EMT-LP, EMSI > Cy-Fair Volunteer Fire Department > Houston, Texas > > > > > > > > > ________________________________________________________________ > Sent via the WebMail system at cyfairvfd.org > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 I don't know Joe....I think if you ask the " Judgement Question " then you'll be OK. :-) magnetass sends Re: Re: Standard of Care > > My 76 year-old mother-in-law was recently in a head-on collision then > received a secondary T-bone impact. The responding agency, I think, was > more than justified in their desire to maintain spinal stabilization. > However, from her side, she told them that she was claustrophobic and > didn't want " the collar thing " and that it hurt her to lay flat. Instead > of exploring options, short-board or K.E.D., she was told that it was all > or nothing, and " had " to sign a refusal. She had chest pain and a > " seatbelt bruise " across the abdomen. Again, while I don't doubt her, > this was only her side of the event. > > For my patients, I try to stress that it is not just my job, but my desire > to transport anyone with suspected injury so if something else appears, I > can treat problems as they occur. > We have the ability, to allow a patient to refuse any specific treatment > or refuse all treatment and allow transport only. After an informed > refusal. I'll admit it's not the ideal situation, but it allows me to > monitor the patient and lets me know I got them to the hospital for > further evaluation. It also takes some of the legal burden off me. Could > I still get sued for not C-spining? Pretty sure the answer is yes. But I > think I'd rather fight that from a well documented run record including > them declining treatment, than leaving the scene with them there and > having them drop like a box of rocks. > > Sorry this was so wordy. Have a great weekend. > > Joe T. Kiff, EMT-LP, EMSI > Cy-Fair Volunteer Fire Department > Houston, Texas > > > > > > > > > ________________________________________________________________ > Sent via the WebMail system at cyfairvfd.org > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 I don't know Joe....I think if you ask the " Judgement Question " then you'll be OK. :-) magnetass sends Re: Re: Standard of Care > > My 76 year-old mother-in-law was recently in a head-on collision then > received a secondary T-bone impact. The responding agency, I think, was > more than justified in their desire to maintain spinal stabilization. > However, from her side, she told them that she was claustrophobic and > didn't want " the collar thing " and that it hurt her to lay flat. Instead > of exploring options, short-board or K.E.D., she was told that it was all > or nothing, and " had " to sign a refusal. She had chest pain and a > " seatbelt bruise " across the abdomen. Again, while I don't doubt her, > this was only her side of the event. > > For my patients, I try to stress that it is not just my job, but my desire > to transport anyone with suspected injury so if something else appears, I > can treat problems as they occur. > We have the ability, to allow a patient to refuse any specific treatment > or refuse all treatment and allow transport only. After an informed > refusal. I'll admit it's not the ideal situation, but it allows me to > monitor the patient and lets me know I got them to the hospital for > further evaluation. It also takes some of the legal burden off me. Could > I still get sued for not C-spining? Pretty sure the answer is yes. But I > think I'd rather fight that from a well documented run record including > them declining treatment, than leaving the scene with them there and > having them drop like a box of rocks. > > Sorry this was so wordy. Have a great weekend. > > Joe T. Kiff, EMT-LP, EMSI > Cy-Fair Volunteer Fire Department > Houston, Texas > > > > > > > > > ________________________________________________________________ > Sent via the WebMail system at cyfairvfd.org > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 I think we're all missing the practical solution to the problem... Flashlights, really strong flashlights. Shine from the left, check for spinal breaks to the right. It'll be the hottest thing since MAST pants...... Joe T. Kiff, EMT-LP, EMSI Cy-Fair Volunteer Fire Department Houston, Texas ---------- Original Message ---------------------------------- From: wegandy1938@... Reply-To: Date: Fri, 18 Feb 2005 10:54:10 EST Rob, Blood sucking lawyers read this list. You've just given them a new idea. " Have you or a loved one sufferred excruciating pain, skin ulcerations, respiratory distress, or claustrophobia from having been needlessly strapped to an unpadded spine board by an EMS Service? " " Call the law firm of Beatum, Cheatum, and Howe, immediately. You pay nothing unless we recover damages. " And Rob, the standard is CHANGING. Read the literature, please. Otherwise,..........who knows? It's not always good to be the 1st in everything. E.(Gene) Gandy POB 1651 Albany, TX 76430 wegandy1938@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 I think we're all missing the practical solution to the problem... Flashlights, really strong flashlights. Shine from the left, check for spinal breaks to the right. It'll be the hottest thing since MAST pants...... Joe T. Kiff, EMT-LP, EMSI Cy-Fair Volunteer Fire Department Houston, Texas ---------- Original Message ---------------------------------- From: wegandy1938@... Reply-To: Date: Fri, 18 Feb 2005 10:54:10 EST Rob, Blood sucking lawyers read this list. You've just given them a new idea. " Have you or a loved one sufferred excruciating pain, skin ulcerations, respiratory distress, or claustrophobia from having been needlessly strapped to an unpadded spine board by an EMS Service? " " Call the law firm of Beatum, Cheatum, and Howe, immediately. You pay nothing unless we recover damages. " And Rob, the standard is CHANGING. Read the literature, please. Otherwise,..........who knows? It's not always good to be the 1st in everything. E.(Gene) Gandy POB 1651 Albany, TX 76430 wegandy1938@... Quote Link to comment Share on other sites More sharing options...
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