Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 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 Since the original subject line of this thread was " Standard of Care " this raises an interesting question. Gene, Dr. B, others?? When the Maine protocol was developed back in the 80', i believe, the standard of care was to immobilize all possible c-spine injuries based on mechanism of injury. Thus, a protocol was needed to deviate from the standard of care. Is this the standard of care anymore, to immobilize anyone who may not need it in any way, shape or form just in case. Or is the standard of care now selective immobilization and not requiring a protocol to perform this, just like we don't need a protocol to NOT intubate someone breathing and with a patent airway. Chambers, AAS, LP -- Fw: Standard of Care I am currently working on a protocol that I am not calling a c-spine clearance protocol, but selective immobilization. There is a criteria to establish who is immobilized and who isn't: 1. Anyone complaining of pain in that area is automaticly immobilized 2. Anyone under the influence of drugs or alcohol 3. Anyone who has an injury that would be distracting from a c-spine injury (major long bone fractures). 4. Anyone under the age of ten and over the age of 65 5. Anyone who is unconscious Of course the medic in charge has the final say so, and the first thing the protocol states is " If you have any doubt at all, IMMOBILIZE!! " With criteria like this, you don't have to immobilize someone who say, has some cuts from broken glass, or who is complaining of knee pain and wants to be transported. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Good idea Troy. I few thoughts that apply to this entire thread. Is it spinal immobilization or spinal motion restriction? We never truly 'immobilize' a patient. Also, 'c-spine' is not what we are trying to protect. We are trying to protect the C, the T, and the L-spine as well. Both of these terms 'spinal motion restriction' and 'c-spine precautions' should leave our vocabulary as they can be trouble makers in court. White, L.P. Assistant Professor Emergency Medical Services Tarrant County College 828 Harwood Road Hurst, TX 76054-3299 shawn.white@... (cell) (office) Fw: Standard of Care I am currently working on a protocol that I am not calling a c-spine clearance protocol, but selective immobilization. There is a criteria to establish who is immobilized and who isn't: 1. Anyone complaining of pain in that area is automaticly immobilized 2. Anyone under the influence of drugs or alcohol 3. Anyone who has an injury that would be distracting from a c-spine injury (major long bone fractures). 4. Anyone under the age of ten and over the age of 65 5. Anyone who is unconscious Of course the medic in charge has the final say so, and the first thing the protocol states is " If you have any doubt at all, IMMOBILIZE!! " With criteria like this, you don't have to immobilize someone who say, has some cuts from broken glass, or who is complaining of knee pain and wants to be transported. Troy Irvine Firefighter/Tactical Paramedic Port Arthur Fire Department 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 Good idea Troy. I few thoughts that apply to this entire thread. Is it spinal immobilization or spinal motion restriction? We never truly 'immobilize' a patient. Also, 'c-spine' is not what we are trying to protect. We are trying to protect the C, the T, and the L-spine as well. Both of these terms 'spinal motion restriction' and 'c-spine precautions' should leave our vocabulary as they can be trouble makers in court. White, L.P. Assistant Professor Emergency Medical Services Tarrant County College 828 Harwood Road Hurst, TX 76054-3299 shawn.white@... (cell) (office) Fw: Standard of Care I am currently working on a protocol that I am not calling a c-spine clearance protocol, but selective immobilization. There is a criteria to establish who is immobilized and who isn't: 1. Anyone complaining of pain in that area is automaticly immobilized 2. Anyone under the influence of drugs or alcohol 3. Anyone who has an injury that would be distracting from a c-spine injury (major long bone fractures). 4. Anyone under the age of ten and over the age of 65 5. Anyone who is unconscious Of course the medic in charge has the final say so, and the first thing the protocol states is " If you have any doubt at all, IMMOBILIZE!! " With criteria like this, you don't have to immobilize someone who say, has some cuts from broken glass, or who is complaining of knee pain and wants to be transported. Troy Irvine Firefighter/Tactical Paramedic Port Arthur Fire Department 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 18, 2005 Report Share Posted February 18, 2005 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 read it. It's crap. It's an excuse for laziness. It's like a <union voting for a strike because, " they can't fire us all if we <all do it! " Yet it is being embraced by the academic elite with <the same zeal that CISM was. <And as someone else rightfully stated, injuries from prolonged <immobilization (for lack of a better term) is the problem of the <hospital, not the medic. <Rob> In today's world there are numerous people who " believe in themselves " . I believe self confidence to be a good thing, in moderation, but there are some, Rob, who push far beyond the limits, creating a " God of Self " . I believe your last statement reflects your total lack of responsibility. Brent....... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " Brent McCain " <rufus@o...> arose from a hallucinogenic stupor to mumble this utter nonsense: > > In today's world there are numerous people who " believe in > themselves " . I believe self confidence to be a good thing, in > moderation, but there are some, Rob, who push far beyond the limits, > creating a " God of Self " . I believe your last statement reflects > your total lack of responsibility. And I, Brent, believe that your entire statement is so incoherent as to discourage any attempt at reply. However, I will respond to what appears to be your hyperverbose point. If I put my patient in spinal immobilization, he remains there by my doing only until he reaches the hospital. Period. Once the ER accepts my patient, he is theirs. Period. If a doctor of medicine there decides that the patient did not need such immobilization, he is taken out of it. However, if that doctor of medicine decides that there is sufficient concern to keep the patient immobilized, he will remain immobilized. That is not my decision. I am neither a " God of Self, " nor a doctor of medicine, nor even a technician of radiation. In fact, at this point, I am not even in the hospital anymore. I am no more responsible for how long the doctor leaves that patient on a board after my departure than I am for how long he leaves the bandage on his forehead after my departure. Perhaps the organization you work for has so many units on the street that you are allowed to remain at the hospital throughout the patients entire stay. If so, great. I am sure that the staff there is thrilled to have you breathing down their necks. But most services do not have that luxury. If you have the ability to express a succinct and coherent thought without obscuring your point with a psychoanalysis of your audience, then I welcome you to tell us all exactly how we are supposed to take responsibility for the medical practice of licensed professionals (unlike yourself) who have assumed the care of the patient. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " Brent McCain " <rufus@o...> arose from a hallucinogenic stupor to mumble this utter nonsense: > > In today's world there are numerous people who " believe in > themselves " . I believe self confidence to be a good thing, in > moderation, but there are some, Rob, who push far beyond the limits, > creating a " God of Self " . I believe your last statement reflects > your total lack of responsibility. And I, Brent, believe that your entire statement is so incoherent as to discourage any attempt at reply. However, I will respond to what appears to be your hyperverbose point. If I put my patient in spinal immobilization, he remains there by my doing only until he reaches the hospital. Period. Once the ER accepts my patient, he is theirs. Period. If a doctor of medicine there decides that the patient did not need such immobilization, he is taken out of it. However, if that doctor of medicine decides that there is sufficient concern to keep the patient immobilized, he will remain immobilized. That is not my decision. I am neither a " God of Self, " nor a doctor of medicine, nor even a technician of radiation. In fact, at this point, I am not even in the hospital anymore. I am no more responsible for how long the doctor leaves that patient on a board after my departure than I am for how long he leaves the bandage on his forehead after my departure. Perhaps the organization you work for has so many units on the street that you are allowed to remain at the hospital throughout the patients entire stay. If so, great. I am sure that the staff there is thrilled to have you breathing down their necks. But most services do not have that luxury. If you have the ability to express a succinct and coherent thought without obscuring your point with a psychoanalysis of your audience, then I welcome you to tell us all exactly how we are supposed to take responsibility for the medical practice of licensed professionals (unlike yourself) who have assumed the care of the patient. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " Brent McCain " <rufus@o...> arose from a hallucinogenic stupor to mumble this utter nonsense: > > In today's world there are numerous people who " believe in > themselves " . I believe self confidence to be a good thing, in > moderation, but there are some, Rob, who push far beyond the limits, > creating a " God of Self " . I believe your last statement reflects > your total lack of responsibility. And I, Brent, believe that your entire statement is so incoherent as to discourage any attempt at reply. However, I will respond to what appears to be your hyperverbose point. If I put my patient in spinal immobilization, he remains there by my doing only until he reaches the hospital. Period. Once the ER accepts my patient, he is theirs. Period. If a doctor of medicine there decides that the patient did not need such immobilization, he is taken out of it. However, if that doctor of medicine decides that there is sufficient concern to keep the patient immobilized, he will remain immobilized. That is not my decision. I am neither a " God of Self, " nor a doctor of medicine, nor even a technician of radiation. In fact, at this point, I am not even in the hospital anymore. I am no more responsible for how long the doctor leaves that patient on a board after my departure than I am for how long he leaves the bandage on his forehead after my departure. Perhaps the organization you work for has so many units on the street that you are allowed to remain at the hospital throughout the patients entire stay. If so, great. I am sure that the staff there is thrilled to have you breathing down their necks. But most services do not have that luxury. If you have the ability to express a succinct and coherent thought without obscuring your point with a psychoanalysis of your audience, then I welcome you to tell us all exactly how we are supposed to take responsibility for the medical practice of licensed professionals (unlike yourself) who have assumed the care of the patient. Rob Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.