Re: Standard of Care

[Guest guest]

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?

>

>

>

>

[Guest guest]

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?

>

>

>

>

[Guest guest]

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?

>

>

>

>

[Guest guest]

Interesting discussion, with one that has no clear answers, at least

from my perspective. If a patient from a seeminly minor MVC complains

of neck pain, who are we to question whether it is soft tissue injury

versus a spinal fracture? PHTLS teaches providers to expect the

worse, but we've all been to BS accidents where patients claim

" insurance injuries. "

Again, no clear answers.

-Alfonso R. Ochoa

> 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?

>

>

>

>

[Guest guest]

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?

> >

> >

> >

> >

[Guest guest]

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?

> >

> >

> >

> >

[Guest guest]

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?

> >

> >

> >

> >

[Guest guest]

yeah im saying why dont we all say ok, here are some, as clear as possible,

guidlines to when we do and do NOT package people. of course there are people

that will insist on going to the ED packaged up, but im talkin more like the

ones where its minor and the Pt. just says man, i think i outta go, i just wanna

get checked out. why package 'em? yeah, now the standard is to package 'em, but

if we all agree to not do it in that case, then we will cover our rears, right?

i know it wont happen, and that there is no clear answer. thought it would be a

good convo topic.

and what about the Pts who have neck or back pain(this is a new topic, different

from the BS MVC one) who are allergic to all pain meds except theirs of

choice(Rx addicts)....what do we do with them? feed their addiction or what? how

do you handle that?

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?

>

>

>

>

[Guest guest]

yeah im saying why dont we all say ok, here are some, as clear as possible,

guidlines to when we do and do NOT package people. of course there are people

that will insist on going to the ED packaged up, but im talkin more like the

ones where its minor and the Pt. just says man, i think i outta go, i just wanna

get checked out. why package 'em? yeah, now the standard is to package 'em, but

if we all agree to not do it in that case, then we will cover our rears, right?

i know it wont happen, and that there is no clear answer. thought it would be a

good convo topic.

and what about the Pts who have neck or back pain(this is a new topic, different

from the BS MVC one) who are allergic to all pain meds except theirs of

choice(Rx addicts)....what do we do with them? feed their addiction or what? how

do you handle that?

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?

>

>

>

>

[Guest guest]

yeah im saying why dont we all say ok, here are some, as clear as possible,

guidlines to when we do and do NOT package people. of course there are people

that will insist on going to the ED packaged up, but im talkin more like the

ones where its minor and the Pt. just says man, i think i outta go, i just wanna

get checked out. why package 'em? yeah, now the standard is to package 'em, but

if we all agree to not do it in that case, then we will cover our rears, right?

i know it wont happen, and that there is no clear answer. thought it would be a

good convo topic.

and what about the Pts who have neck or back pain(this is a new topic, different

from the BS MVC one) who are allergic to all pain meds except theirs of

choice(Rx addicts)....what do we do with them? feed their addiction or what? how

do you handle that?

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?

>

>

>

>

[Guest guest]

Many services do have c-spine......not clearance....but rather

non-immobilization rules in place. They include NO signifigant mechanism, NO

neck or back pain, NO pain that is so bad else where so as to distract the

pt. from neck pain, NO deformity of the spine and NO evidence that the pt.

is impaired by alchohol or drugs, legal or otherwise.

If gramma falls and hits her arm on the dresser, I'm not going to subject a

90 year old woman to a c-collar and backboard if there is no involvement of

the head or c-spine.

If little Jimmy falls off his bike and breaks his leg, I'm not going to

c-spine him unless it is suspected that he hit his head.

The options are in place in many progressive services to allow a medic to

use some common sense judgement about trauma mechanism that is unlikely to

cause c-spine injuries. How much you use them is up to you. I board a lot of

people that probably don't need it because I just KNOW that one pt. out of a

million that has a C-2 fx that is painless is going to trip and fall on my

shift, in my city and have me respond to " check 'em out " . Thats just how

life works for me....you might be different.

Trust me when I tell you that when a guy from a fender bender says " man, i

think i outta go, i just wanna get checked out. " what he is really saying is

" I'm going to need an ambulance bill to show a lawyer " .

Here's another question for your class on " standard of care " .

You have a drunk belligerent guy who's wiped out a lightpole, and has a 6

inch gash on his head. You go to collar and board him, but that just makes

him mad and violent, so he thrashes around trying to fight you off. Anything

you do makes him angry and violent, but if you leave him alone, he sits

serenrely on the cot and mumbles to himself.

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?

> >

> >

> >

> >

[Guest guest]

Many services do have c-spine......not clearance....but rather

non-immobilization rules in place. They include NO signifigant mechanism, NO

neck or back pain, NO pain that is so bad else where so as to distract the

pt. from neck pain, NO deformity of the spine and NO evidence that the pt.

is impaired by alchohol or drugs, legal or otherwise.

If gramma falls and hits her arm on the dresser, I'm not going to subject a

90 year old woman to a c-collar and backboard if there is no involvement of

the head or c-spine.

If little Jimmy falls off his bike and breaks his leg, I'm not going to

c-spine him unless it is suspected that he hit his head.

The options are in place in many progressive services to allow a medic to

use some common sense judgement about trauma mechanism that is unlikely to

cause c-spine injuries. How much you use them is up to you. I board a lot of

people that probably don't need it because I just KNOW that one pt. out of a

million that has a C-2 fx that is painless is going to trip and fall on my

shift, in my city and have me respond to " check 'em out " . Thats just how

life works for me....you might be different.

Trust me when I tell you that when a guy from a fender bender says " man, i

think i outta go, i just wanna get checked out. " what he is really saying is

" I'm going to need an ambulance bill to show a lawyer " .

Here's another question for your class on " standard of care " .

You have a drunk belligerent guy who's wiped out a lightpole, and has a 6

inch gash on his head. You go to collar and board him, but that just makes

him mad and violent, so he thrashes around trying to fight you off. Anything

you do makes him angry and violent, but if you leave him alone, he sits

serenrely on the cot and mumbles to himself.

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?

> >

> >

> >

> >

[Guest guest]

Many services do have c-spine......not clearance....but rather

non-immobilization rules in place. They include NO signifigant mechanism, NO

neck or back pain, NO pain that is so bad else where so as to distract the

pt. from neck pain, NO deformity of the spine and NO evidence that the pt.

is impaired by alchohol or drugs, legal or otherwise.

If gramma falls and hits her arm on the dresser, I'm not going to subject a

90 year old woman to a c-collar and backboard if there is no involvement of

the head or c-spine.

If little Jimmy falls off his bike and breaks his leg, I'm not going to

c-spine him unless it is suspected that he hit his head.

The options are in place in many progressive services to allow a medic to

use some common sense judgement about trauma mechanism that is unlikely to

cause c-spine injuries. How much you use them is up to you. I board a lot of

people that probably don't need it because I just KNOW that one pt. out of a

million that has a C-2 fx that is painless is going to trip and fall on my

shift, in my city and have me respond to " check 'em out " . Thats just how

life works for me....you might be different.

Trust me when I tell you that when a guy from a fender bender says " man, i

think i outta go, i just wanna get checked out. " what he is really saying is

" I'm going to need an ambulance bill to show a lawyer " .

Here's another question for your class on " standard of care " .

You have a drunk belligerent guy who's wiped out a lightpole, and has a 6

inch gash on his head. You go to collar and board him, but that just makes

him mad and violent, so he thrashes around trying to fight you off. Anything

you do makes him angry and violent, but if you leave him alone, he sits

serenrely on the cot and mumbles to himself.

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?

> >

> >

> >

> >

[Guest guest]

What other history can he or someone else close to him give? What are the

circumstances in which EMS is called?

Sounds like possible meningitis but need a little more information.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

Good point . Here in the PEMSS system we have the ability to use or

not use motion restriction as needed.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

On the flip side of this with regards to the elderly. I have had several

70+ year old patients come in within the last six months with relatively

minor complaints ( " I just hurt all over " ) that have had C spine fractures

and ended up in halos without neuro deficit due to being properly

immobilized by EMS in the field.

I know. I know. " Anecdotal cases. " I HAVE spent hours on a backboard and

I'd rather be safe than sorry at least with our older population.

Just my .02 worth

Hollett

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: Standard of Care

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

On the flip side of this with regards to the elderly. I have had several

70+ year old patients come in within the last six months with relatively

minor complaints ( " I just hurt all over " ) that have had C spine fractures

and ended up in halos without neuro deficit due to being properly

immobilized by EMS in the field.

I know. I know. " Anecdotal cases. " I HAVE spent hours on a backboard and

I'd rather be safe than sorry at least with our older population.

Just my .02 worth

Hollett

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: Standard of Care

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

On the flip side of this with regards to the elderly. I have had several

70+ year old patients come in within the last six months with relatively

minor complaints ( " I just hurt all over " ) that have had C spine fractures

and ended up in halos without neuro deficit due to being properly

immobilized by EMS in the field.

I know. I know. " Anecdotal cases. " I HAVE spent hours on a backboard and

I'd rather be safe than sorry at least with our older population.

Just my .02 worth

Hollett

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: Standard of Care

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 (http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

One thing I'd mention about c-spine for the elderly population is to remember to

pad with pillows or blankets as needed. I've seen several older patients with

spinal curvatures that might make a straight board less than effective.

-Wes Ogilvie, MPA, JD, EMT

[Guest guest]

I would like to clarify that if a patient complains of pain (true or insurance

induced) to their neck or back they should receive spinal motion restriction.

The point I tried to make in class is that most in EMS feel the need to apply

spinal motion restriction to anyone involved in an MVC or with a 'ground level

fall' who is not complaining of neck or back pain.

Re: Standard of Care

It's always a good point and as others have already pointed out there

are protocols that mirror the Maine statewide spine protocol and allow

crews to " rule out " the need for motion restriction. We have one as well

but still there are WAY TOO MANY patients that receive the ever-so-cruel

board binding and you better believe it's gonna hurt your back if you're

the patient. The money-seekers deserve it. The others don't and that's

the real problem. We're putting people on boards and hurting them.

Obviously moreso the elderly. It's just plain mean but is the " standard

of care " . " Standard of poor care " .

Hines (from London and another reason to go to EMStock and hear

him speak) can relate their studies that, of course, show how ridiculous

it is to do what we do. 200 out of appr. 44,000 had injuries justifying

it (0.0045%) in a year study there. Some day it's gotta change. You and

I don't want to be strapped down to these hard boards either. What a

wonderful legal world we're in! Great food-for-thought for all new EMS

students however. Maybe the young ones will actually see a change during

their careers.

You'll probably get plenty of thoughts on this one.

Don Elbert

Tyler

Don't miss EMStock 2005 ( http://www.EMStock.com)

>>> fireems@... 2/14/2005 10:03:15 PM >>>

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?

[Guest guest]

Sounds like a catch-22. If not family members are around to

corrobate a story, what should we do? We could be dealing with

anything from meningitis to tetanus to an accidental fall with a

cervical fracture.

-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?

> > >

> > >

> > >

> > >

[Guest guest]

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..