Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 Sometimes you are caught in a catch-22. You bring in a patient on a backboard and the hospital looks at you like you're crazy. But when you don't immobilize you get yelled at. That can even vary from hospital to hospital and doctor to doctor. Toucing on the Trauma Designations of hospitals. There is no consistancy there either. Level 4 Hospital-Diverted for an assault with a facial abrasion (according to the hospital they needed a trauma center) Dx: psych with a facial abrasion Level 3 Hospital-Diverted for a fall from the roof of a one story home, landing on their feet, with an ankle injury (according to the hospital they needed a trauma center, what if they have a femur fracture?, " I'll start the MEDCOM paperwork " ) Dx: fractured ankle Level 1 Hospital-Diverted for level 2 trauma from an MVA-left clavicular and sternum pain (they aren't military-active, retired or dependent) Dx: bruised sternum I guess it's a good thing we are able to charge mileage on those transports. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 Sometimes you are caught in a catch-22. You bring in a patient on a backboard and the hospital looks at you like you're crazy. But when you don't immobilize you get yelled at. That can even vary from hospital to hospital and doctor to doctor. Toucing on the Trauma Designations of hospitals. There is no consistancy there either. Level 4 Hospital-Diverted for an assault with a facial abrasion (according to the hospital they needed a trauma center) Dx: psych with a facial abrasion Level 3 Hospital-Diverted for a fall from the roof of a one story home, landing on their feet, with an ankle injury (according to the hospital they needed a trauma center, what if they have a femur fracture?, " I'll start the MEDCOM paperwork " ) Dx: fractured ankle Level 1 Hospital-Diverted for level 2 trauma from an MVA-left clavicular and sternum pain (they aren't military-active, retired or dependent) Dx: bruised sternum I guess it's a good thing we are able to charge mileage on those transports. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 Sometimes you are caught in a catch-22. You bring in a patient on a backboard and the hospital looks at you like you're crazy. But when you don't immobilize you get yelled at. That can even vary from hospital to hospital and doctor to doctor. Toucing on the Trauma Designations of hospitals. There is no consistancy there either. Level 4 Hospital-Diverted for an assault with a facial abrasion (according to the hospital they needed a trauma center) Dx: psych with a facial abrasion Level 3 Hospital-Diverted for a fall from the roof of a one story home, landing on their feet, with an ankle injury (according to the hospital they needed a trauma center, what if they have a femur fracture?, " I'll start the MEDCOM paperwork " ) Dx: fractured ankle Level 1 Hospital-Diverted for level 2 trauma from an MVA-left clavicular and sternum pain (they aren't military-active, retired or dependent) Dx: bruised sternum I guess it's a good thing we are able to charge mileage on those transports. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 wegandy1938@a... wrote: > > I don't have numbers on that [morbidity and mortality due to spinal > immobilization]. Do you have numbers on asymptomatic c-spine injuries? I don't need numbers, Gene. And neither should you. We both know it happens. And we both know that under the Maine Protocol, those patients will not receive proper treatment from EMS. > Potential for mistakes? Sure. How many have happened? I > frankly do not know. If you have studies and reports, I'd like to > know about them. So, you admit that you are buying into the Maine Protocol even though the data is -- by your own admission -- incomplete. THAT is exactly what I mean when I refer to the myopic zeal of people who rush to jump on the bandwagon of " the next big thing. " And yes, that is exactly how CISM got wings. > I cannot comment upon whether or not I would have caught your > " asymptomatic " injury since I wasn't there. That right there should be enough to have you seriously questioning whether or not the Maine Protocol is as good as you claim, shouldn't it? > We can argue all night about what's the higher standard. I am also > not understanding your comments about " asymptomatic c-spine > injuries. " I don't understand that. I don't know how I can make the concept any simpler, but I will try: 1. The Maine Protocol uses a checklist approach to spinal assessment. 2. Those patients who exhibit none of the signs or symptoms on that checklist are automatically deemed to be non-candidates for immobilization. 3. Some patients with significant spinal injury requiring immobilization do not exhibit any of the signs and symptoms listed in the Maine Protocol. 4. Those patients will either be transported without proper treatment and precautions, or worse yet, encouraged to " refuse transport " (wink wink) by medics who are now convinced there is nothing wrong with the patient. How many patients will this happen to? It doesn't matter! It is a travesty for it to happen to ONE patient when it simply does not have to! Quibbling over numbers is nice and sterile in the statistical arena, but what we are really talking about here are not just numbers; they are PEOPLE! To dismiss those people is as unconscionable as dismissing the Holocaust because of all the 'good things' Hitler did for Germany. I don't recall who it was that commented that by not taking the Maine Protocol hook, line, and sinker, that I was somehow a " God of self, " but that is the very opposite of what I am. It is those who contend that letting a few people die or end up quadriplegics is a statistically acceptable loss if it saves us the time and effort of immobilizing them who are playing God. Do I have a better protocol? Nope. Never claimed to. I don't have to have a better protocol to know that this one is dangerously flawed, just like I don't have to be a helicopter pilot to know they crash too much. I am not against progress or improvement. But so far I have yet to see ANY studies which show this to be an improvement in patient care. I have yet to see ANY statistics on the plague of " pressure sores " that we are supposedly battling. All it does is cut down on unnecessary field procedures. It does nothing to improve morbidity or mortality. Shouldn't that be our ultimate goal? I support further research into this matter. And if a protocol is developed which cuts down unnecessary immobilization while not simultaneously jeopardizing the lives of a significant segment of our patient population, I am all for it. Maine just ain't it. And utilizing it simply because it is " all we have so far, " full well knowing that it needs improvement, is reckless. Back to the CISM analogy, the comparison seems very clear to me. A lot of people leaping without looking. At least with CISM we can claim that we were really trying to provide the best possible care for people. With the Maine Protocol, the only thing we can claim is that we are trying to GET OUT of providing the best possible care for people. Is that the bandwagon YOU want to be on? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 I just keep thinking - I hope the younger medics/EMT's will see a change in spine " immobilization " practices during their lifetimes. EMS has come a long way but.... Don Elbert, Tyler >>> picapiedras13@... 2/21/2005 10:12:49 AM >>> Sometimes you are caught in a catch-22. You bring in a patient on a backboard and the hospital looks at you like you're crazy. But when you don't immobilize you get yelled at. That can even vary from hospital to hospital and doctor to doctor. Toucing on the Trauma Designations of hospitals. There is no consistancy there either. Level 4 Hospital-Diverted for an assault with a facial abrasion (according to the hospital they needed a trauma center) Dx: psych with a facial abrasion Level 3 Hospital-Diverted for a fall from the roof of a one story home, landing on their feet, with an ankle injury (according to the hospital they needed a trauma center, what if they have a femur fracture?, " I'll start the MEDCOM paperwork " ) Dx: fractured ankle Level 1 Hospital-Diverted for level 2 trauma from an MVA-left clavicular and sternum pain (they aren't military-active, retired or dependent) Dx: bruised sternum I guess it's a good thing we are able to charge mileage on those transports. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 I just keep thinking - I hope the younger medics/EMT's will see a change in spine " immobilization " practices during their lifetimes. EMS has come a long way but.... Don Elbert, Tyler >>> picapiedras13@... 2/21/2005 10:12:49 AM >>> Sometimes you are caught in a catch-22. You bring in a patient on a backboard and the hospital looks at you like you're crazy. But when you don't immobilize you get yelled at. That can even vary from hospital to hospital and doctor to doctor. Toucing on the Trauma Designations of hospitals. There is no consistancy there either. Level 4 Hospital-Diverted for an assault with a facial abrasion (according to the hospital they needed a trauma center) Dx: psych with a facial abrasion Level 3 Hospital-Diverted for a fall from the roof of a one story home, landing on their feet, with an ankle injury (according to the hospital they needed a trauma center, what if they have a femur fracture?, " I'll start the MEDCOM paperwork " ) Dx: fractured ankle Level 1 Hospital-Diverted for level 2 trauma from an MVA-left clavicular and sternum pain (they aren't military-active, retired or dependent) Dx: bruised sternum I guess it's a good thing we are able to charge mileage on those transports. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. -------------------------------------------------------------------------------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. -------------------------------------------------------------------------------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. -------------------------------------------------------------------------------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 What!? If you would define standard of care, which is providing MEDICAL care under the auspicies of a licensed physician, this post would make no sense. -aro > 1. You are providing pt. care you sneeze. > 2. You don't have protocols to cover you sneezing. > 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. > 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 What!? If you would define standard of care, which is providing MEDICAL care under the auspicies of a licensed physician, this post would make no sense. -aro > 1. You are providing pt. care you sneeze. > 2. You don't have protocols to cover you sneezing. > 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. > 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 What!? If you would define standard of care, which is providing MEDICAL care under the auspicies of a licensed physician, this post would make no sense. -aro > 1. You are providing pt. care you sneeze. > 2. You don't have protocols to cover you sneezing. > 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. > 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 " Alfonso R. Ochoa " <asclapius@a...> wrote: > > That procedure alone is above and beyond our scope of > practice as paramedics. So were many of the things we now do at one time. Progress happens. Never say never. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 AMEN DR. B...here's a thought...maybe we should try thinking on ambulance calls! Lonnie Tarrant NTCC Re: Standard of Care 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. ------------------------------------------------------------------------ -------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 AMEN DR. B...here's a thought...maybe we should try thinking on ambulance calls! Lonnie Tarrant NTCC Re: Standard of Care 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. ------------------------------------------------------------------------ -------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 AMEN DR. B...here's a thought...maybe we should try thinking on ambulance calls! Lonnie Tarrant NTCC Re: Standard of Care 1. You are providing pt. care you sneeze. 2. You don't have protocols to cover you sneezing. 3. You are now being sued for sneezing with out protocols to cover that thus not conforming to standards of practice for the area. 4. Next we sill cover breaking wind in the back of the EMS unit while under stress providing medical care with out a license. ------------------------------------------------------------------------ -------- Re: Standard of Care 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 wegandy1938@a... wrote: > > If I fall and break my hip, or if my hip breaks and I fall, and I'm moving > everything and can tell you that my c-spine is OK, and you try to force me onto > an unpadded long board, you'd better find and relieve me of my Glock Model 21, > 'cause I'll shoot yer ass if you try to do that to me. Sorry to break the news to you Gene, but you just got caught in your own tangled web. You see, your broken hip is a " distracting painful injury " which renders my physical examination " unreliable " under the Maine Protocol. That means you get backboarded because you are incapable of reliably telling me if your have spinal pain. If this were a game of chess, instead of the mental masturbation it has become, I believe at this point you would be in " check. " > For too long we have fostered the notion that we > can only function through rigid protocols, concrete thinking, and unyielding > medical control because we have failed to manifest the abilities to function as > independent critical thinkers. If I didn't know better, I would swear you were talking about me, and not somebody who believes that the rigid, black and white cookbook known as the " Maine Protocol " is the state of the art. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 wegandy1938@a... wrote: > > If I fall and break my hip, or if my hip breaks and I fall, and I'm moving > everything and can tell you that my c-spine is OK, and you try to force me onto > an unpadded long board, you'd better find and relieve me of my Glock Model 21, > 'cause I'll shoot yer ass if you try to do that to me. Sorry to break the news to you Gene, but you just got caught in your own tangled web. You see, your broken hip is a " distracting painful injury " which renders my physical examination " unreliable " under the Maine Protocol. That means you get backboarded because you are incapable of reliably telling me if your have spinal pain. If this were a game of chess, instead of the mental masturbation it has become, I believe at this point you would be in " check. " > For too long we have fostered the notion that we > can only function through rigid protocols, concrete thinking, and unyielding > medical control because we have failed to manifest the abilities to function as > independent critical thinkers. If I didn't know better, I would swear you were talking about me, and not somebody who believes that the rigid, black and white cookbook known as the " Maine Protocol " is the state of the art. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 wegandy1938@a... wrote: > > If I fall and break my hip, or if my hip breaks and I fall, and I'm moving > everything and can tell you that my c-spine is OK, and you try to force me onto > an unpadded long board, you'd better find and relieve me of my Glock Model 21, > 'cause I'll shoot yer ass if you try to do that to me. Sorry to break the news to you Gene, but you just got caught in your own tangled web. You see, your broken hip is a " distracting painful injury " which renders my physical examination " unreliable " under the Maine Protocol. That means you get backboarded because you are incapable of reliably telling me if your have spinal pain. If this were a game of chess, instead of the mental masturbation it has become, I believe at this point you would be in " check. " > For too long we have fostered the notion that we > can only function through rigid protocols, concrete thinking, and unyielding > medical control because we have failed to manifest the abilities to function as > independent critical thinkers. If I didn't know better, I would swear you were talking about me, and not somebody who believes that the rigid, black and white cookbook known as the " Maine Protocol " is the state of the art. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2005 Report Share Posted February 24, 2005 hire-Pattison EMS <bpems@c...> wrote: > > ...that I have had a number of patients with broken hips who > were very calm and reliably cooperative--the broken hip was > not distracting. But how do you know that it was not distracting? What evidence do you have? If it is painful enough for them to request assistance, it is painful enough for it to be distracting. It doesn't have to be excruciating to be distracting. All it has to be is one simple degree more painful than their neck to keep their focus diverted. So, the question is, how do we qualify and quantify distraction? For some reason, a couple of you are failing to comprehend the issue being debated (Not talking about you, Maxine). The question is not whether or not spinal immobilization needs to be a lot more selective than it has been up until now. That is a given! I don't think anybody seriously disagrees with that premise. The issue is how do we best determine who does and who does not receive spinal immobilization. Although I have said time and time again that I do not support the mindless, automatic MOI criteria of the past, Gene continues to try to paint me with that brush. And although there are very clearly instances of persons with spinal injury not meeting the criteria for immobilization under the Maine Protocol, Gene continues to turn a blind eye to them. And now Gene uses a hypothetical situation involving himself to illustrate his point which only contradicts his point. Again, MORE solid proof that the Maine Protocol provides room for abuse, misuse, and misinterpretation. It's a good start, but I honestly cannot see how anybody in their right mind can be touting this things as the be-all, end-all of spinal protocols. It sounds to me like those people are simply too lazy to fix it. Rob Quote Link to comment Share on other sites More sharing options...
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