Re: Standard of Care

[Guest guest]

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.

[Guest guest]

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.

[Guest guest]

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.

[Guest guest]

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

[Guest guest]

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.

[Guest guest]

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.

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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.

>

>

[Guest guest]

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.

>

>

[Guest guest]

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.

>

>

[Guest guest]

" 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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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