Sunday, October 3, 2010

Eyebrow raiser

Clinicals are still eating my life. I think I'm putting in more hours/week than if I was actually working.

Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.

If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.

So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.

So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.

Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.

So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.

I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).

I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.

I will be better than that in the future.