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  1. #1
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    Default Maybe this should be in an EMS forum.

    Ok guys I pose a question to you. This maybe should probably go in a EMS forum but I figured I would get your guys' opinioins first.

    You get called to a 75 y/o male, he has cancer but hasnt had a chemo treatment in about a month. He has fallen and is extremely confussed and weak all of which are new to him according to his spouse. No one was around to witness the fall so its unknown why he fell, if he lost consciousness, or if he hit his head. The direction in which he is laying is kinda ackward to what the wife thinks happened. There is no obvious signs of trauma. Do you take C-spine precautions. now you are upstairs and its kinda cramped. How would you have gotten him down stairs? You can use a full backboard or a KED and put him in a chair from the dinner table.

    I want to know how many people would have done the same thing as I, but I wont tell you what i wanted to do just yet. I want a few responses first to see if i was right or wrong. I obviously want to learn from this call to help make my patient care better.
    "Let's Roll." Todd Beamer 9/11 first soldier in the war on terror

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  2. #2
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    If there is any doubt i would have boarded him. Even with no signs of trauma he could have a fx of the c-spine. With the confusion being new you can't take the word of the pt. I have had more than one person without any complaints after a fall that have ended up with a c-spine injury. Always cover your a#@, it may be uncomfortable for them but it is will keep you out of court. Had a lady just the other day involved in a low speed mva, c/o shoulder pain, no trauma. Boarded her and took her in, 2 hours later she went to the trauma center with a C-7 fx, hours later the picture of us immbolizing her was in the paper, treat every call like the pt is going to sue you, cause this day and age you never know.

  3. #3
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    how would you have immobilized this patient? Long board or considering where he was and stuff would you have put him in a ked, but him in a kitchen chair taken him down and then put him on a full board.
    "Let's Roll." Todd Beamer 9/11 first soldier in the war on terror

    "I pledge allegiance to the flag of the United States of America. And to the republic for which it stands ONE NATION UNDER GOD indivisible,with liberty, and justice for all.

    I.A.C.O.J. Probie and darn proud of it.

  4. #4
    MembersZone Subscriber jaybird210's Avatar
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    Gotta agree with 824 on immobilization. Without having been there, and having seen where your patient was popsitioned, it's hard to answer the KED vs. long board question. I would prefer a long board, because that's one less time you'll have to move the patient. Is it possible to use spider-straps and stand the board up after he's on it? If you don't have spider-strps, is there anybody on your department that could whip up a quick hasty harness to hold him to the board while youse guys stand him and pivot? Hard to say right or wrong here, without knowing how he is positioned, but I definately would've tried sompin.....
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  5. #5
    MembersZone Subscriber lilyogi's Avatar
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    I would have to agree with both 824 and Jay, I have been in EMS for 12 years now and I will always do my best to cover my A@# AND Protect my patients. In a stituation like this one I would have placed them on the backboard and used spider straps to secure him to the board. Don't get me wrong, I am not a big user of the spider straps but there is a time and place for them. I am also in an EMS system that allows us to make the decision to backboard patients or not depending on mech of inj.
    but with the confusion and unknown what acctually happened I would have fully immobilzed him.
    Lilyogi

  6. #6
    MembersZone Subscriber dneptun81's Avatar
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    Hey 824, I work for St. Francis MedComm/LifeFlight Dispatch, I think that I set up your Pt's transfer. Or at least one just like it.

    As for the question at hand. I would have boarded him, full c-spine precautions, CID, straps the whole shot. I've carried some Pt's down some funky staircases and it sucks, but one guy did have a C-spine Fx. All he did was fall out of bed!!! If the Pt was altered at all and it was a new thing I would have been highly suspicious of some type of neurologic event, either before or after the fall. Also rule out hypo/hyperglycemia with an accucheck.
    The views expressed by me are my opinions and do not reflect the opinions of any of my affiliations.

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  7. #7
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    Ok here is the rest of the story. We were gonna move him downstairs where we could wait for the bus (we do not transport we only run first responders) and our medic student was like lets get a chair and move him down. And I go (only a basic student) go well shouldnt we board him ya know, we dont know if he lost consciousness, we dont know much about what happened. So our medic student agreed, we went ahead and got the equip to board him(all we have are spider straps). We went to board him and another first responder goes "what are you guys doing" and im like we are gonna board him to take him downstairs" and she was like well why do we need to do that and i explained what me and the medic student thought. And she was like well lets wait for the ambulance to get here so after we argued a little bit i decided whatever we'll wait for the bus. First question in the door "why isnt he immobilized?" So I was just wondering who was in the right here. I will always respect her opinion because she is a nurse but she doesnt really understand what its like out in the field. As far as the hyper/hypoglycemia. We arent allowed to do that kinda thing as first responders, i think in the not too far future and we get rid of some of the old guys we will be going to an EMT-B staffed ambulance. Good to hear me and my buddy weren't wrong on this call.
    "Let's Roll." Todd Beamer 9/11 first soldier in the war on terror

    "I pledge allegiance to the flag of the United States of America. And to the republic for which it stands ONE NATION UNDER GOD indivisible,with liberty, and justice for all.

    I.A.C.O.J. Probie and darn proud of it.

  8. #8
    MembersZone Subscriber F18Wub's Avatar
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    Without a doubt board him. Its a lot easier to explain to the doc and lawyers why you boarded a patient when it wasn't needed that to explain why you didn't, and it was. In my system we can clear C-Spine in the field, but one big requirement is that the patient needs to be fully conscious and alert with no intoxicants or distracting injuries. A level 1 trauma center that I recently worked at would leave a soft collar on unconscious patients after they had been cleared by X-Ray and CT. They would only take them off after they were awake and had no pain and passed a full neuro checks. Remember to err on the side of your patient.
    IACOJ, Flatlander Division

  9. #9
    MembersZone Subscriber JHR1985's Avatar
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    sounds like you had enough time to use the KED, put him in a chair, and take him down and then put him on a backboard.

  10. #10
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    Quote Originally Posted by JHR1985
    sounds like you had enough time to use the KED, put him in a chair, and take him down and then put him on a backboard.
    We had plenty of time to do it, we were probably on scene a good 15 min before the ambulance arrived. Most of this time was spent talking the situation over with other members present. In hind sight probably should have dropped it and tended to the patient and discussed the issue at a later time.
    "Let's Roll." Todd Beamer 9/11 first soldier in the war on terror

    "I pledge allegiance to the flag of the United States of America. And to the republic for which it stands ONE NATION UNDER GOD indivisible,with liberty, and justice for all.

    I.A.C.O.J. Probie and darn proud of it.

  11. #11
    MembersZone Subscriber dneptun81's Avatar
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    My experience with RN's in the pre-hospital setting, they are clueless. Put them in a hospital and they function wonderfully, put 'em pre-hospital, circuits cross and the whole system shuts down. Not trying to slam RN's don't get me wrong. The nursing mentality is about 180 degrees away from pre-hospital or vice-versa.
    The views expressed by me are my opinions and do not reflect the opinions of any of my affiliations.

    "Hope is not a plan of action"
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  12. #12
    Forum Member Weruj1's Avatar
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    Quote Originally Posted by dneptun81
    My experience with RN's in the pre-hospital setting, they are clueless. Put them in a hospital and they function wonderfully, put 'em pre-hospital, circuits cross and the whole system shuts down. Not trying to slam RN's don't get me wrong. The nursing mentality is about 180 degrees away from pre-hospital or vice-versa.
    .............uhm.............. where did we say anything bad about RN's ? I would have used a vacuum mat or chaired him down ...but I dont fault you for imobilizing him either. Also **Side Note- we can calear c-spine here as well-Medics only.
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  13. #13
    MembersZone Subscriber dneptun81's Avatar
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    Quote Originally Posted by firefighterox
    We went to board him and another first responder goes "what are you guys doing" and im like we are gonna board him to take him downstairs" and she was like well why do we need to do that and i explained what me and the medic student thought. And she was like well lets wait for the ambulance to get here so after we argued a little bit i decided whatever we'll wait for the bus. First question in the door "why isnt he immobilized?" So I was just wondering who was in the right here. I will always respect her opinion because she is a nurse but she doesnt really understand what its like out in the field.
    Not saying RN's are bad, just saying the pre-hospital mentality is a LOT different than the hospital setting. In the Peoria system an EMT must call Medical Control to get non-immoblization orders and have a pretty good reason too.
    The views expressed by me are my opinions and do not reflect the opinions of any of my affiliations.

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  14. #14
    MembersZone Subscriber BVFD1983's Avatar
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    Kitchen chair?

    Don't you have stair chairs?
    FTM - PTB

  15. #15
    MembersZone Subscriber lilyogi's Avatar
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    I have used kitchen chairs a lot instead of the stair chair. They are quicker to get, don't have to run back out to the ambulance. As long as they look sturdy I use them.
    Lilyogi

  16. #16
    MembersZone Subscriber BVFD1983's Avatar
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    What if the chair breaks?

    Fill in the zeros on the check...
    FTM - PTB

  17. #17
    MembersZone Subscriber lilyogi's Avatar
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    Quote Originally Posted by BVFD1983
    What if the chair breaks?

    Fill in the zeros on the check...
    I always make sure they are sturdy, if there is any question on this i don't use them.
    You can sit and say what if all day about anything that you do.. What if the stair chair fails, what if the cot falls? What if you lose your grip and drop them? I agree you have to be sure of a decision however to sit and what if everything you won't get anything done. I appoligize if this sounds wrong, I don't mean for it to. I am going by my experience in the use of chairs vs stair chairs. I agree there is a place for stair chairs but I personally don't use them very often. I will also say that the newer stair chairs are a lot better than the older ones. Does anyone else use sturdy kitchen chairs vs stair chairs?
    Lilyogi

  18. #18
    MembersZone Subscriber BVFD1983's Avatar
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    We don't transport so the guys on the box make the call on what to use. IMO, using someone's kitchen chair opens you and your agency up to huge liability, as if there wasn't enough already.
    FTM - PTB

  19. #19
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    Sorry guys,
    I came in kinda late on this thread. But wow, I would never use a kitchen chair from someone's home. If something was to happen, I agree with the earlier post.....How many zero's was that? You are correct in stating earlier that the stairchair may break, or the cot, etc.; however, at least then you will be covered by insurance, or the liability will be with your employer. Maybe even the company that sold you the stairchair or cot. Depending on what the malfunction was.
    And YES, definately I would have taken C-spine precaution.......when in doubt, take all precautions needed. Keep in mind I wasn't there to see the house, but sounds like I would have used C-Collar, KED, stairchair.

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