Field Neuro Exam in Haiti; Why Bother?

[Emergency RN]

http://news.bbc.co.uk/2/hi/americas/8464649.stm

Interesting video from the BBC News about a Danish UN worker recovered alive from the Haitian rubble. I noticed that the rescuer was performing a gross field neurological exam, which IMHO would not change anything. I mean they had already pulled him out without C-collar or board, and they're certainly weren't about to take him to any place different even if he could not move his arms or legs, right? If anything, the man was probably severely dehydrated from several days underground; so why not start an IV in him immediately instead?

Don't get me wrong, I'm certainly not about to second guess the on scene rescuers from the limited information that was available from the short clip; but that question did pop into my mind.

Opinions?

[GilaRRT]

Pretty standard assessment stuff IMHO. Would really suck to place in IV in a crushed limb because you failed to assess. Asking somebody to move their limbs provides more information than just assessing dermatones for neurological compromise. It is a quick way to see if things are working and if injuries are present. The exam only took seconds, yet from the brief clip the provider was able to assess gross mentation and neuro/motor function. Along with this comes the assumption that the patient has a patent airway and circulation to the central nervous system.

The fundamentals of START triage utilises a somewhat similar approach when assessing a multiple casualty incident.

[Lacie, BSN, RN]

Also the amount of medical supplies is limited therefore needing a quick yet through assessment before jumping in putting in lines, etc. I'm sure they are triaging and utlilizing for the most severely life threatening situations at this point until they get more medical workers and supplies in. Priorities become very different in these situations then what we would do in a normal hospital setting for trauma. It has to be treated essentially like a war zone.

[Spidey's mom, ADN, BSN, RN]

I agree with Lacie and Gila - I've been to Vietnam twice on medical missions and you work with what you have and you must assess.

Thanks for that video Emergency RN.

steph

[mwboswell]

If the pt fails their neuro exam (grossly) you might consider NOT wasting the resources on them, especially if access to a neurosurgical suite was not an option. Disaster medicine is doing a little for the most, rather than getting encumbered by resource intensive patients that have high odds of having poor outcomes.