What would you have done? rant

[Nursingangel]

I work in a large family practice office and had a situation this week that I would like some info on what you would do.

I was called by our front office cordanator and told that a 4 yr old boy was just brought end and that his father states that he feel off a trampaline and could not move his neck. I stated that the pt should have gone to the ER as we are not set up to deal with this type of injiry. I imedatly went to my suppervisor and one of our doctors and aprased them of the situation. We do not even have a c-coller in the office so the doctor asked that we call 911 and get the perimetics out to help stablize the pt. We called and went out to the waiting room and I held the boy's head and talked with the father of the boy. It turns out that the boy had fell the night before, turning flips and landed on his Head. The EMT's got there and my superviser and spoke with them and explained the situation. The EMT then asked if a doctor had seen the pt and when I said no that we don't have the equipment to deal with this type of inujury, He ROLLED HIS EYES AT ME THEN TOLD THE FATHER THAT there was no reason for them to transport. At this point I went and told the Doctor what was going on and she went out and dealt with the situation. The next thing I know my office manger is coming and griping at me because I did not call her BEFORE I called the peramedics and went out to the pt. Luckly the doctor backed me up and said that she had told me to get out there an imobilze the pt as best I could. Neddles to say the EMT's Refused to put the child on a c-collar and WALKED him out to the ambulance telling the dad that he could just drive the boy over if he wanted that the child was fine. The doctor has filed a complant about EMS and the back talk they gave us and I seem to be off the hook as far as not calling the office manager but was told that next time to CALL HER FIRST!!! I am sorry but isn't more important to take care of the PT not her dang paper work!!!:angryfire

[suzanne4, RN]

You were 100% correct, and hope that the crew was reported. Have seen way too many sub-luxed necks with this type of injury. And the EMS crew are not physicians, and they did not have x-ray equipment with them.

And they are accountable as well as any medical personnel. All I can say is what woukd they have done if it was their child?

:angryfire :angryfire :angryfire :angryfire

[nursesaideBen]

That is the most ridiculous thing! That just absolutely infuriates me!! I'm sorry I just don't know what else to say other than I think you did the right thing and your manager needs to get off your back :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

[UM Review RN, ASN, RN]

Since when did your manager get a degree in Ortho?

No?

Well then, tell her your nursing education and experience trumps her medical knowledge and remind her that no matter what area employs you, your first duty is to the patient.

My first husband broke the 3rd & 4th cervical vertebrae in a car accident and he was walking around afterward too. Had someone not stabilized his neck, he would've either died or been paralyzed for life.

You did good.

[km5v6r, EdD, RN]

You absolutely did the right thing.

Years ago on my first nursing job I received a call at home to do a transport from our small hospital to the larger city hospital. The pt was a young guy involved in a roll over truck accident with a possible neck injury. He had helped transport his friend in to the ER and sat down complaining of a sore neck. Since he had an abrasion down the middle of his back the doc ordered thorasic spine x-rays. The x-ray tech also took cervical spine films by mistake. The odontode ?sp process (the part of C2 the projects up into C1 and your head rotates on) was broken off and free floating down around C4-5. I transported him by ground; complaining all the way about the cervical collar. We arrived at the ER, doc looked at the films I brought and started yelling for the Crutchfield tongs. After I got back home I found out about the films and what was actually wrong. If I had known before transport I probably wouldn't have gone. We bounced over mountain roads with the gurney literally coming up off the floor at times. I look back at how naive (read stupid) I was at times and cringe.

[EricJRN, MSN, RN]

I hope that your physician filed that complaint with the state regulatory agency for EMS (often the state board of health). Sounds pretty irresponsible.

[Grace Oz]

You did the right thing. Rest easy now and enjoy your Christmas!

Best Wishes to you.

[DizzyLizard]

I agree, was the EMS regulatory agency notified about patient neglect?? Having worked in EMS for years if the mechanism of injury is there and someone is complaining of neck pain, regardless of when the injury occurred they will be fully c-spined and transported to a trauma facility whether they like it or not. Children especially can compensate real well and then crash. So, with kids especially don't take any chances. Nursingangel you did the right thing....pt care is top priority. Don't let anyone tell you any different. Your manager will get over it eventually. At least the doc backed you up.

[TheCommuter, BSN, RN]

I, too, have encountered my fair share of rude paramedics who sometimes behave as obstructionists when the nurses are attempting to send someone out to the hospital.

If I am dealing with a testy paramedic who tries to obstruct my job, I will state their name and say, "Within my legally binding nurses notes, I plan to document that you're obstructing the continuity of patient care by causing delays and refusing to transport. Get moving or risk getting sued."

The paramedics usually move faster once they hear my words.

[babynurselsa, RN]

I got a 3 year old one time that ems CARRIED into my ER. He had a C-5 fracture. Let's just say they NEVER do that now.

[AnnieOaklyRN, BSN, RN, EMT-P]

My oppinion is that as a paramedic I expect people to respect my and my partners desicion whether or not to backboard someone, especially given that we are trained for this type of stuff and see it on a daily basis. You are right in thinking the mechanism is there for a neck injury, however it is NOT recommended that a patient be placed on a backboard and be put through all of that stuff if they have been ambulating and moving around for that long after the injury without any problems. If they had an unstable vertebral fx chances are VERY HIGH that they would have already suffered symptoms of that such as paralysis or limb numbness etc before they made it to your facility which you had not described.

You also do not state if the pain was over the vertibrae or not, a lot of people hear neck pain and automatically assume that backboarding is in order without assessing where the pain is.

I also do not beleive that others have the right to ridicule any caregiver about how a call went or how a patient situation went UNLESS they were there and saw it first hand, in other words it is unfair of people on this board to ridicule this EMS crew just by hear-say!

While I disagree with the attitude you said you were given I have been given plently of attitude from nurses so that goes both ways! I am by no means saying you deserved it I am just sick of hearing nurses complaining about our attitude towards them when we have also been on the receiving end plenty of times from them!

Swtooth

[EricJRN, MSN, RN]

Swtooth,

You make some good points in your post. Prehospital personnel and other providers do need to understand that spinal motion restriction via backboard is not a benign procedure. A lot of attention has been given recently to reducing unnecessary backboarding and many services even work prehospital C-spine clearance into their protocols now. I've seen lots of examples of these protocols, though, and I don't know of any that would clear a 4 year old.

Putting the age aside, another question could also be raised: Would the difficulty in moving the neck be considered a distracting injury? Would it raise suspicion of a neurologic deficit? Either of those possibilities would typically exclude a patient from field clearance.

You raise an interesting point about the time/amount of walking that occurred between the injury and EMS contact. If you know of a source that suggests it is okay to avoid backboarding if the patient has been ambulatory for a given amount of time (or even any protocols that state it), please let us know. It would further the discussion quite a bit.

I can sympathize with how hard it is to roll up on a scene and assume command when there are non-EMS healthcare workers present. However, I don't think we can ever fall into the trap of expecting people to respect our decisions just because we're medics. You undoubtedly know that most people, medical and non-medical, have misunderstandings about the roles, training, and scope of practice for EMS providers. We have to behave in a way that conveys to patients, families, and bystanders alike that we deserve respect. Becoming visibly disgruntled about having to transport a potentially non-emergent patient just doesn't do that.

My point in all of this? While it's generally not good to be a Monday morning quarterback, it's safe to say here that there are numerous things that appear to have gone wrong in the EMS response, both in patient care and professionalism.