Friday, March 13

You Make the Call...Trauma room

As an EMT-Intermediate with an EMT partner, I am responding to a possible entrapment out on the desert. A utility company has been digging up and replacing large diameter concrete tubing a good 10 minutes off the main road up a dirt sideway.

We arrive to a work truck, pickup style, and a good half mile of pipes, each 40" in diameter and up on 12-16" of cribbing, except the one nearest the truck. The pipe is on the cribbing at one end, but the other end of the 20 foot long section is resting against the back side of the truck and on the ground.

Our patient is conscious, alert and is complaining of vague "hip" pain. Turns out he saw the cribbing fail and barely escaped being pinned against the truck. He states the large pipe struck his hip and pushed him against the truck, then he was able to spin away towards the rear and escape entrapment.

We take full C-spine precautions and do everything within our protocols en route to the trauma center.
As we arrived, I gave my report and they began to remove the long spine board almost as soon as we moved him over. I had just finished stating he had good motor and sensory response distal to the injury when the patient began to grimace and groan as the board was removed. The common chaos in the trauma room was drowning him out so I moved towards his head to calm him when he told me his right leg, the one connected to the hip that got hit, was now "numb and tingly."

I told the physician closest to me of this and I was told it was "common" for this type of injury. I thought the timing of the new symptoms with the removal of the board could not be coincidence.

I need to do something...You Make the Call.


Bitter Blonde said...

Keep being vocal about it without getting kicked out of the ER.
I had a run where a kid fell off of a second story balcony. Complaining of leg/hip pain; C-spine, longboard and complete packaging. 5 min after arrival in the ER, the doc unboards him despite our protests.
Result? Fx to the lower lumbar region and therapy to walk again.
I learned the hard way to always be your pt.'s advocate . . .

Jean said...

I agree with BitterBlonde. That was my first thoughts. Be vocal. Make sure doctor heard and understood you that it is something NEW, not existing. If that doctor refuses to hear you, how about a person higher in authority or a high-ranking nurse who is also concerned?

Nobody was "vocal" for me at my ER visit (brain bleeding). I had no sign language interpreter. I wasn't pleased at all when I found out later on. They was going to write it off as magarine headache and yet NEVER ASKED ME IF I EVER HAD IT BEFORE!! I didn't understand what they were talking about so I never had chance to speak up. Sorry for being little off tracked.

Anonymous said...

A couple of things for this one HM.

1) As the others have already stated, you have to ensure that the medics understand what you are saying and that you have noticed a change in the patients condition following the move. Especially with a trauma call, things can get lost whilst everyone is looking for the biggies i.e. A, B, C`s. I would try and tell the trauma team leader and if they were unable or unwilling to acknowledge what I was informing them about then if necessary I would ensure that their senior knew about the change in condition.

2) If I was seriously concerned about what had happened and I felt that the patients condition may have been put in a compromise due to the actions of the A&E (ER) staff, then I would flag it as a clinical concern with the ambulance service which would result it the case being investigated and more importantly it would log my concern so that if any further complaints/claims or questions about my practice are raised, there is a clear record of what happened. (Our hospitals are always quick to complain if they disagree with anything we have done pre-hospital)
3) To take all the emotion away from the argument – Once the nurse or medic signs my patient report form, the patient is now their responsibility. If they want to move a potential unstable patient of a board without doing all of the required checks, then on their necks be it!!
You can be happy that you did everything required and everything by the book, and as long as your patient report form is accurate and completed fully, you have nothing to worry about.