Rogue Medic is in a great mood as of late and this article about the complete joke that is Mechanism of Injury (MOI) hits the nail on the head. I recently had to triage a car over a patient because of strict trauma guidelines, luckily finding the always available "Paramedic Judgement" to wiggle my way out of it.
The simple point is this: Mechanism needs to be a symbol on a map, not the destination. With cars designed to crumple around our patients, what if it does take 30 minutes to get them out but they are unharmed? And the pedestrian clipped by the mirror on the arm by a passing car at 40MPH? Why are they on a board and in a collar?
Because 30 years ago when this Profession was still trying to figure itself out we bought into some crazy ideas, that's why. Now that we're actually starting to study some of these ideas and finding them hurting more patients than they are supposed to help, we need to start revamping a number of our "standards of care" which actually should read "That's what everyone else does..."
Whenever I have to document damage to a vehicle (mainly for my recollection of the run later on, just in case) I try to use some basic terms that at least remain consistent in my own description of vehicles. Those are:
Light truck, truck, large truck, coupe, sedan, wagon, van and commercial vehicle.
Then I go and describe the damage using 3 terms, light, moderate and considerable.
Those are mine and can be widely interpreted. Maybe I'll get Motorcop to jump in on this but...A coupe hitting a brick wall at 40MPH will look differently than a van that hits another van at 25MPH. One is a trauma, the other not by protocol, even though one may indeed have carried far more force.
And even if I do mention light damage to the front of the vehicle, what does that mean? What kind of car? What kind of impact? Against what? Did the vehicle's protection systems discharge properly? If the driver was able to self extricate and has no chief complaint, why am I chasing him down with a C-Collar? Because the folks who wrote the policy are in a committee long ago and far away.
MOI is important as far as it gives us an idea of POSSIBLE injuries to consider. I consider it as a part of the Past Medical History and weigh it just as heavily. If it does not apply to the patient's presentation it will be considered, but not relied upon.
One rollover will have a 17 year old girl sitting on the curb completely unharmed while a minor damage collision could yield significant injuries to the passengers. We won't know until we assess them.
I remember long ago in far off new Mexico, some medics would launch the helicopter just based on dispatch information of the reported damage. And we're back to the telephone game of one person's "Oh my God! They're trapped!" and another's "She's just not getting out, but looks fine."
Assess. Use MOI as a tool, not a guide. We always look inside the passenger compartment for deformity, blood, marks, bent steering column etc, but we should not be basing a transport on the vehicle.
Then again, try documenting that you let a driver refuse transport who had moderate damage after a head on collision into a guardrail, deploying front airbags with a non-complete recollection of events.
Now if I tell you they hit the guardrail head on after sideswiping another vehicle at 40MPH and spinning around, coming to rest in the slow lane and is avoiding telling the police they cut across 6 lanes of traffic to make an exit...now can I let them go home? Or should I be chasing him down with a collar? We all know the answer to that one.
Looking forward to more, Rogue!
The simple point is this: Mechanism needs to be a symbol on a map, not the destination. With cars designed to crumple around our patients, what if it does take 30 minutes to get them out but they are unharmed? And the pedestrian clipped by the mirror on the arm by a passing car at 40MPH? Why are they on a board and in a collar?
Because 30 years ago when this Profession was still trying to figure itself out we bought into some crazy ideas, that's why. Now that we're actually starting to study some of these ideas and finding them hurting more patients than they are supposed to help, we need to start revamping a number of our "standards of care" which actually should read "That's what everyone else does..."
Whenever I have to document damage to a vehicle (mainly for my recollection of the run later on, just in case) I try to use some basic terms that at least remain consistent in my own description of vehicles. Those are:
Light truck, truck, large truck, coupe, sedan, wagon, van and commercial vehicle.
Then I go and describe the damage using 3 terms, light, moderate and considerable.
Those are mine and can be widely interpreted. Maybe I'll get Motorcop to jump in on this but...A coupe hitting a brick wall at 40MPH will look differently than a van that hits another van at 25MPH. One is a trauma, the other not by protocol, even though one may indeed have carried far more force.
And even if I do mention light damage to the front of the vehicle, what does that mean? What kind of car? What kind of impact? Against what? Did the vehicle's protection systems discharge properly? If the driver was able to self extricate and has no chief complaint, why am I chasing him down with a C-Collar? Because the folks who wrote the policy are in a committee long ago and far away.
MOI is important as far as it gives us an idea of POSSIBLE injuries to consider. I consider it as a part of the Past Medical History and weigh it just as heavily. If it does not apply to the patient's presentation it will be considered, but not relied upon.
One rollover will have a 17 year old girl sitting on the curb completely unharmed while a minor damage collision could yield significant injuries to the passengers. We won't know until we assess them.
I remember long ago in far off new Mexico, some medics would launch the helicopter just based on dispatch information of the reported damage. And we're back to the telephone game of one person's "Oh my God! They're trapped!" and another's "She's just not getting out, but looks fine."
Assess. Use MOI as a tool, not a guide. We always look inside the passenger compartment for deformity, blood, marks, bent steering column etc, but we should not be basing a transport on the vehicle.
Then again, try documenting that you let a driver refuse transport who had moderate damage after a head on collision into a guardrail, deploying front airbags with a non-complete recollection of events.
Now if I tell you they hit the guardrail head on after sideswiping another vehicle at 40MPH and spinning around, coming to rest in the slow lane and is avoiding telling the police they cut across 6 lanes of traffic to make an exit...now can I let them go home? Or should I be chasing him down with a collar? We all know the answer to that one.
Looking forward to more, Rogue!
Comments
http://www.youtube.com/watch?v=YzYxz_uvtSI
When it comes to a refusal, what matters is what the person is able to understand about the potential risks and benefits of whatever the person is refusing at the time of refusal.
Does it matter that the person may have been spinning clockwise a half an hour ago? What if they had been spinning counterclockwise? Does that change if we cross the Equator?
Since EMS is very poor at providing appropriate information for informed consent, how do we have any capacity to determine if someone else has the capacity to make decisions about treatment or transport?
We would rather be felons (by abducting people against their wishes) than violate a company protocol/SOP that we probably do not understand. And yet, we want to be seen as professionals.
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