Broken Bone and no care!

[Echoburger]

This is an incident I happened to observe while on a ride along few days ago.

We were going to a hospital-to-hospital transfer on a 6 y/o female with a left arm compound fracture.

The hospital that she was originally at was a fully staffed adult emergency department. The hospital she was going to was a fully staffed pediatric level 1 trauma center.

She had tripped over her shoes and got a fracture, mom took her to the hospital. When we got there she was sleeping on mommy who was in the hospital bed. The EMT and Medic thought something was wrong. Indeed, I thought something was wrong too.

She had no splint or immbolization in place.

The medic offered to make a 'temporary cast' because the hospital was equipped and could do it. The medic wanted to do it so it would be more confortable for the poor little girl during the 25 minute trip in the back of the ever bumpy MICU. The nurses and/or doc said something either along the line of "Dont worry..." or "Nahh..."

So "we" (the EMT and Medic) had to go get splint supplies and splint it themselves!

It appeared ot me that the girl did not receive any care, however, I did notice that there was an "IV needle" sticking in her right hand. I wasnt sure if it was for a IV drip or an injection "port" for pain management.

Later, after we had finished the transport and were going over the call, the EMT and Medic told me the reason he wouldnt do a splint or immobolization or anything because he was afraid of "liability"...im guessing because this was a pediatric pt and it was an adult hospital.

What do you think? I thought the doc could at least give them uhm...a blanket or an icy packy. But nope.

the EMT and Medic wernt exactly 'happy' with this call after knowing nothing was done for this poor girl

whats your opinion on this?

[vs-eh?]

I am assuming (hoping), that you are making an error when you say "compound fracture". This patient had one of the bones of her arm physically visible through the skin? Hmmmm...

No dressing, no splint, no padding, nothing? Just a bone sticking out of the arm and a 6 year old sleeping on mom? Hmmmm....

I assume the "IV needle" was a lock or something...

1) Did your crew not ask the MD/RN why the arm wasn't in a splint?

2) Did your crew not ask if she had been given pain management? I assume she was given this scenerio and the fact she was "sleeping on mommy" with a open fracture.

Just because a child rolls into an "adult hospital" does mean the staff forgets everything including basic first aid.

Something is amiss somewhere...

[Doczilla]

What kind of fracture was it?

We don't really use "compound fracture" as a term anymore, largely because it means different things to different people. Open? Closed? Comminuted? Intraarticular? Which bone?

'zilla

[Chief1C]

I'd have immobilized it, if necessary with stuff from the rig. If they're concerned with loss of pulses or setting off bleeding, make them do it. I'm very picky about splinting, and I have a strict policy on not moving ppl that aren't properly immobilized. Especially open fractures with anything that should be on the inside, protruding. Unless of course there is some factor that calls for them to be moved, eg. fire, fluids, toxins, etc.

Just for the sake of infection control, it should be at least covered. I mean damn, I won't even get in the rig w/ out any open injuries covered. Esp. w/ all the hospital borne infections. This seems a little odd, I'd say it would be more of a liability to leave a fracture open and free to move about.

[Echoburger]

:oops: I was wrong. I thought a "compound" fracture was a fracture broken at more than one place. My mistake...after looking at http://en.wikipedia.org/wiki/Bone_fracture

I meant "closed fracture"

But the bone was broken at 2 places ( I believe). It was the first time I had saw a "real" broken bone x-ray so I could be wrong that it was broken at 2 places. Maybe it was broken in more or less than 2 places. Not sure on that.

I believe the crew asked the RN/MD's why there wasnt a splint in place and the ER Doc said he was afraid of "liability". I cannot remember if they asked about pain management...but im pretty sure they did.

The ER doc also came in at the last second when we were LEAVING to ASK WHAT HAPPENED!

So...all this time the pt was with mom and a few other family members waiting. And the ER doc never even came in to ask what happened until we were leaving. *sigh*

[Timmy]

You’ll find that a lot of patients with fractures especially arms are more than happy to support it with the other hand. A lot of people are just happy with a pillow for support. Although if it’s a confirmed fracture and considering they were being transfer they should have at least applyed a back slab. Was your doctor an intern? A history should have been sort upon triage…

[Dustdevil]

Yeah, if that had actually been a "compound" fracture (a term that started slipping out of favour probably twenty years ago), then I would share your concern. But if the arm is well aligned, has good circulation, and the child is resting comfortably, there's nothing wrong with letting it be. It's frequently a smart move. I don't know if you've ever had a fractured limb before, but I have one right now as we speak, and the splinting process was pretty damn painful. Despite the nonsense they teach in EMT school, in a great many cases, there is no compelling reason to splint many of these in the field. In fact, as soon as they finish mastering B&S, I usually tell my students that those are probably the least used skills in real EMS. Unfortunately, while you can train a monkey to splint in 120 hours, you can't educate him on how to properly assess who does and does not need splinting in 120 hours. Consequently, we have to teach to just splint everything in the field, which -- if you are going to practise by the cookbook -- is really the only way to go. But, as always, don't assume that medical professionals use the same cookbook as EMS. They don't.

[DwayneEMTP]

I think there are probably many things here that you might not have understood.

For example, the patient was being transferred to another hospital. I'm guessing, though am not certain, that that would have required a Dr's intervention. How did he decide to transfer a patient that he wasn't aware existed until the unit was there to transfer it...?

See what I mean? Sometimes we need to stand back and say "There was so much wrong with that situation, that perhaps correct things were happening but I'm just not in a position to understand them."

Of course, other times folks can just be boneheads.

Dwayne