cynical_as_hell Posted February 23, 2009 Share Posted February 23, 2009 I have been thinking about this call since it happened and now it's really starting to bug me, so I would like input from the rest of you as to how you would have handled this call... Called to the scene of a MVA, dispatch says that an off duty officer believes that a possible heart attack is the reason for the accident. We got on scene to find in vehicle 1 an elderly man who is extremely aggitated, complains of no injuries, and confirms that he remembers the accident. Vehicle 1 has airbag deployment. Vehicle 2 has two passangers who are out walking around and are refusing all treatments and transportation. SO back to vehicle 1.... The patient tells the fire department that he remembers the accident but shortly after tells the police that he does not. When questioned by EMS about remembering the accident, he says that he doesn not remember. After the fire department does their evaluation and checks the pts glucose level, they get a reading of 49. The patient decides to go to the hospital, I told my partner, who then passed on to fire, that the patient needed to be c spined due to mechanism and airbag deployment. The paramedic from the fire department then told us the they were not going to c spine the patient because the patient was not complaining of any neck or back pain. She then questioned the fire medic about not c spining even though there was airbag deployment. The fire medic replies with "Airbag deployment doesn't mean anything because they go off at 20 mph as well as higher speeds. It's not important." So again, my question to you, Would you have done c spine on this patient or not and why? I feel that it should have been done but even in my own department I'm getting different opinions. Link to comment Share on other sites More sharing options...
Dustdevil Posted February 23, 2009 Share Posted February 23, 2009 Would you have done c spine on this patient or not and why? No, because there were no signs to indicate a probability of spinal injury. Treat the patient, not the car. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted February 23, 2009 Share Posted February 23, 2009 Though I'd suggest pursuing a thorough physical assessment before ruling it out entirely, including a brief neuro exam. Rule out on more than chief complaint and rule in on more than airbag deployment. Consider using a spinal clearance protocol if you're not sure of your clinical judgement such as the Maine Protocol for SMR as a way of confirming or dissuading your impression. Link to comment Share on other sites More sharing options...
mrmeaner Posted February 23, 2009 Share Posted February 23, 2009 There are a few key pieces of info that would make me reconsider, but based on what you've reported, yes. Link to comment Share on other sites More sharing options...
ERDoc Posted February 23, 2009 Share Posted February 23, 2009 From the info provided it sounds like the answer is yes based on both NEXUS and Canadian Cspine rules. Link to comment Share on other sites More sharing options...
island emt Posted February 23, 2009 Share Posted February 23, 2009 From the info provided it sounds like the answer is yes based on both NEXUS and Canadian Cspine rules. As Doc has stated based on the unreliability factor of the pt, [ changing story on remembering the incident] he would not be able to be cleared by using Our Maine protocol or the Nexus algorithm . Thus he should be immobilized. Air bag deployment does not indicate immobilization any more than mechanism . Link to comment Share on other sites More sharing options...
mobey Posted February 23, 2009 Share Posted February 23, 2009 What was the speed of impact? Anyone else ever see the vid on youtube where an old lady hits the front of a car with her purse, and the airbag deploys in the drivers face? Link to comment Share on other sites More sharing options...
mrmeaner Posted February 23, 2009 Share Posted February 23, 2009 As Doc has stated based on the unreliability factor of the pt, [ changing story on remembering the incident] There would be a grain of salt added to the changing stories part as the change was between two different interviewers. Not discounting it completely, but there's a bit of unreliablility. Link to comment Share on other sites More sharing options...
WelshMedic Posted February 23, 2009 Share Posted February 23, 2009 He's altered if he's telling 2 different stories of the accident on-scene. So yes,yes and yes. (Not mentioning the fact that the elderly are an entirely different patient population that are extremely vulnerable, and you should have a lower index of suspicion with them). WM. Link to comment Share on other sites More sharing options...
brentoli Posted February 23, 2009 Share Posted February 23, 2009 What was the speed of impact? Anyone else ever see the vid on youtube where an old lady hits the front of a car with her purse, and the airbag deploys in the drivers face? Link to comment Share on other sites More sharing options...
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