Looking For Sasquatch (A Challenge)

My EMT instructor told me his version of the story back in 1989. He was forthcoming that he had not been in the emergency room when it happened, he had only heard the story passed on. (As I would pass it on in later years.) Then he explained how a middle aged man had reported to the emergency room for evaluation following a fall. The patient had received relatively unremarkable blunt force trauma to the rear of his head and neck. As the nurse asked him questions the man replied yes and nodded his head up and down.

Nurse: “Do you remember the event?”

Patient: “Yes I do.” [Nod, nod]

Nurse, “Do you take medications?”

Patient, “Yes, I take an Albuterol inhaler for my Asthma.” [Nod, nod]

Nurse: “Do you have any allergies?”

Patient, “No I don’t.”

And that’s when it happened. For the first time since the event the patient shook his head back and forth and the he slumped over and stopped breathing. My instructor then went on to describe how the patient had completely severed his spinal cord and, as long as his head and neck remained mid-line, he had fully-intact neurological functioning. As soon as he turned his head to the side, in dramatic fashion, he lost all ability to move or breath.

You can guess when my instructor chose to tell us this story. It was during our head, neck and spine lecture. The story was meant to drive home the importance of careful spinal immobilization in all head, neck and spine mechanisms. Turn that head just a little bit in the wrong direction and BANG, that completely normal patient can become an apneic quadriplegic and we can all but kiss our hard earned EMT certifications goodbye.

You probably heard some version of this scary story in your EMT class as well. They all contain the same essential components. 1) Patient has low to moderate mechanism of injury. 2) Patient has no neurological deficits. 3) Patient gets mishandled by an EMS provider. 4) Patient develops significant neurological compromise.

Here’s the rub. None of these things ever happened. The mishandled patient who progressed into neurological compromise is an EMS myth. It’s never been documented, anywhere. With all the stories out there being passed on, you would think we would have a database of these patients by now. You would think there would be an online support group for medically induced quadriplegia patients.

But there isn’t. These stories are like fuzzy pictures of Sasquatch from last years camping trip.(YouTube is loaded with these by the way.)

“There he is!”

“Where?”

“The fuzzy blob in the middle.”

“It looks like a log.”

“No, it’s clearly got ears.”

You get the picture. Ask someone who tells these stories for the details and the facts will start to fall apart faster than a Congressional balanced budget plan. “Where did it happen?” you ask. “Somewhere back east”, your helpful friend replies.

And yet, there are still gobs of EMS providers who are convinced that they have the real story. They couldn’t have been lied too; that’s not possible. It’s difficult to convince ourselves that something that we’ve chosen to believe for a long time might be false. So, with those providers in mind, I’ve decided to issue the Sasquatch challenge. Here it is.

The Sasquatch Challenge:

I challenge anyone to produce documentation of a patient having neurological deficits that were induced or worsened by emergency medical personnel mishandling the patient. Let’s break that down. Remember the four parts to every one of these stories? We need all four parts, documented. So we need a patient that 1) Experienced some sort of trauma to the head and or neck. 2) Had little or no neurological compromise on initial evaluation. 3) Had some sort of motion induced by a medical provider who was providing an evaluation, an intervention or transport. 4) Experienced a noticeable worsening of neurological status after handling.

Bring on the documentation. Prove me wrong. I want the real deal. Any online case review from a reputable source will do. I’ll take HIPAA redacted patient care reports…anything. If something like this actually happened, it would be reviewed everywhere. If there were lawsuits filled we could look at those records. What about those revoked certifications? There must be some record of that happening to someone at some point in history.

Bring it on. Bring me the documentation and I’ll post it right here on this site. If YouTube can have dozens of documented sightings of Sasquatch, we should be able to produce one credible report of a medical provider making a c-spine injury worse.

And if we can’t…if we can’t, we need to start considering that all this c-spine immobilization may be a bunch of hooey. Think about it.

The challenge is on.

Comments

  1. Hi,

    Interesting post. Interesting challenge.
    Hopefully, there will be equally interesting replies.

    Do you know of any quality journals wherein similar concerns have been expressed?

    Regards,

    Nadeem Q.

  2. That’s funny, there’s a a story about a sasquatch siting in my area. It allegedly took place about 20 years ago after a low speed crash. A woman was apparently walking around, turned her head to the side, died, and had a broken neck. It’s hard to find people who were there or provide details, though.
    Seriously, I hope we can apply logic to spinal immobilization soon, and one day look back at how silly it is to strap people to hard boards to protect their back and neck.

  3. Bryan Bledsoe says:

    I have reviewed several cases where patient with ankylosing spondyitis suffered neurologic injury with deficits from prehospital care (primarily airway management). The Ankylosing Spondylitis Society contacted us and we did a cautionary feature in JEMS and updated the textbooks.

  4. Andrew Przepioski says:

    I don’t have much to contribute, but I’d like to say excellent metaphor. I laughed when you said “shook his head back and forth and the he slumped over” because I knew exactly where this was heading. I believe I read that you did your internship and worked for AMR Santa Clara County in California too, right? From what I’ve heard, Alameda County and Santa Cruz County (not Santa Clara County yet) no longer fully immobilize their patients; they put on a c-collar only. I also believe that ITLS (I am unsure about PHTLS) no longer recommends immobilizing penetrating wound patients (e.g. GSW). Do you know of other areas that do that too? Do you believe that we are starting to trend away from fully immobilizing patients?

    Thanks Dr. Bledsoe. Never heard of Ankylosing Spondylitis.

  5. Steve, I share almost all your views here, and have asked around for quite a while trying to find a single reputable example of this boogieman event. I have heard from highly experienced ED, trauma, and prehospital folks who reported 2-3 patients in their careers who experienced delayed or occult neurological deterioration in the days after a low-risk event, but so far, nobody significant in the prehospital phase.

    However, there is ONE published paper that suggests it’s not only possible, it happens frequently. That’s Toscano’s Paraplegia paper here: http://www.nature.com/sc/journal/v26/n3/abs/sc198823a.html

    This is an very uninspiring piece, but he swears that this sort of thing happens all the time, and that he followed up ad nauseam to prove it. If there’s any chance of this being real, one would want to look at the whole dataset and detailed methods, but these are unfortunately locked away in the thesis Toscano wrote for medical school — which he based the above paper on — and seems to only exist as a bound hardcopy in the University of Melbourne library. They don’t seem willing to release it for interlibrary loan; I have been gathering donations to pay the ~$80 fee to get it scanned so the rest of the world can examine it and try to settle this question, so let me know if you’re interested.

  6. Ran a few PubMed searches and haven’t found anything yet. However, I did find this, documenting injury by correctly placed c-collar, though in a very specific and unusual context:
    http://www.ncbi.nlm.nih.gov/pubmed/21183526
    We report the case of a young man who attempted suicide by hanging and whose neurological status deteriorated until the cervical collar, that had been correctly placed by the prehospital team, was removed. We discuss the physiopathological mechanisms leading to death in hanging that is, a blockage of the blood stream to the brain leading to vasogenic and cytotoxic cerebral edema rather than asphyxia or spinal fracture. Our case supports the early removal of neck stabilization devices that can dangerously harm the patient after an attempted suicide by hanging, by increasing intracerebral pressure.

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