The good news in the world of head trauma and brain injury is that we’re seeing a lot more folks putting on helmets before they go out and do 
potentially dangerous, head crushing stuff. The good/bad news is that we’re encountering more patients who are wearing helmets and need to be placed in full spinal immobilization. This brings up a controversial decision. Should we remove the helmet or leave it in place?
The leave it or remove it controversy has been around for as long as I’ve been in EMS and, like most controversies that remain unresolved for years, there are merits to both options. In these instances, it’s easy to create blanket rules and then follow them mindlessly.
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C-spine immobilization is not a benign procedure.
It’s not something that’s always worth doing “just in case.” It’s not risk free, comfortable or even practical. And, now, recent research from the Washington University School of Medicine suggests that it may not even do such a good job of keeping the patient’s head still.
Does anyone else agree that we’ve seen enough bad news about c-spine now that we can stop the massive overuse that plagues our industry? Can we start evaluating people and deciding who does and doesn’t meet criteria for spinal immobilization. Please?
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I have a Labrador named Eddie (pictured below). He eats only Eukanuba dog food. That’s because we buy it for
him. If we bought him a different brand, I’m sure he would eat that as well. He might need to get a little hungry before he agreed to the switch, but my gut tells me that he would eventually concede.
Knowing my dog, probably sooner than later.
I want to quote from the Eukanuba web site:
Satisfy your dog’s taste buds with the succulent flavors of beef and rice. Your dog is sure to enjoy every bite with real beef as a key ingredient.
Reading this, one thing is clear. Dogs don’t by dog food. This product was clearly not formulated for dogs and it isn’t marketed to dogs. This product is designed to make people feel good about what they’re feeding their dogs. If dog food was made for dogs it would be cat flavored or rodent flavored or bird flavored … or maybe even other dogs butt flavored. My dog doesn’t care about succulent beef and rice. He cares about feeling full. Nobody is going to convince me that rice tastes succulent to a dog.
So what about backboards? Patients don’t buy the backboards they ride to the hospital on do they? Patients are the end users of the product, but EMS organizations make the decision which backboards to buy. It stands to reason that the backboards are probably designed more for the people who buy them than the people who use them.
You see where I’m going with this right?
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We all have our good calls and our bad calls. Don’t we? Sometimes things just flow. Sometimes the patient, the bystanders, the crew members, everyone just clicks. And it’s beautiful. It’s like that perfect drive off the tee box that keeps you coming back for another round. The three point jumper that makes you wonder if you should have tried to play college ball.
Unfortunately (perhaps) it is the rare scene that runs flawlessly. More often than not we look back on our calls and think about the things we could have, and should have done better. Of course, that’s how it should be. Without those moments we don’t grow or become better. Some EMT’s carry the philosophy that we should emerge from our field instruction with flawless medicine. Nothing could be further from the truth.
Here is my list of five common trauma scene mistakes I have encountered frequently in my career. I am guilty of doing all of these, some with painful frequency. In those moments of personal scene review, I rank these as my top five, “I wish we had done that differently.” items.
#1 Failing to manage the scene.
We learn a lot about patient care in school. Unfortunately our education regarding management of the scene may be limited to being taught to blindly recite the words, “Scene safe, BSI” as we enter our skills stations. Scene management can be hard. Especially management of big scenes with multiple priorities like calling for more resources, assessing hazards, protecting bystanders, interacting with family and friends of the injured and triaging multiple patients.
On these scenes, patient care suddenly becomes a warm comforting blanket. Caring for one patient seems so much more manageable. Patient care priorities like holding c-spine and doing an assessment call to us like a sirens song. Don’t do it! It seems obvious but, when it’s your job to manage the scene, manage the scene.
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