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veinglory
01-17-2011, 11:29 PM
I have a couple of question about medical procedures for a modern story set in illinois.

1) There has been a traffic accident, the two drivers have no obvious major injuries. One of the passengers was knocked unconscious but by the time the ambulance arrives his is sitting on the side of the road and complaining of pain in his back and neck. What would the paramedics do?

2) Once in the hospital the patient shows no neurological symptoms and not injury to his spine. He is adament trhat he wants to go home. However no one can come and get him and he has no money or ID on him. Assuming that they release him, how would they help him get home?

sheadakota
01-17-2011, 11:42 PM
I have a couple of question about medical procedures for a modern story set in illinois.

1) There has been a traffic accident, the two drivers have no obvious major injuries. One of the passengers was knocked unconscious but by the time the ambulance arrives his is sitting on the side of the road and complaining of pain in his back and neck. What would the paramedics do?

2) Once in the hospital the patient shows no neurological symptoms and not injury to his spine. He is adament trhat he wants to go home. However no one can come and get him and he has no money or ID on him. Assuming that they release him, how would they help him get home?
I can answer the first question with some degree of certainty- in this case with the guy unconcious and then ap and c/o of necka nd back pain- the medics would immidiatly immobilize his neck and back with a cervical collar and then make him lie on a back board and secure him to it so he can not move his head or neck. a lot of head/ neck/ back injureis can present like this and they would be very cautious- in fact a potentially life threatening head bleed presents just like this- (Epidural bleed- pt is at first unconcious and then regains consciouness- you can be dead in hours if left untreated)

If no injury is found and pt wants to be discharged AMA -but has no money or means to get there- the ED personal would ask him to call a friend to come and pick him up- if thats not possible and he has no where else to go and no way to get there- I'm not sure they can legally discharge him- could be wrong here- but that is my gut reaction- hope that helps a little-

jclarkdawe
01-18-2011, 12:32 AM
Sheadakota's treatment is right as far as it goes, but I'd make sure from the first minute the ambulance is on scene that spinal immobilization in applied, as first manually by someone holding his head, until we backboard him. Head blocks would be used as well as the backboard. He'll be secured so well that you can tip the board upside down (so he's hanging by the straps) and he won't move.

Head would be carefully examined for leaking from ears, bruising behind ears, and pupil responses. O2 would be administered, probably by a non-rebreather and probably about 6/liters per minute, unless he was showing other signs of distress. Preparations would be made for the patient crashing on us. Monitor would be attached and heart rate/rhythm checked. CSMs would be monitored.

There's not really much an ambulance crew can do, but the vitals are going to determine whether we advise the hospital to activate the trauma team.

He's going to be in the hospital for quite a while (several hours) as various tests are done. Until the x-ray and C-T are back, they're not going to let him go since you can't tell whether his refusal to be treated is a result of brain injury or just his dumb thought patterns that are normal for him.

A lot of what a hospital will do to help you on release depends upon where you are. Big cities might give you a buck for the subway, smaller cities might give you taxi fare. They hospital might not give you anything if you're leaving AMA. After all, one way to discourage AMA is to make it difficult. Checking out with medical clearance would involve a social worker, who has access to a lot of resources.

Best of luck,

Jim Clark-Dawe

veinglory
01-18-2011, 12:46 AM
Thanks guys, that makes sense.