I’m well aware that it is important not to move a vehicular crash victim until paramedics arrive unless there’s an extremely good reason to do so, due to the danger of exacerbating a potential spinal injury and maybe crippling them. But when the paramedics do arrive, what sorts of things do they do to try to determine the possible presence of such an injury?
I’m writing a short story in which this is a consideration. As it happens, the situation is urgent (the vehicle is an aircraft, the wreckage is about to explode, and there is no prospect of any professional medical help arriving soon, or ever, for that matter), so the victim is getting moved one way or another. But the person doing the moving in this situation should at least have some idea of what he’s doing, and I want to make sure that he acts in a way that is plausible under the circumstances.
In this case, the victim is responsive (but not ambulatory) after brief unconsciousness due to a concussion, with other obvious injuries including a fractured arm and/or leg. Ultimately, the victim is fortunate and has no spinal injury, but how would a competent first responder go about determining that? If the victim can move her legs slightly or wiggle her toes, is that a good sign? Or is it one of those things you can’t really be sure about without a proper inspection in a stable environment by a medical professional?
Someone with more experience will come in, but until then, my 2 cents. I’m a former EMT, in most cases for any kind of serious crash, you would assume the presence of spinal injury and treat accordingly with back board and neck brace. The times when you would disregard this would be some kind of imminent danger, for example the car is on fire and you need to get the patient out now.
Any military vet will get the job done. If as you say it comes down to do something or die a vet will make things happen. You now have to make it good, bad, or indifferent in your story.
Under more normal situations, we check first for head and spinal injuries by feeling the head, looking in and around the ears and eyes, and feeling the spine for ‘stair steps’, a dislocation indicating a spinal fracture. Even if none are found, the patient is usually immobilized.
Neurological checks are done later, in the ambulance.
In a situation where life threatening danger exists, we don’t bother with the spinal assessments. The patient is rapidly extricated and moved to safety. Period. The working theory is “better alive and paralyzed than dead and intact”.
Remember the Virginia Tech Massacre, with the picture of the cops carrying out the guy with the makeshift tourniquet around his leg? Prime example. Under regular circumstances, he would have been immobilized before being moved, but with the possibility of a shooter on the loose, he was evacuated instead, and packaged/treated later.
Yeah, all the above posts are the current thinking. But I recall in the past few years reading a study (or maybe I heard it on NPR). It was some country (Brazil? Korea?) where when EMTs show up, they usually just grab your ass and thow you in the ambulance and hit the road. Or, in other words, unless its obvious you have spinal considerations, they don’t bother trying to protect your neck or spine.
Interestingly, the study showed a very little difference, if not statistically the same, in the risk of patients having spinal problems whether they got the USA’s be very careful approach or the grab em up and run approach.
Personally, barring imminent explosion or fire, I’d prefer the careful approach, but at the very least, it appears that the danger of moving someone isnt as great as commonly thought.
Sorry, no cites, but I can’t imagine this is something my mind just happened to make up one day.
We used to fireman’s carry our casualties, there was even a test around it, now they prefer the drag method - keeps everyone low.
If I was in an accident and had to move someone I would brace their head and neck with my forearems and drag them by their shoulders, if I had time and access.
If not, whatever I can grab, they are coming with me.
Alright, thanks for the input, guys. I mainly wanted to make sure I wasn’t omitting any sort of quick or simple procedure that would be expected even in an emergency; the sort of thing that would cause any EMTs or combat medics or other such types reading the story to roll their eyes and say “Well, obviously this idiot didn’t do even the least amount of research!”
A competent first responder would ask what hurts and if the patient has any trouble breathing. He would then palpate the neck and ask if that hurts. He would then move the patient immediately with some effort to stablize the neck (placing a hand on the back of the neck is just fine in an emergency).
If something is about to explode no questions would, or should, be asked, so it’s a judgment call on how much to assess and how much effort to expend stabilizing a neck. And of course any competent first responder understands the presence of distracting injuries such as a busted bone might render any history inaccurate, so a reasonable effort to protect a broken neck is usually undertaken if possible even if a history is negative.
As a rule of thumb, broken necks hurt like any other broken bone. It’s not useful to assess for neurologic injury emergently; you are looking for an unstable neck, not its neurologic sequelae. And the actual odds of precipitating neurologic injury are not very great since most necks are not broken and most broken ones are not so unstable that some slight movement finishes off the spinal cord.
Emergency airway management is much more critical, and if the patient is breathing and talking OK, his airway is OK.
I won’t be back to defend the fine points of this since I am in a rather remote part of the northern Himalayas, so just assume it’s correct. However if it’s a real injury, call 911 and let the pros handle it. I was just satisfying my SDMB withdrawal symptoms while I’m galavanting.
However if it’s a real injury, call 911 and let the pros handle it. I was just satisfying my SDMB withdrawal symptoms while I’m galavanting.