Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Rollover – Mechanism

In response to my post Helicopter Crash vs. Ambulance Crash, there is a comment by Greg Friese.

Rollover crashes can be catastrophic if seatbelts are not being used. The fact that four people emerged from a rollover crash with only minor injuries likely (and I am speculating) means they were all wearing seatbelts and their minor injuries were caused by being hit by unsecured equipment (more speculation).

We do not know whether they were all restrained, whether some were restrained and others were not, or whether none were restrained.

The way to determine appropriate care is to perform a skillful assessment of the actual patient, not by assessment of the mechanism. Some EMS systems choose to avoid education in assessment. This is wrong.

Let’s get silly, here. What if I do not hear the mechanism half a dozen times, or more, before I meet the patient? Am I going to be able to assess that patient appropriately?

No, that is not, in any way, an unfair question.

How many times do we arrive and find everyone out of the vehicle?

How many times are these self-extricated people actually seriously injured?

How accurate is the description of what happened, compared to an accurate accident reconstruction?

If we go by mechanism, self-extrication has absolutely nothing to do with anything. Extrication comes after mechanism, at least according to mechanism.

A rollover with the patient out of the vehicle, walking about, without any complaint – no matter how thoroughly we assess the patient – CT scan, MRI, X-ray – all negative. That patient, by mechanism, is a rollover.

A rollover with the patient decapitated is also, by mechanism, just another rollover.

I might leave both of these patients on scene, but if I do, it will be for entirely different reasons.

Patient 1 is a rollover, left on scene.

Patient 2 is a rollover, left on scene.

Based on that, which one still has a pulse? Which one still has a head attached to his/her body?

If I am presented with a patient, but I have no information about the mechanism of injury, am I be able to provide a competent assessment and identify the actual injuries?

I think that I would be able to identify the actual injuries.

I think that any competent medic should be able to identify the actual injuries.

I think that any competent basic EMT should be able to identify the actual injuries.

When contacting medical command, what is medical command most interested in?

The mythological mechanism.

It is better to not understand something true, than to understand something false. – Neils Bohr.

Just another example of where we use one faulty intervention to reinforce another faulty intervention.

The great defense of medical command is that if we do not agree with the conclusions of medical command about patient care, it must be because the medical command doctor is a card carrying doctor, who knows something that we lowly EMS providers do not know.

Assessment/triage by mechanism of injury over-ruling actual assessment is a myth that needs to be stopped.

If medical command does know something that we do not know, and that something is false, how is that a justification for these medical command permission requirements that harm patients?

It is better to not understand something true, than to understand something false. – Neils Bohr.

Medical command requirements and mechanism of injury assessments – both dangerous to our patients.

Why aren’t we taking care of the patient?

Picture from Firegeezer.

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Comments

  1. I just can’t agree more with and I feel many competent providers BLS & ALS would also agree. But how do we get around following protocols and med control, when all they do is bang that MOI drum on everything AND if you fail to comply get reprimanded or even suspended for going outside protocol. On top of this, I personally have tried to follow new c-spine guidelines in my state that attempt to give some relief of the MOI flogging and have pt assessment rule on c-spine. When I do I get called in for not doing c-spine due to “no fault” not paying. So of course the argument ensues with me asking “Am I treating the patient for medical reasons or insurance reasons?” (See my newest post on Free EMS). The response is that I need to follow the agency guidelines that apparently state ALL pts in ANY MVA get immobilized and that overrides the state guideline. This non sense has to stop, but what is the first step? Blog posts like these? Providers banding together and refusing to treat MOI and back themselves up with proper assessment and documentation. Right now I just don’t know which would win. Sorry for the rant, but I have to prepare myself for the next “talking to” for not immobilizing the 5MPH MVA with no complaints. Hey whats the worse they can do?