The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

How Important is Mechanism Of Injury

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As a part of the assessment of trauma patients, how important is Mechanism Of Injury?

If there is one thing that Mechanism Of Injury definitely is not – that thing is patient assessment.

Mechanism Of Injury is assessment of the kinematics of the delivery of forces to the patients body. Fortunately, EMS requires a degree in Physics with a Kinematics major. If that were not the case, we would not have this over-triage rate that encourages blind squirrels to laugh at us.

Using Mechanism Of Injury alone, our over-triage rate is about 99%.

In other industries, this would be considered a humiliating failure. In EMS, we suggest that Mechanism Of Injury just needs the slightest tweak and it will be just right. Our Tweaking makes the other Tweaking look almost smart. Almost.

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Snorting meth off a cop car not a good idea.

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Our medical command permission system may not be much better than paying a psychic for a phone consult. However, the psychic might be more likely to order pain medicine for patients in severe pain. Might – anyone who engages in this kind of fraud cannot be considered empathetic.

Given this pathetic lack useful information, why do we pay so much attention to Mechanism Of Injury?

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Original image credit.

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Maybe you doubt my comment that Using Mechanism Of Injury alone, our over-triage rate is about 99%.

The following results combined show a less than 1% ability to predict major trauma.

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Image source.[1] Click on image to make it larger.

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Motor vehicle collision at a speed greater than 60 KMH (just over 37 MPH)?

Have any of us ever been required to demonstrate that we can estimate motor vehicle collision speeds?

All we do is invoke the Barney Rule – We use our imaginations.

We need to stop paying so much attention to Mechanism Of Injury.

We need to pay more attention to actual patient assessment.

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Footnotes:

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[1] Is mechanism of injury alone a useful predictor of major trauma?
Boyle MJ, Smith EC, Archer F.
Injury. 2008 Sep;39(9):986-92. Epub 2008 Jul 31.
PMID: 18674759 [PubMed - indexed for MEDLINE]

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Comments

  1. Loving the pics as usual. You’re killing me. LOL.

  2. http://www.youtube.com/watch?v=YzYxz_uvtSI

    ^^^ Perfect youtube video for this post.

  3. You’d have a stroke if you saw how over triaged things are in my neck of the woods. I’ve had BLS providers tell me that they think that because someone is on a LSB they need to go to a trauma center. It doesn’t help that the hospitals are inconsistant on there trauma criteria.

    • CS,

      You’d have a stroke if you saw how over triaged things are in my neck of the woods.

      Then, I’ll stay away.

      I’ve had BLS providers tell me that they think that because someone is on a LSB they need to go to a trauma center.

      I’ve had doctors tell me that.

      I’ve called the hospital to give notification and then received a call from Fireboard saying that I may not continue to the hospital until I call medical command (not a valid order, but some doctors will do all they can to avoid trauma). I wait a bit, so that we will be pulling up at the ED at the end of the conversation if the doctor does not agree to accept the patient. I explain that the immobilization is due to the protocols at the time and that the patient only has a knee injury and a complete lack of understanding of how to drive. I have to promise the doctor that I am not trying to sneak some multi-system trauma into his suburban ED.

      It doesn’t help that the hospitals are inconsistant on there trauma criteria.

      My way to deal with that is tell them that I don’t work for the hospital, so I can’t legally follow protocols that contradict my protocols. Pennsylvania (Dr. Kupas) is doing a lot to improve the trauma triage criteria.

      However, the same idiots who would refuse to do anything against protocol, because it might get them in trouble, will routinely violate PA protocols to fly a patient. What is even worse is that the medical command doctors don’t have a problem with flying uninjured people from fender benders.

      It’s all fun and games – until someone loses a friend in a helicopter crash to transport a minor injury.

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Trackbacks

  1. [...] Rogue Medic is in a great mood as of late and this article about the complete joke that is Mechanism of Injury (MOI) hits the nail on the head.  I recently had to triage a car over a patient because of strict trauma guidelines, luckily finding the always available “Paramedic Judgement” to wiggle my way out of it. [...]

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