We are there for the good of the patient, not for the good of the protocol, not for the good of the medical director, and not for the good of the company.

- Rogue Medic

Student Falls Four Feet From Dorm Bed, Paralyzed From Neck Down

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Christopher, from My Variables Only Have 6 Letters and EMS 12 Lead, sent me a link to this story.

A university student went to sleep drunk and woke up in hospital paralysed from the neck down – after falling more nearly four feet from his dorm bed.

When Kei Usami, 20, fell from the school-supplied ‘loft’ bed at Fordham University, he smacked his head so hard that the impact fractured his spine.

Now a law suit has been brought against the Bronx campus for neglecting to install guardrails along the side of the bed.[1]


Image credit.

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I did a Google Images search for bunk bed,[2] which is not remotely a scientific sampling. In the first 10 pages of results, I could not find a single image of a bunk bed without some type of rail on the upper bunk. None. Has this become an industry standard? None of them were listed as ideal for drunk college students, either.

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Image credit.

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The reason I am writing about this is –

Mr Usami, who played tennis for the university, was then taken by the university’s volunteer EMS team to hospital – without a neck brace.

These actions led to the student becoming paralysed from the neck down, according to his lawyer, Vito Cannavo.[1]

People will point to this case and claim that –

If only he had been immobilized, he would be saved from paralysis!

 

That claim is complete nonsense.

 

Where is there any evidence that immobilization leads to improved outcomes for patients with unstable spinal fractures?

This is an example of the logical mistake of assuming that because he was not immobilized, he is paralyzed.

He is able to move his left arm. Why do we assume that he would still be able to move even his left arm after being strapped to a board with a rigid cervical collar placed around his neck?

What do drunk college students do when you try to immobilize them?

They push against the restraints. There is absolutely no reason to expect that there would be any kind of good outcome with Mr. Usami trying to move his against the restraints of a rigid collar and straps. But this is the Standard Of Care Abuse that has become traditional in so many places.

Maybe we need a Hamlet to change things –

But to my mind, though I am native here
And to the manner born, it is a custom
More honor’d in the breach than the observance,
[3]

We need to stop harming our patients by performing rituals on them, just because they are traditional (the Standard Of Care Abuse).

The only research we have shows that immobilization doubles the rate of disability from unstable spinal injuries -

The OR for disability was higher for patients in the United States (all with spinal immobilization) after adjustment for the effect of all other independent variables (2.03; 95% CI 1.03-3.99; p = 0.04).[4]

RESULTS:
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04).
[4]

For a person with a spinal injury, being immobilized doubles the likelihood of being disabled.

There is no good evidence to demonstrate that immobilization is safe.

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We need to demand research to demonstrate that spinal immobilization is safe.

Or

We need to stop immobilizing patients.

We are the ignorant barbers of medieval times. We just pretend that we know what we are doing.

We cannot ethically continue to immobilize patients with absolutely no evidence of safety, but with evidence of harm.

We have too much respect for tradition (the Standard Of Care Abuse), but not enough respect for our patients.

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Footnotes:

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[1] Paralysed in his sleep: Drunk university tennis star unable to move from neck down after falling from 4ft dorm bed
By Lydia Warren
Last updated at 7:01 PM on 14th November 2011
Daily Mail
Article
Read more: http://www.dailymail.co.uk/news/article-2061366/Drunk-university-tennis-star-left-unable-falling-foot-dorm-bed.html#ixzz1dmqHVEHD

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[2] bunk bed
Google Images
Search

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[3] Hamlet
Hamlet Act 1, scene 4, 7–16
eNotes explanation of the quote

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[4] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed - indexed for MEDLINE]

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Comments

  1. My loft bed at college didn’t have rails. But I never went to sleep drunk in that bed. I was usually too drunk to make it up that high.

  2. really!!!! your DUMBASS was DRUNK YOU fell and now you want to sue the school??? (by the way ..isn’t the drinking age 21??? NOT 20?)

    • Anonymous,

      The drinking age is arbitrarily determined by politicians, but has nothing to do with maturity.

      There is no fairness in being able to die in combat in uniform and not being able to buy a beer.

      I would not be surprised if the elevated drinking age increases the problems with alcohol, rather than discourages them.

      .

  3. @Anonymous: Is there any reason to believe that this wouldn’t have happened if he was 21? Additionally, underage drinking happens, especially in adults between the age of 18 and 21, especially when at college.

    ….and yep, my undergrad didn’t have guard rails either for the bunk beds. I believe that we could request them, but they didn’t come standard.

  4. I commute to my current school, and there are no dorming options available there.

    But at the school I previously attended, our beds were at weird heights. If you only had one roommate (lucky you!), your bed was 3.5ish feet off the ground. I’m 5’8″, and the bed was level with my bottom ribs. If you weren’t so lucky and were forced into a tiny room with two other roommates, your bed was more like 5.5 feet off the ground, leaving you barely enough room to sit upright when you were in the bed. Furthermore, there was no ladder of any sort to climb into bed–you had to climb on top of your desk and then kind of hop to get up there.

    They weren’t terribly safe. They didn’t have railings either. I think this is pretty much standard at any college.

  5. The protocol is there for a reason! Until updates improve the system, it should be implemented! It’s Basics. How often are we called to respond for someone’s act of stupidity?!?! We’re not there to judge, we’re there to help. The missing collar may or may not have saved him from being paralyzed but if they had put it on, this would have been a non issue.

    • So EMS is not a profession, just a technical trade that is supposed to follow the cookbook-ocol without question?

    • Mario,

      The protocol is there for a reason!

      Too often it is a bad reason.

      Until updates improve the system, it should be implemented! It’s Basics. How often are we called to respond for someone’s act of stupidity?!?! We’re not there to judge, we’re there to help. The missing collar may or may not have saved him from being paralyzed

      Or maybe the only reason he is able to move his left arm is that he was not immobilized.

      We need to stop disabling our patients just to follow protocols.

      but if they had put it on, this would have been a non issue.

      How is his paralysis a non-issue?

      This would have been less of a legal issue, but not a non-issue.

      We need to stop harming our patients in our attempts to protect ourselves.

      .

    • There is no scientific evidence that a collar would have helped him.

      Zero.

      Nada.

      Zip.

      Zilch.

      There is, however, a generation’s worth of bullshit, anecdotes and conjecture…

      … and enough sound scientific evidence to make it plausible that, had the story been of a student with a fractured neck AND a cervical collar, the cervical collar may have even worsened his condition.

      “The protocol is there for a reason” is a lame excuse when the conjecture the protocol was based upon has been debunked in study after study after study.

  6. Ritualistic immobilization is nothing short of torture for the patient and stupidity on our part. Period.

    The problem with articles such as this is that they do not provide enough information. Neuro assessments upon arrival would tell us a good deal; as would an in depth review of all imaging studies and physical findings which would in turn help us to build a much more accurate theory on what exactly occurred.

    I am not saying that the responding crew did not make any mistakes, just that choosing to not immobilize is not one of them. Did that make sense?

    Did I mention I hate protocol Nazis?

  7. So would you put a collar on anyone rouge? I can recount several drunk college students that fell and we had to immobilize because the way things are.

    • CS,

      I generally call medical command and explain to them the risks that I see. If they are not able to be reasoned with, I explain the way I will document the call and the risks to the patient, who should not be immobilized without sedation. I doubt I have ever received an order to sedate a patient to permit safer immobilization.

      Since the doctors are basically acting out of fear of lawyers, they tend not to appreciate that I am essentially waving a red cape at the lawyers in my documentation.

      .

  8. I don’t recall any selective spinal immobilization criteria or protocol that would allow an intoxicated patient to be selected out of immobilization, though I’m willing to be wrong.

    I agree that we over-immobilize- that said, the jury hearing the lawsuit will probably never hear about the LACK of supporting research. They’ll just hear that it might have prevented paralysis, but wasn’t done. “And all that the EMTs had to do to prevent my client’s devastating paralysis was to FOLLOW PROTOCOL.”

    Then they get a $300/hour hired gun paramedic expert witness on the stand who says that he would have immobilized, and then it just becomes an academic conversation between the lawyers about how many zeros go on the check.

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