Pre-Hospital Blog

EMS can be better

Mechanism of injury

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Rogue Medic has a great post up on trauma triage criteria, leading into some harsh criticism of mechanism of injury as a treatment criteria.

Treatment based on mechanism needs to go the way of bloodletting and alchemy. I recall being trained to assess a patient based on signs and symptoms, not the vague possibility that they might at some point have sustained some hypothetical injury.

A good example of this is vehicle crashes. It is not uncommon to arrive on scene of a rough looking crash at highway speeds and see a patient who appears lucid and uninjured being encouraged to get down on a backboard, despite his protests that “I feel fine. No, my neck doesn’t hurt. Stop that.” Modern vehicles are designed to be destroyed in a crash. The vehicle will be subjected to far greater forces than the occupants. So when you see a car that’s crunched up like a pop can and a guy sitting on the curb, there’s not necessarily a need to toss him on a back board and run him emergent to the ED while you place bilateral 14′s and cut off all of his clothes. He needs assessed and treated based on his signs and symptoms, not those of the vehicle.

I am prepared to make the bold, unsupported claim that treatment based on mechanism is lazy medicine that creates unnecessary ambulance rides for a lot of “patients.”

Pop on over and check out Rogue Medic’s post. It’s worth your time.

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Written by ben

December 9th, 2009 at 12:00 pm

Posted in links,rants

One Response to 'Mechanism of injury'

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  1. Of course, everyone has been focussing on California with Arnold Schwarzenegger leading the charge to the winning post on getting the budget signed into law.

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