Rule #1: Any correlation between the dispatch and the actual call is strictly a coincidental.
Dispatcher: Band-aid brigade, copy medical. Swimming accident at the local pool. At least one patient. Lifeguards have backboarded the first patient.
Groan. Clear across our response area for a stubbed toe? There are a number of assumed facts here that could easily be wrong. We go en route. Our supervisor beats us to the scene by just a minute or so.
Supervisor: Dispatch, we have a single patient. Lifeguards are holding c-spine. Patient is complaining of neck pain and tingling in her feet. Let’s roll city fire on this.
I cough a little bit on my water bottle as I sit shotgun. Seriously? Normally I do all I can do rule out immobilisation. I think backboarding based on mechanism, as most people are taught in Basic class, is stupid. Mechanism informs your index of suspicion, not your treatment. And truth be told, certain combinations of physical assessment indicators are more accurate than a reading of an x-ray or a CT. But… based on this update the guy already qualifies under every spinal criteria I know.
We roll up and the supervisor already on scene gives me a hand off. I tell the lifeguard she’s doing a great job holding c-spine and it’ll help us if she can keep it up. I’m going to need my hands.
I lean directly over the patient so she doesn’t have to move her head. “Hi, I’m nerd alert with the band-aid brigade. What’s going on?”
Alert and Oriented x4, Glasgow of 15, tracking well. These are all good thing. Now how about that neck pain. Tell me if this hurts. It does? That’s close to mid-line. Crap.
Squeeze my hands, wiggle your toes, you said your feet tingle? Crap. Collar on.
Crap. This is my first even potentially legitimate spinal. Crap. Crap. Crap.
Luckily the patient is almost in textbook Resusci-Anni position, and I am with 5 other people that are trained how to backboard.
Right. Now, stand back, deep breath, and think this through completely. Have everyone else do the doing.
C-spine taken. ABCs are okay.
D(isability) has been established. I said she was in almost textbook position. A quick 5 person lift and a slide of the board and things are managed.
E(xposure). She’s starting to shiver and has a decreasing LOC. I noticed the tile was cold while I was kneeling. The backboard has her off the ground. Extra Lifeguard get some towels and dry her off as best she can. Probie go out to the vanbulance and fetch fresh blankets.
F(arenheit). Vitals, please include a tympanic temp. 98º. Well that’s less bad.
G(et Vitals). Hypertensive. Not good considering this all started with a head truma, but nothing to be done about that at the BLS level other than document it.
H(ead-to-toe assessment). She’s still shivering. I had a quick peek before she was covered up, and she was completely alert when denying other injuries. Sooooo…..I’ll save this for the hospital when she’s dry and warm and can participate completely in the assessment. Yeah, that’s it.
I(nspect the back). Had a quick palpation when we slid her on the board. Nothing remarkable, but no visual inspection happening now that she’s immobilised.
City fire arrives. I give my hand off. One SAMPLE history later and she’s being loaded up to go to hospital. I’m getting ready to ask the medic if I can ride along (an Intermediates running with a BLS agency craves that chance for an IV stick like a fish does water) when Supervisor throws a probie in the back of the Rescue for the ride in.
Dammit. Thus endeth the call.
The moral of the story is that rule 1 always applies, and when you size up the call in your head prepare for the least expected – that the dispatch might actually be right!