Let's place a game of You make the call...
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This call was one of the ones I look back on as a perfect example of why a blanket C-Spine protocol is never a good idea. Paramedics need the training and authority to "clear" C-Spine in the field based on proven assessment techniques.
I'm assigned to an ALS ambulance dispatched to a PD eval late on a Saturday night to a nightclub famous for trouble.
On scene PD advises that they responded to a call for a fight, but the defending party fled the scene 30 minutes ago, then suddenly returned.
Our patient is in his late 20's, conscious and alert, no alcohol or elicit drug use admitted or evidenced on assessment. He states the bouncer came at him with a "baseball bat" which the bouncer denies.
The patient has a small, non suturable laceration, approx 2 cm to his right parietal skull, bleeding controlled, and there is some blood in his long unkempt hair.
He is initially refusing treatment, but after talking him into the back of the ambulance where there is better light he decides to go with us simply to escape the situation.
He has no pain, no complaint and makes no indications that the laceration is bothering him. He also states he does not recall the bat hitting him and that he may have scraped his head on a wall as he ducked out of the way of the bat.
From my experience, and the fact I had to talk him into the ambulance, if I break out a cervical collar this guy will freak and fight, twisting his neck this way and that to avoid my cervical immobilization device.
My protocol states that full C-Spine precautions are to be taken on any person with trauma noted above the clavicles.
Do I C-spine this patient? Just collar? Based on your protocols...You make the call.