I was working on the rapid response car, and was called to tend to a young adult male, collapse? cause.
On arriving at the scene it became apparent that this was much more than a collapse ? cause. There were 4 police cars, 2 police vans and alot of commotion going on in the street. Working on the car, we do not normally get sent to assaults, as it is deemed to high a risk of a job for a solo paramedic to attend to. However in this case, I was already on scene and there was a whole load of police around me, so I felt fairly safe!
I asked the closest police officer, who my patient was? I was directed to a 26 yr old male who was very angry and upset. He was being physically held back by the police to stop him from going after the men who had attacked him.
On approach I made the following visual observations:
- Obviously fully conscious, alert and orientated.
- Good colour, normal breathing – A, B, C, D all normal.
- Did not appear intoxicated or under the influence of recreational drugs
- Was moving without any apparent discomfort or significant injury
- Was uncomplaining of any pain.
- Had a small amount of dried blood from the corner of his eye, down his face.
Once I got him calmed down and moved to the car, I finished my examination. All of his observations were entirely normal. I asked if he had any pain anywhere and he said, No. He had two very small wounds to his face, one at the corner of his eye and one on his nose, neither of which were now bleeding.
On further questioning, he said that he had been hit in the head with a bottle which had smashed, he stated that he had been knocked out and fell to the floor and he thought that his assailants had stamped on his head. Whilst palpating his C-spine for tenderness he told me that he had some pain down the centre of his C-Spine (even though he stated he was pain free before). Despite the alledged pain, it was impossible to keep him still and from moving his head in all directions. I asked if it hurt his neck when he was moving like that, again he said no, but when I rechecked his C-Spine, he again stated that it hurt on palpation.
I love my job (as I keep saying), so as far as I was concerned (even though I wasn’t entirely convinced) there was a significant mechanism of injury – hit over the head with a bottle, loss of consciousness, and possibly stamped on whilst unconscious. To me, that means he has to be collared and transported by ambulance on a spinal board, but I know that at that particular time of night, I will have to wait longer than normal for my back up crew as the service in our area was extremely busy at that moment in time.
The question is, do you follow protocol to the word, or do you decide that the physical presentation of symptoms does not tally up with the patients descriptions, and transport him to the hospital in the car, thereby leaving other valuable resources free to deal with other emergencies and ultimately becoming available yourself quicker than if you had to wait for the ambulance to arrive to take him on the spinal board.
Your decision, what would you do?