Avoiding a headache...

As I was walking along the boulevard in Los Angeles, I witnessed a a young man trip and fall to the ground. As he fell, a car was turning close by, which gave the appearance that maybe the man was hit by the car. Quickly a crowd gathered and a discussion began about what happened. The man, clearly without injury, attempted to get up by himself but many in the crowd told him to just lie still. An ambulance arrived, took out their equipment and attempted to strap the man to a back-board. He didn't seem to have any symptoms just an abrasion across his nose.

“What are you doing?” the man asked as they put on a c-collar and strapped him to a back-board. “Do I really need this” he asked? “It’s protocol, we do this to everyone.” replied the EMS worker. “But there is nothing wrong with him, just ask him,” a family member replied.

The man didn't argue with the EMS worker but seemed upset. He was placed in the ambulance with a cervical collar in place, on a backboard and brought to the Emergency Department.

As I walked away, I began to think about what EMS said about protocol. I'm a strong believer in being cautious, but I think it is reasonable to stray from a strict protocol, occasionally. There are many protocols in place. Trauma care, chest pain, and disaster cases are some examples. But more often we are faced with situations in which we have time to think and decide and use our clinical judgment but frequently don't. We should spend more time trying to individualize protocols. If we have any sense of judgment and experience, we should use it. I hope that when this man arrives in ED, he is quickly evaluated, gets unstrapped from the back-board, removed from the cervical collar and is discharged. Likely, this was not the case. He probably walked out of the ED hours later.

Comments welcomed

Post submitted by a New York City Attending Physician in Emergency Medicine

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