Buy stock in ambulance companies. There is no way around it. There will always be ambulance transports. Talk all you want about treat and release. It’s not going to happen. Here are the problems. Liability. No body wants to take it. Plus people seem to like ambulance rides. There is a certain cachet about them. Nothing but the best for our people. There are a lot of myths out there and one of them is that riding in an ambulance is neccessary more than it really is. Another myth is that patients need to stay awake in the ambulance.
9-year-old midget football player feels dizzy after he tackles another player. No LOC, Pupils equal and reactive. No pain. Good vitals. Maybe he scrimped a little on his pregame meal. Parents insist patient be taken by ambulance to the hospital for evaluation of a possible concussion. I could reassure the mother that I don't think there is anyway he has a concussion seeing as he wasn't knocked out even for a second, but I just say which hospital? She tells me the name and I pass it on to my partner who will drive. Stay awake, the mother tells the boy, as we set him on the stretcher. Goes for you to, I whisper to my partner.
Every fall in every town midget football players get transported for hurt legs and bent fingers and headaches. These are tiny kids wearing more padding than those summa wrestling suits. They can’t generate enough force to do damage to anything. Yet they go to the hospital at epidemic rates. An EMT in one town told me he was called onto the field for a player down. He gets there and the kid’s finger is bent, but everyone is telling him not to move. If you bend your finger at home, you don’t need an ambulance, but I guess ambulances are part of the football experience, along with someone telling you to stay awake.
This weekend a player at a college football game was airlifted from the stadium to the trauma center. The report was he was moving all extremities, but they were telling him to stay awake, stay awake. My guess is that the airlift was more for advertising for the helicopter service than medically necessary. Reports say he was released from the hospital when all tests came back negative.
I saw in the paper the other day an area police officer was in a crash and transported by helicopter for a serious head injury. The officer was released the same day. Maybe it was because they told the officer to stay awake the whole way, shouting it through the noise of the helicopter's whirling blades.
We transport another 9-year-old with a possible leg injury. We find him on the field being told not to move. No deformity. It doesn’t hurt badly, he says. He can move the leg. Family wants him to go to the hospital by ambulance. So do the coaches and the referees and the bystanders. Which hospital? I say. My place is just to transport if they want to go. On the way there, he closes his tired eyes. Stay awake, stay awake, his mother says.
Later in the day, we are sent to a nursing home for unresponsive CPR in progress. We get there and the nurse says, she responded, thank goodness. You didn’t do CPR? I say. No, we didn’t have to. Three sternal rubs finally aroused her.
She is 94-years-old and has Alzheimer’s. It seems she was found unresponsive in her wheelchair. Eyes closed, not responding to the first two sternal rubs. They want her sent to the hospital to be checked. Her vitals are better than mine. I ask if they called her doctor. He ordered it, they say. Don’t want to take chances.
I ask the woman how she feels. She doesn’t respond. I think she is sleeping. I give her a little rub. She opens one eye and looks at me as if to say “Yes?”
“How are you feeling?”
“Tired,” she says.
I am tempted to say “stay awake, stay awake.” Instead, I say, “Well, you nap some and we’ll try to give you a smooth ride. See you at the hospital.”
Before I fill out the billing information on the back of the run form, I finish the front side by writing in the "Clinical Impression" box. I write "Tired."
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Mythbusting: Concussions and Staying Awake
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