Aug 2, 2010

Compressions Only CPR


Chest Compressions Alone Best With CPR

Studies support bystanders not using mouth-to-mouth breathing

By Serena Gordon HealthDay Reporter

WEDNESDAY, July 28 (HealthDay News) -- If you haven't been well-trained in CPR and you see someone having what appears to be a heart attack, just doing chest compressions to help keep the blood flowing can be as effective as CPR that includes mouth-to-mouth breathing, new research claims.

Two new studies, appearing in the July 29 issue of the New England Journal of Medicine, found that when bystanders were instructed by emergency dispatchers to give either standard CPR, which includes mouth-to-mouth breathing, or chest-compression-only CPR, survival rates were similar between the two techniques.

Experts hope that by simplifying the procedure and removing the mouth-to-mouth contact that more bystanders might be willing to attempt CPR.

"Bystander CPR can double your chances of survival, but the biggest thing is getting more people to try it. Only one in three people who need it get bystander CPR," explained the lead author of one of the studies, Dr. Thomas Rea, medical director of the Emergency Medical Services Division of Public Health for Seattle and King County in Washington. "If we can make it less complicated, it may enable more people to perform CPR."

Rea said that rescue breathing can be difficult, especially for someone who isn't trained in the technique. Even in people who are trained, but don't often have the chance to practice rescue breathing, it can be hard to do.

"Even for myself as a physician, because I don't do mouth-to-mouth on a regular basis, it's hard to do," said Dr. Dana Peres Edelson, director of clinical research at the emergency resuscitation center at the University of Chicago Medical Center.

Edelson said that if you see a seemingly healthy adult suddenly drop, call 911 and then begin chest compressions. Emergency dispatchers can provide instructions on where to place your hands. If someone else is available to help, she said to have them call 911 and to go look for an automatic defibrillator, which are now present in many public places, such as malls, schools and stadiums.

"Push hard, push fast and don't stop unless you have to give a breath or use a defibrillator," said Edelson. "If you do stop, keep the pause as brief as possible."

"Chest compressions are paramount," said Rea.

Rea and his colleagues conducted a multi-center randomized trial of dispatcher-assisted bystander CPR. Adults who needed CPR were randomly assigned to receive either traditional CPR or chest-compression-only CPR. A total of 1,941 people were included in the study and 981 received chest-compression only CPR.

Survival rates (at hospital discharge) were 12.5 percent for the chest-compression-only group and 11 percent for those who received chest compressions plus rescue breathing.
The second study was similarly designed, but conducted in Sweden. This study included 1,276 people, with 620 receiving chest-only CPR.

The Swedish researchers measured 30-day survival rates and found that 8.7 percent of those receiving chest-only CPR had survived compared to 7 percent of those receiving standard CPR.
Both groups of researchers concluded that compression-only CPR with instructions from emergency dispatchers was likely to be as effective as traditional CPR, possibly even slightly more so.

The findings do not apply to emergency workers and others who are well-trained in CPR, Rea stressed.

There are some times when rescue breathing is necessary. Edelson said that it's recommended that children generally receive rescue breathing, as well as anyone who was choking or looked like they were having trouble breathing before they became unconscious.

But, Edelson said that lay people might not be able to discern who needs rescue breathing or not, so she advised, "If you haven't been trained in CPR, just start doing chest compressions as fast as you possibly can."

Rea agreed. "You can make a life-and-death difference by providing chest compressions. You don't have to be perfect; all you can do is provide benefit. Your actions can save a life."

More information
Learn more about hands-only CPR from the American Heart Association.
SOURCES: Thomas Rea, M.D., medical director, Emergency Medical Services Division of Public Health for Seattle and King County, Wash.; Dana Peres Edelson, M.D., assistant professor, section of hospital medicine, and director, clinical research, emergency resuscitation center, University of Chicago Medical Center; July 29, 2010, New England Journal of Medicine

Jul 20, 2010

What? 80% of ED patients have insurance?

Wow!  When I first read this I thought "no way" -it's got to be more than that!  We've all heard it before, "ED patient's don't have insurance - that's why they come to the ED in the first place".  Well information relased by the Federal HHS Department shows that lack of insurance in our ED population is the minority when all is tallied up.  

Original article can be found at:

New Data Say Uninsured Account for Nearly One-Fifth of Emergency Room Visits

July 16, 2010

HHS Secretary Kathleen Sebelius today released new data from the Nationwide Emergency Department Sample -- the largest, all-payer emergency department database in the United States.  The Nationwide Emergency Department Sample is designed to help public health experts, policymakers, health care administrators, researchers, journalists and others find the data they need to answer questions about care that occurs in U.S. hospital emergency departments.

These data indicate that uninsured persons accounted for nearly one-fifth of the 120 million hospital-based emergency department visits in 2006. 

"Our health care system has forced too many uninsured Americans to depend on the emergency room for the care they need," said Secretary Sebelius. "We cannot wait for reform that gives all Americans the high-quality, affordable care they need and helps prevent illnesses from turning into emergencies."

The database is managed by HHS' Agency for Healthcare Research and Quality (AHRQ) and generates national estimates on the number of emergency department visits in all community hospitals, by region, urban/rural location, teaching status, ownership and trauma designation.  It also provides in-depth information on acute management of patients for all visits, including why patients were seen in the emergency department, the treatments they received, what happened to them at the end of the visit (admitted to the hospital, discharged home, transferred to another hospital, died in the emergency room or left against medical advice), the charge for their care and who was billed.

The Nationwide Emergency Department Sample contains 26 million records from emergency department visits from approximately 1,000 community hospitals nationwide.  This represents 20 percent of all U.S. hospital emergency departments.  The database also provides weighted calculations for national estimates of the 120 million emergency department visits in 2006.
"AHRQ has a long history of supporting health services research related to emergency medicine, and the richness of these new data will increase our capacity for research and decision making," said AHRQ Director Carolyn M. Clancy, M.D. "The new database will give emergency planners and other policymakers the data they need to help improve the quality, safety and effectiveness of emergency medical care."  

AHRQ also released its latest Nationwide Inpatient Sample-- the largest, most powerful database on hospital care in the United States, covering all patients, regardless of their type of insurance or whether they were insured. The 2007 Nationwide Inpatient Sample provides users with an in-depth look at why patients were hospitalized, the treatments and procedures they received and what happened to them at discharge. Researchers can use the Nationwide Inpatient Sample to examine trend data as far back as 1988. The 2007 Nationwide Inpatient Sample is based on discharge data from 8 million hospital stays at more than 1,000 community hospitals.

The two databases, as well as the 2006 Kids' Inpatient Database on pediatric inpatient care, are part of AHRQ's Healthcare Cost and Utilization Project (HCUP), a federal-state-industry partnership for building a standardized, multi-state health data system. In addition to databases, HCUP includes software tools and statistical reports to inform policymakers, health system leaders, researchers and the public.

HCUP databases can be accessed by using the AHRQ on-line query tool, HCUPnet. Researchers and analysts who need the most in-depth data should contact the HCUP Central Distributor about purchasing the 2006 Nationwide Emergency Department Sample and the 2007 Nationwide Inpatient Sample datasets and for further information about their composition and technical requirements.

Jul 15, 2010

Health Care Reform Might WORSEN ED Crowding

Reform To Exacerbate Emergency Department Crowding, Experts Say

The new health reform law might exacerbate emergency department overcrowding, according to health care facility experts, The Hill reports.

Advocates of the overhaul said the law would help address ED overcrowding by ensuring more U.S. residents had insurance to cover physician visits.

However, EDs likely will experience higher patient volumes over the next four to eight years because of a dearth of primary care physicians in the U.S., according to Rich Dallam, a partner at health care architectural firm NBBJ.

Lessons From Massachusetts?
Rep. Jim McDermott (D-Wash.) agreed that increased stress on EDs is a possibility. He pointed to Massachusetts, where a 2006 health law that created near-universal health coverage for state residents has failed to abate ED demand

 A recent American College of Emergency Physicians poll found that nearly two-thirds of Massachusetts residents said ED wait times have increased or remained the same since the law was enacted.

In addition, a report by the Council of State Governments released in February found that wait times had not declined since Massachusetts' law took effect.

Jul 6, 2010

Fireworks Related Mortality Report

(NOTE: The data for 2009 and 2010 has not been compiled yet)
Below are some interesting factoids about fireworks related mortality.

     This report provides the results of the U. S. Consumer Product Safety Commission (CPSC) staff analysis of data on non-occupational fireworks-related deaths and injuries during 2008. The report also includes a summary of CPSC staff enforcement activities during 2008.
     Staff obtained information on fireworks-related deaths from news clippings and other sources in CPSC’s Injury and Potential Injury Incident (IPII) database. Staff estimated fireworks-related injuries from CPSC’s National Electronic Injury Surveillance System (NEISS). More detailed analyses of injuries including the type of injury, the fireworks involved, and the characteristics of the victim were based on a special study conducted by CPSC staff between June 20 and July 20, 2008. About two-thirds of the annual fireworks-related injuries for 2008 occurred during that period.

Highlights of the report are as follows:
•CPSC staff has reports of 7 fireworks-related deaths during 2008. Two people were killed in incidents involving aerial and display fireworks. One person died in a fire where a firework was the ignition source. Three people were killed in incidents involving homemade fireworks. One person, on oxygen, suffered serious burns when a firecracker exploded near his face. He died 18 days later in the hospital. CPSC staff has reports of 11 fireworks-related deaths in 2007.

•Fireworks were involved in an estimated 7,000 injuries treated in U. S. hospital emergency departments during calendar year 2008 (95 percent confidence interval 5,200 – 9,000). CPSC staff estimated that there were 9,800 fireworks-related injuries during 2007.

•An estimated 5,000 fireworks-related injuries (or 70 percent of the total fireworks-related injuries) were treated in U.S. hospital emergency departments during the one-month special study period between June 20, 2008 and July 20, 2008 (95 percent confidence interval 3,400 – 6,500). CPSC staff estimated that there were 6,300 fireworks-related injuries (66 percent of the annual total) during the 2007 special study period.

Results from the special study include the following:
•Of the fireworks-related injuries sustained, 62 percent were to males and 38 percent were to females.

•Injuries to children were a major component of total fireworks-related injuries with children under 15 accounting for 40 percent of the estimated injuries. Children and young adults under 20 had 58 percent of the estimated injuries.

•There were an estimated 900 injuries associated with firecrackers. Of these, 500 were associated with small firecrackers, 100 with illegal firecrackers, and 300 where the type of firecracker was not specified.

•There were an estimated 800 injuries associated with sparklers and 300 with bottle rockets.

•The parts of the body most often injured were hands and fingers (estimated 1,400 injuries), eyes (1,000 injuries), and legs (900 injuries).

•More than half of the injuries were burns. Burns were the most common injury to all parts of the body except the eyes, where contusions, lacerations, and foreign bodies in the eye occurred more frequently.

•Most patients were treated at the emergency department and then released. An estimated 8 percent of patients were treated and transferred to another hospital or admitted to the hospital.

Jun 29, 2010

Need And Use For Air Ambulance Service Is On The Rise

Despite the debate between providers and various authorities, demand for air ambulances is rising. Before hiring an air medical transport, patients and their families should make sure that the operators are licensed and bonded, that the life support systems and other medical equipment meet all requirements and that pilots and medical personnel have the experience necessary to provide for safe transport.

While it has its origins in the wartime transport of injured soldiers, air ambulance services have come to be used by medical facilities everywhere. Thousands of aircraft engage in aeromedical transport, from short-range, rotary-winged flights to more extensive journeys aboard small fixed-wing jets. Air ambulances are available for emergency and non-emergency use, and the costs can be quite high. Services range from basic medical monitoring to airborne surgical facilities. While all agree that safety and uniformity are of paramount importance, the industry lacks the regulation necessary to create equitability between all interested parties. Still, demand for this service is not going away, so regulatory change is inevitable.

An air ambulance has two basic functions: to provide fast transport from the scene of an accident to the appropriate medical facilities in an emergency situation; and to provide timely, sometimes long-distance shuttling of patients from one facility to another. Helicopters provide a more mobile, short-range solution in an emergency. Fixed-wing aircraft, such as private jets, are more suited to long-range trips. However, aircraft in both cases can be outfitted with a variety of life support systems and trained medical staff.

Private medical transport via small jets typically starts with a base fee in addition to the expense of trained staff and mileage. It is not uncommon for an intercontinental medical transport to cost $50,000 or more, although domestic flights are generally much less expensive. Depending on a patient’s insurance coverage, air evacuation might be included but only in emergencies and over limited distances. Fixed-wing medical transport specializes in long-distance movement of patients, most commonly in non-emergency situations.

Onboard medical personnel must be trained and certified according to the requirements of their profession, as well as in operational procedures and in-flight safety. While regulation generally eludes the industry, aeromedical service providers must hold an Operations Specifications Part 135 certificate authorizing them to operate an air ambulance.

The Uniform Fixed-wing Air Ambulance Regulation Project has been attempting to create a cohesive set of rules that coordinates the actions of federal and state health regulators, as well as the FAA, with regards to these medical transporters. But for now, those seeking to utilize these services for themselves or loved ones should look into safety records and customer testimonials before a final decision is made about which service to book.

Original article can be found at:

Jun 16, 2010

Woman shoots self to get surgery

Woman shoots self to get surgery

Desperate and uninsured, Kathy Myers hoped wound would lead to shoulder repair she couldn't afford

By DEBRA HAIGHT - H-P Correspondent
Published: Saturday, June 12, 2010 1:08 PM EDT
NILES - A woman suffering from severe shoulder pain and without any health insurance shot herself in the upper arm Thursday so she could get emergency room care.

Police said the incident happened around 4 p.m. at a home in the 1500 block of Michigan Street on the city's southeast side. Niles police found 41-year-old Kathy Myers suffering from a gunshot wound.

City firefighters and SMCAS ambulance staff tended to her wound, and she was taken to Lakeland Hospital in Niles, where she was treated and released a few hours later.

The bullet, from a .25-caliber handgun, entered her upper arm and exited a few inches lower on her arm.

She told WNDU-TV that she couldn't see a specialist about her lingering shoulder pain because she couldn't afford health insurance.

"If it's not a threatening situation then they won't do anything about it," she said. "So I thought I would give them a life-threatening situation.

"I really didn't accomplish what I hoped it would accomplish," Myers told WSBT-TV. "I was really hoping it would hit an artery or bone so they would do the surgery and fix me. I have no suicide wish. My life sucks right now, but I want to live."

Paul Smallmon, the father of Myers' friend, spoke with The Herald-Palladium Friday evening. Myers lives in the Smallmons' home.

"She had a shoulder injury from about a month ago and was trying to get some help for that," Smallmon said. "She went about it the wrong way."

It was the Smallmons' gun that she reportedly used to shoot herself.

The WNDU story said Myers had been injured when she tried to restrain her bigger dog after it lunged at her Chihuahuas.

Smallmon said Myers had her shoulder injury checked out by doctors, who said she didn't have any broken bones but likely a torn or stretched ligament. They gave her pain pills, which he said hadn't taken away all the pain.

"She was in so much pain, she went out of her head," he said about Myers shooting herself. "She was at her wit's end."

Smallmon said Myers had been out of work as an asbestos remover for close to a year, had run out of unemployment benefits and didn't have any health insurance.

He said she had tried to get work recently in order to get some health insurance but couldn't work because of her shoulder injury.

By Friday evening people had come forward to try to help Myers get the medical attention she needs for her shoulder injury.

Smallmon said the gunshot wound was minor and not causing her much pain, if any, in comparison with the pain from the shoulder injury.

As for the possibility of criminal charges being filed against Myers for shooting herself, he said, "We're hoping nothing happens."

Niles Police Capt. Jim Millin said Friday that the information was turned over to the Berrien County prosecutor Friday as a routine matter. He said it would be up to the prosecutor whether charges are filed.

Millin said possible charges would be discharge of a firearm in the city, which is a local ordinance violation, or careless or reckless discharge of a firearm.

Original article can be found at:

Jun 13, 2010

Is The ED still for "Emergencies"?

Below is a commentary I posted on an online bulletin board a few days ago.  The original poster was discussing the fact that yet another hospital system has gone public with their "ER Wait Times" (see original article at: )

I think the elephant/rhino/gorilla in the room here is that we need to aknowledge that ED is "not just for emergencies" any more!

As a nation and a culture, we have shifted the mindset to "Now" care regardless if it's an ER Wait Times"emergency"or not.

People that are working in emergency medicine or nursing need to realize that this IS the way it IS now - it's not what it WAS before and it's NOT going back to that anytime soon.

If emergency staff find themselves being upset, disgruntled, frustrated, mad etc about "non-emergencies" coming in, they need to either (a) adjust their mindset or (b) find a new line of work because an unhappy employee is an unsatisfied employee and (i) more prone to mistakes (ii) more likely to give bad customer service etc, etc.

What the "secret" is that your admin is NOT telling you, is that they WANT the business.

The PRIMARY role of the ED is that which is mandated by federal law (EMTALA), the SECONDARY role of the ED is an "intake" or "access" point for hospital admissions. Hospital admissions = revenue, which equals profit for the shareholders/stakeholders.

Ah, but the old argument that "all our patients have no insurance"....
...this is only partly true.

The national average is that approximately 30% of your ED patient mix has NO insurance whatsoever. The other 60% has some form of payor status (private, third party, auto, medicare, medicaid). That 60% is what the hospital wants.

And if you think about it, who are you more likely to admit?
a) a medicare patient (someone typically over 65 +/- who has health conditions)
b) an unisured patient (who typically is <45, and has many fewer comorbidities)

Look at your trauma patients.
What is the #1 cause of trauma? ANS: Blunt trauma
What is the #1 cause of blunt trauma? ANS: MVC's
For the most part, what payor status are MVC patients - INSURED (auto liability insurance in MOST states)....This pays big $$$$$

Even if your ED patient doesn't get admitted, think of all the referrals that come out of the ED: referrals for outpatient testing, office visits, specialist consults, procedures etc - if your hospital is networked with the providers of THOSE services, then it's a 2/3 (60%) chance that the pt being referred has insurance and thus the referrals will have about a 60% payor status.

So, you give away 1/3 of your care to capture the 2/3 that are paying...not too shabby.

But wait, there's more....

If your facility is not the "average" and your unisured payor status is greater than 30%, you argue that you're loosing money...
Well, maybe, but that's where state and federal matching money comes in to subsidize uninsured care based on your percentage uninsured.

Also, if your facility is listed as "non-profit", then the tax benefit for writing off "charity care" is even more beneficial to them which helps keep their income taxes reduced even more which means MORE of the 60% payor's money goes into their pockets.

Why am I saying all this...?

When it was the time that I finally realized that the ED was not "the" money-maker, but rather it played a role in the hospital making money - it all became much easier to swallow and understand the bigger picture.

For when you see the big picture, you start to see your role, your department's role in it.

May 28, 2010

Use of glucometer testing to detect CSF leaks

Emerg Med J 2005;22:556-557 doi:10.1136/emj.2004.022111
  • Short report

New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea


Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available.
Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is <6 mmol.L−1, and if there are no symptoms of upper respiratory tract infection.

May 1, 2010

FREE CEU's - Emergency Preparedness Courses in SC


Preparedness Courses

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(EMTs, paramedics, and other non-hospital emergency care personnel)
Brought to you by: SC DHEC and Emergency Services Special Operations Group

Mass Casualty Incidents/START Triage (Lecture with practical exercise/scenario) During a mass casualty incident (MCI), local resources will be overwhelmed. By utilizing the Simple Triage and Rapid Transport/Treatment method of sorting victims of an MCI responders will be able to “Do the best for the most.”
Meth Lab Awareness (Lecture)
Meth labs are more prevalent than ever and first responders need to know how to identify the properties and uses for methamphetamines, identify the hazards associated with and what actions to take when responding to a methamphetamine lab, and treat victims of a methamphetamine incident appropriately.
Pandemic Influenza (Lecture) Considerations for Emergency Medical Services participants will support the development of or review their organization’s pandemic influenza plan, know their role, and ensure they are ready to clinically respond in the event of pandemic influenza.
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Florence EMS Training Center, Pandemic Influenza for EMS and WMD Awareness
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Berkeley County Emergency Services Training Center, Pandemic Influenza for EMS and WMD  
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Lexington County EMS, Pandemic Influenza for EMS and WMD Awareness
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Jan 26, 2010

Study questions the standard of C-Collars

Baylor study doubts neck brace standard
In some cases, device might hurt accident victims



   Applying a brace to the neck of a trauma patient, standard procedure for many decades, can worsen the injury and lead to severe paralysis or death, according to a new study by Houston researchers.

   Baylor College of Medicine doctors used cadavers to confirm that so-called cervical collars can be counterproductive, a finding that could upturn the way emergency medical personnel and doctors act to stabilize and protect the upper spine in potentially fatal neck injuries, such as those that commonly occur in bad automobile accidents.

   "This study is a proof of concept that in cases of severely unstable neck injuries, cervical collars are not only not helpful, but harmful in many situations," said Dr. Peleg Ben-Galim, a professor of orthopedic surgery and the study's lead author. "More research needs to be done, but it might be that we can prevent some of the deaths and quadriplegia that occur in these injuries."

   The study appeared this week in the Journal of Trauma.

   Dr. David Persse, medical director of Houston's Emergency Management Services, called the study "compelling" and "concerning" and said it will come up for discussion at the annual meeting of the nation's 30 largest EMS departments in Dallas next month. But he also said he doesn't want to overreact.

   "We need to look at this thoughtfully before we change the standard of care," said Persse. "It concerned a particular kind of injury. It may apply to other injuries as well, but we don't know that yet."

   But Persse added that he understands the need to act quickly, that "it's not like a lot of areas where there's not as serious downside to waiting for the next study."

Car-crash victims

   Ben-Galim said cervical spine injuries are found in the autopsies of up to 94 percent of people who die in car crashes, which claim about 44,000 U.S. lives annually. There are about 11,000 people annually who survive spinal cord injuries.

   There is no obvious alternative to cervical collars, though hospitals often place sandbags under the back of the patient's head and, less commonly, some EMS teams at the scene of the crash wedge the head of the patient between foam bolsters on the backboard.

   The injuries in question involve the area where the brain connects to the spinal cord. Doctors treating such injuries work to stabilize the ligaments, muscle and bone to prevent secondary injury and to protect the brain stem and cord.
   Baylor researchers undertook the study after a case in which a broken jaw precluded the use of a cervical collar on the survivor of a car wreck brought to Ben Taub. When the doctors started to put a collar on the patient, fluoroscopy showed two of the patient's vertebrae separate, causing doctors to immediately remove the collar. The treated patient ultimately walked out of the hospital on his own.

   Ben-Galim noted that there are other such case histories in medical literature.

   To study the phenomenon, Baylor researchers made an incision in cadaver neck ligaments based on patient X-rays, then simulated clinical scenarios by applying cervical collars and putting the bodies in ambulances and driving a distance.

   In all of the cadavers, imaging technologies found that the collar increased the rupture.

   In effect, the collars pushed the head away from the shoulders, Ben-Galim said.

   He said the rupture stretching occurs because of both the application of the collars and their continued use.

   One national expert called the study interesting but said he wasn't sure it would one day change the standard of care.

   "There are certain cases, like the ones in this study, that can be dangerous, but they're rare -- most people who suffer high neck injuries die immediately," said Dr. Tom Scaletta, the past president of the American Academy of Emergency Medicine. "I think the study's importance will be to raise awareness about the special care that must be taken -- preserving patients' normal head position, making sure they're not having difficulty breathing."

Anecdotal cases

   Dr. Walter Lowe, director of the Memorial Hermann Sports Medicine Institute and team physician for the Houston Texans football team, said the study wouldn't change the care of injured football players removed from the field in collars and on stretchers because those injuries tend to involve lower areas of the spine.

   Ben-Galim said that since the study was undertaken, Ben Taub doctors have saved patients with severe neck injuries by loosening or removing cervical collars early and rushing them to the operating room, but he acknowledged such cases are anecdotal.

   He said the research team looked at 400 articles and found no scientific evidence that cervical collars can stabilize severely unstabilized spine injuries.

Original source:

Jan 21, 2010

Pain Scale - "Zero to Ten"...!

In this business of ER/EMS/Healthcare, we have been tasked with an attempt to objectify a patient's "pain".  Apparently many bean-counters and doctoral candidates have done research on how to do this, and as such the "Zero to Ten" scale was born.

Now most of you reading this are undoubtedly of the ER/EMS genre' and are all too familiar with this "scale".  Our instructors, mentors, preceptors, managers, educators (ad nauseum); pound it into us to use this scale.  It's pretty easy for them to say that because on paper it looks good, but as most of you, my readers know, it is haphazard at best to apply effectively...  Oh, wait, let me also throw in what they told us in feel-good-nursing-school, "pain is whatever your patient says it is".   So, we are asked to unquestioningly document "whatever" the patient says about their pain.

By itself, this is not too bad, however, it is when the patient is savvy to this whole pain scale thing that they begin to manipulate it to suit their own needs and wants.  We are left to unquestioningly just "write it down" with no practical attempt to help the patient understand what we are trying to measure.

So we write what the patient says, then we spend the next 5-10 minutes charting all those "little things" that we observe about the patient's behaviors - those things that seem to make the patient's self-assessment inconsistent at best....

"patient talking/texting/IM'ing on cell phone..."
"patient laughing, joking with friends..."
"patient walks to room with steady, coordinated gait..."
"patient smiling..."
"patient resting (sleeping) on stretcher spooning with boyfriend...!"
...and on and on

Sometimes we go further to note more objective findings such as the vital signs:
-reported pain score "10"
-Pulse rate: 56....???

However, in an attempt to further quantify this pain scale, and maybe to help the patient understand what we're looking for, I came across this table (see below) which strives to put some defining characteristics to the different pain levels....

Comparative Pain Scale

No pain. Feeling perfectly normal.
Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.
Very Mild

Very light barely noticable pain, like a mosquito bite or a poison ivy itch.

Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails.

Very noticable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection.

Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to adapt to pain.

Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard

Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed.

Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. Comparable to a bad non-migriane headache combined with several bee stings, or a bad back pain.
Unable to engage in normal activities. Patient is disabled and unable to function independently.

Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. Comparable to an average migraine headache.

Pain so intense you can no longer think clearly at all.. Comparable to childbirth or a real bad migraine headache.

Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. Comparable to throat cancer.

Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.

So, now, here's your clinical story to illustrate the use of this scale...

Dr: "Between zero, being no pain and 10 being the worst you can imagine, how would you rate your pain?"
Pt: (calmly)..."a 10"....
Dr: "Okay, at 10 would be you getting hit in the face with a 15 pound sledgehammer, and unconscious from the pain, not the head injury.  Most people have never and will never experience this pain level ~ and if they do, will undoubtedly be unconscious..."
Pt: (again calmly)..."okay, 9-and-a-half..."