By James J. Augustine, MD, FACEP
A Clear Mandate
An accident victim refuses spinal immobilization—what’s a crew to do?
The call on this cold afternoon is for an auto accident in a congested
area of the city. The Attack One crew is on scene quickly, and the
drivers in the low-speed accident are sitting in their warm vehicles. A 28-year-old female with a laceration to her forearm
The driver of the rear vehicle denies injury of any type. There is a young following a motor vehicle accident.
woman in the front vehicle with minor damage to the rear of the car. Airway: Intact and uncompromised.
This patient states she is bleeding from her arm and has back pain. Breathing: No distress, able to speak in full sentences.
She denies neck pain, headache, loss of consciousness and any chest Circulation: Normal capillary refill, pink skin.
or abdominal pain. Her seat and shoulder belt are in place, as well Disability: No neurologic deficits.
as a protective pillow she’s been sitting on. She says she sliced her Exposure of Other Major Problems: A lacerated
arm on a piece of sharp plastic on the storage area between the front right forearm with no active bleeding and intact distal
seats, and a gaping 6-cm laceration of the right mid-forearm is now neurovascular function. Patient had recent surgery on
just oozing some blood. Neurovascular status in the hand and wrist her lower back and sacral area for a cyst and, due to
are completely intact. this, refuses to have spinal immobilization performed.
“My young children accidentally broke that storage area jumping
between the seats,” the woman explains, “and I should have covered Vital Signs
it with some tape until I could get it replaced. What am I going to do Time HR BP RR Pulse Ox.
about my children? I was going to pick them up from school when that
lady ran into me. And my back hurts where I had my surgery.”
Crew members elicit the history of a surgery on the woman’s sacral
area for a cyst she’d had since birth. The surgery