Immobilising Drunks

It's a simple little rule really, one that I learnt in training school. 'If they are drunk and have fallen a long way, collar and board them'.

It sounds simple, but there is a world of difference between what should be done and what can be done.

My current chappie was drunk which, to be honest, was probably a normal state of affairs for him. He'd taken some imagined offence at the person living upstairs from him (for this was the classic Newham housing scheme where a landowner converts a perfectly nice house into eight or nine one bedroom flats). He'd staggered upstairs and been banging on the other person's door – then when the door was answered had become aggressive. The flat owner had given him a push and our drunken patient had stumbled backwards and fallen down the stairs.

The person who'd pushed him was the one who'd called the ambulance.

The police were in attendance as the drunk was acting aggressive, again called by the person who'd pushed my patient.

We arrived to find a couple of drunks, one of which was our patient. He was verbally aggressive – but not physically violent, although I had the suspicion that it wouldn't take much before he started waving his fists around.

Topless, like many of our drunks, he sat on the end of his bed. Because he was topless you could see the obvious fracture of his clavicle (although to be fair I thought it was a dislocated AC joint, but then, that is what x-rays are for).

Restless and agitated, although more likely due to the drink rather than any suspected head injury, it took me quite some time to persuade the patient that it was in his own best interests to come to hospital. It was only when I told him that the bone he had broken could cause fatal bleeding (the truth, although not in this case) that he agreed to come to hospital.

He refused to be collared and boarded, and besides, he was much too agitated to lay still for any amount of time.

It's here that judgement comes into play. You balance up the need to 'collar him' because he fell down a complete flight of stairs and is so drunk he could be walking around with a broken neck and not realise it with the realisation that if you try to strap him down to a board he's going to struggle and put his neck through more contortions than if he were to just sit quietly in the back of the ambulance.

I remember one study that said that if someone is walking around on scene and hasn't got any signs of spinal cord damage, then it's incredibly unlikely that they have damaged their spine.

(This isn't it, but it's something similar)

So, on balance, trying to force someone into being immobilised is probably going to do more harm than good.

And so I sat him in the ambulance checked him out and at the end of my journey walked him into the hospital – and after telling my tale they sent him to the minor injury department.

I also made sure that I documented everything on my patient report form, just in case…

In the past, when I was less wise, I'd struggled with drunk patient's to get them collared and boarded – and each time I'd thought that the struggle had done more harm than good. The same with the person agitated from a head injury, where the only way to safely transport them is to sedate them – something that we cannot do and instead have to call out a HEMS or BASICS doctor.

So while it would be nice to have the option to sedate patients, i think that it would be more important to have a less dogmatic approach to our immobilisation of patients.

8 thoughts on “Immobilising Drunks”

  1. Not so much likely that they haven't done *any* damage to their spine, but that, in the absence of neurological deficits,, it's much more likely to be a stable fracture that will not benefit from immobilization.That is, of course, if you actually believe that immobilization actually offers any benefit. That's what we've always thought, but there is no research to prove the hypothesis. Just the opposite, in fact.

    But I feel your pain when it comes to immobilizing drunks. It is far easier said than done. For this reason, the current term in vogue around here is “spinal motion restriction,” because rarely can we actually “immobilize” even a cooperative patient.

  2. I nearly got caught out by a drunk at the bottom of a flight of stairs.We were initially led to believe that he had fallen there. Turned out that he had bounced down the lot. Fortunately my crew mate decided to play it safe.

    He had # base of skull. There but for the grace. That's why you need two qualified people on a truck.

  3. around 900 people have spinal injury a year yet we board ten of thousands for no good reason. We follow very stupid USA that dictate what we have to do. We have the brains to think so why can we not use them ?? I have loved the job for 43 years but I'm glad to be leaving soon ., Too much shit and not enough backing from our managementHow is it that as soon as people get promoted they turn into pricks and forget what the real world is like ????

  4. I agree 100% with last comments on Managers.When i got to those dizzy hieghts i hated all yes men and women the HR director hated me for sticking up for the staff My reign didnt last when he got going!!. A Manager that suspends a paramedic for failing to carry out cpr for the 20mins as laid down by JALC. even though the patient is deceased through a tumor on the lung and the ambulance swimming with blood. I call that bullying The manager if i was still his boss would be suspended and sent out in the real world. But no one has the Balls now, everyone is to busy looking over their shoulder, is it HR that runs the show? What happened to the ops Directors have they forgot as you say they once drove a white thing and meet proper people that we are supposed to look after.

  5. I suppose the answer to that is that some smartarse lawyer out there will say..he may have had ca lung, there may have been blood everywhere and it may have been humiliating and inhuman to add broken ribs to the an already pointless resus but according to jrcalc they should have kept going. Where's there's blame………..

  6. Oh absolutely, I agree with you 100%Actually it's reading you and rogue medic that has given me more confidence to use the skills that I have rather than do everything as laid down by our 'guidelines'.

  7. JRCALC are only guidelines . . . . every situation/incident is different and treatment should be tailored around JRCALC to suit the given situation.Discuss?


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