>From: Gautam <[log in to unmask]>
>1) Do other departments give priority (as we usually do) to log-rolling off
> boards
>on arrival onto something more humane (e.g. a bed of nails)?
---> In our department the aim is to have registrar informed on arrival of
such patients so that he/she is at least aware of a patient who may well
have significant injury other than just C-spine. i.e. not a question of
"doctor" vs "nurse", but someone with experince to cast an eye and conduct
or assign staff to conduct full log-roll.
Department luckily well-enough staffed so that there is no question of there
being no-one to log-roll such patients within, say, 15 minutes of arrival.
>2) do other departments encourage / allow nursing staff to log-roll off
>(even if not
>to formally examine the back) on arrival WITHOUT waiting for a doctor to be
>free to
>"supervise"? In my experience, doctors are rarely involved with the
>practical
>handling of a log-roll anyway, as they are usually poised to examine the
>undercarriage from the other side.
---> Will use at least one doctor in ALL log-rolls to perform examination of
back, etc. That still needs to be done AND DOCUMENTED FULLY by a doctor.
Person at the head of patient usually conducts the count and is thus "in
charge", this may be nurse or doctor, so long as they are confident in their
skills. We have many of either group in the department who are.
Use THREE others (more with heavy patients or with limb injuries which need
supporting etc...) to roll shoulders, hips, legs in usual ATLS fashion.
Any combination of the latter 4 people in terms of doctors and nurses is
acceptable! I have seen all tried (4 docs, 4 nurses and all "salads"), but
try not to waste a log roll by doing it without back exam. This also ensures
that docs do get "involved" and master all roles well enough to teach them.
When senior person and spare staff around we try to take opportunity to
bring in a junior doctor/nurse/student and teach them. Start on legs and
move up later.
>3) My understanding is that it takes a minimum of 3 persons to safely
>log-roll a
>patient (1 for neck, 2 for body). Can one of you paramedics / pre-hospital
>types
>lurking out there tell me how the 2 of you manage safely to get the patient
>onto a
>board at the scene?
>
>
>
>Dr G Ray
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