Stay Awake

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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4 Comments

  • Anonymous says:

    Once when in college, I had an obscene amount of booze and wacked my head on a counter top. Felt next to no pain at the time, but the next day I had a hangover from hell. It was a concussion + hangover. Lasted for about 24 hours. If anyone had tried to wake me every 2 hours, they’d have gotten a good stiff profanity-laced spit storm.The “stay awake” thing goes even further than just head trauma. I was interrogated by a coworker who was shocked that I let someone in the ambulance sleep during a 4 hour transfer. They said, “What if they quit breathing!?” I said that the nurses in the ED were only checking on patients every 30 minutes, and their desk is across the room and they have 12 other rooms. So you mean I should worry that the person I’m sitting 12 inches away from that has an visible o2 sat monitor on and is stable as can be with a broken femoral head is going to sudden crap out on my and I’m not going to realize it? Forget that, I said. That’s stupid.

  • Angelfire says:

    I remember getting concussed when I was in high school (about 14-15 years old at the time) doign woodword… smacked my head with a saw when the wood I was cutting split. Ended up with a nice egg shaped bruise on my forehead. I managed to make it through the rest of the day dazed, and the advice my GP gave me when my mother took me to see him. “Let her sleep, and just keep a general eye on her”This was a good 10+ years ago. Shame people always assume that concussion = coma = death if you leave people alone. That and it’s a shame they don’t consult the GPs first before thinking of ringing the ambulances…

  • F says:

    Seems to me that monitoring the patient’s concious behavior for a period immediatedly following the injury (IE that time period when us EMS folks are in contact with the patient) might be useful, no? The article you cited also mentioned it: that patients suspected to be concussed should be watched “closely for any changes in behavior or for any new symptoms.” I assume those symptoms we’re looking for – changes in mentation, memory, vision, n/v, etc – are much more easially assessed with the patient conscious. …Also I imagine it might be difficult to tell sometimes if a patient is in fact sleeping, or possibly unconscious/unresponsive. Obviously MOI is probably the most important factor here, but still… Personally, I’d rather keep the patient awake and talking to me- that way I can both assess for changes, and avoid having the embarrassing possibility of arriving to the ED with an unrecgonized unresponsive patient. My opinion of course, but neuro injuries are one of those “you never really know” areas that that just begs for CYA precautions. Especially with kids and frantic football moms.

  • Anonymous says:

    I’ve just noticed your trick of posting relevant links at the bottom of your post. Fantastic idea, do you mind if I steal it?

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