By the very nature of their job, police officers often have to shy away from performing EMS—particularly at traffic collisions. Their first priority is to ensure their own safety, and the safety of the patients and responders, by slowing and redirecting traffic away from the incident and its associated debris field.
Frequently, fast-moving or intoxicated drivers run into officers, their patrol vehicles and other vehicles at an incident, turning a simple traffic stop into an MCI. In June 2010, California Highway Patrol (CHP) motorcycle officer Phil Ortiz was making a traffic stop on a freeway near LA when he was struck by a speeding vehicle. The collision sent four people to the hospital, including the motor officer, who was in a coma for two weeks before he succumbed to his injuries.
I’m keenly aware of the hazard control and patient care challenges that officers face because my son, Joe, is a CHP motor officer, tasked with performing these duties on some of the busiest freeways in the nation. So when I heard that he performed first response care on a patient at a highway incident before EMS crews arrived, I knew some factors involved would be significant.
Joe was the second CHP officer on scene at a vehicle collision involving a pickup into the rear of a flatbed truck. The impact sheared the roof off the pickup. On arrival, he observed the driver of the pickup seated on a curb nearby with a large forehead laceration. When Joe approached him, the injured party told him he had significant neck pain, found it painful to move his neck and was experiencing a loss of sensation in one arm.
In February 2010, I had shown Joe images from a lecture presented at the 2010 EMS State of the Science (i.e., “Eagles”) Conference based on research conducted at Ben Taub Trauma Center in Houston. They found patients who appeared physically intact on the outside but were “internally decapitated” on the inside when bones, tendons and ligaments were separated or torn during incidents involving high levels of force.(1–2)
They also pointed out that these injuries could prove fatal to individuals and be exacerbated by emergency personnel who apply a C-collar in an inappropriate manner or excessively move a patient’s neck during C-collar application, causing cervical distraction.(3) I summarized their findings in my April 2010 column, “Immobilization Study Presents Wake-Up Call” (www.jems.com/article/patient-care/immobilization-study-presents).
Joe’s assessment of the mechanism of injury, patient complaints and his knowledge of this important EMS research results gave him a “bad feeling” about the patient’s potential injuries. So he went to the trunk of a nearby CHP patrol vehicle and retrieved a trauma bag and adjustable C-collar. He carefully sized and applied the collar to the patient. He also bandaged the man’s forehead—careful not to cause movement of the man’s injured neck.
On arrival of the ALS ambulance, the senior paramedic asked Joe, “Who applied this C-collar to this patient?”
He hesitantly replied, “I did.”
The paramedic responded, “Great job!”
The EMS crew continued the immobilization and care of the patient and transported him to a nearby trauma center. At the trauma center, the emergency department physician sought out the CHP officer investigating the crash and asked, “Who immobilized this man’s neck before the EMS crew arrived?”
She told him it was one of their motor officers.
The physician’s response was that Joe’s actions on scene, particularly his early and careful immobilization of the patient’s neck, “kept the patient from being a paraplegic and probably saved his life.” A follow-up report revealed that the patient had suffered a comminuted and transverse C2 fracture.
This case points out the impact police can make in life-threatening situations. My son Joe’s awareness of symptoms of head-to-neck dissociation injuries made a significant different on the patient’s outcome. Share this case and research with your first responders and ask them to be vigilant in their early assessment and care of obvious, unseen and high-potential C-spine injuries. JEMS
1. Persee D, Ben-Galim P, Hipp J. C-collar or de-collar: Are cervical devices harmful? http://gatheringofeagles.us/2010/Presentations/Eagles2010Presentations.html.
2. Ben-Galim P, Sibai T, Hipp J, et al. Internal Decapitation: Survival after head to neck dissociation injuries. J Spec Oper Med. 2010; 10(2):35–39.
3. Ben-Galim P, Dreiangel N, Mattox K, et al. Extrication collars can result in abnormal separation between vertebrae in the presence of dissociative injury. J Trauma. 2010; 69(2):447–450.
This article originally appeared in April 2011 JEMS as “Impact of Early Care: Law office care often makes the difference.”