Board & Collar for Nursing Home Falls

[adamNYC]

Board & Collar for Nursing Home Falls

I notice depending on my partner I'm working with, we will just collar and sometimes we will board and collar. The main indication being if they hit their head. What I do most of the time is just collar if they hit their head. Recently my partner said "If you collar, you must board too" and we took a poor guy who was eating his lunch and in no apparent distress and did a standing takedown board and collar. Now that just agitated him on the whole ride to the hospital and the Doctor didn't seem to happy with it either.

Thoughts? Suggestions?

Thanks

 

[CentralCalEMT]

First off, the normal disclaimer....Follow your local protocols.

That being said, it sounds like you are right to question backboarding. If he was eating lunch, he was obviously up and walking around after the fall and I would assume moving all extremities well. Here (Central CA) he would not have gotten anything other than transport to the hospital in the position of comfort. Did he have any neuro deficits, numbness or tingling? Did he have any mid line neck pain inhibiting movement? If the answer to all those questions is no, and if your local protocol allows it, transport in the position of comfort is generally the way to go. Possibly if the mid line neck pain inhibits movement, a collar can be used. We only use soft collars here, but I do not know if that is an option for you. It does no good to immobilize people who do not need it. Especially if they are weak and frail which most people in nursing homes are. If you lie patient with chronic COPD or CHF on his back, really bad things can happen, and it seems inhumane to c-spine elderly patients who can not tolerate it. It sounds like he was minding his own business and EMS came up to him and threw him on a backboard. That would agitate anyone. We all have had that over zealous partner at times, and if that is the case, then it might be a good idea to take him or her aside and remind them we have to think in the best interest of our patient and not over treat patients if they do not need it.

 

[281mustang]

Neck pain upon palpation: C-Collar

Neck and back pain upon palpation: C-Collar/scoop stretcher(I also typically put a pillow under their head for comfort)

No neck/back pain upon palpation: Nothing

That's just my personal preference. Not a big fan of backboards, scoop stretchers technically are a form of SMR and circumvent many of the issues associated with boards. I typically only use backboards on MVCs(due to the fact that the slick flat surface makes it easy to transition the pt from a seated position to supine on the stretcher) and heavy unconscious patients(due to the fact that it's logistically typically the easiest way to get them from the floor to the stretcher.)

 

[DrParasite]

Recently my partner said "If you collar, you must board too" and we took a poor guy who was eating his lunch and in no apparent distress and did a standing takedown board and collar. Now that just agitated him on the whole ride to the hospital and the Doctor didn't seem to happy with it either.

maybe I'm missing something, but why did you board and collar him? last I checked, eating lunch wasn't criteria for c-spine precautions....

 

[adamNYC]

He fell, hit his head, and it was bandaged. Fall wasn't witnessed. Pt was found by us in the middle of lunch all bandaged up and ready to get checked out.

Good points on the palpating the neck and spine. Will do on next fall as part of trauma assessment.

 

[ERDoc]

NYS is at least a decade behind the literature and the providers are even more so. The only real use for a long board anymore is to move a pt. Once they are in the hospital we are taking them right off the board for a multitude of reasons (they serve no purpose, they interfere with xrays, they cause pressure sores, etc). You are probably more likely to limit spinal movement by placing them on the stretcher mattress than you are on a long board because they will be much more comfortable and not move around as much.

As has been said, follow your local protocols but if you want to educate yourself, look up the NEXUS criteria and the Canadian C-Spine Rules.

 

[NYBLS]

NYS is at least a decade behind the literature and the providers are even more so. The only real use for a long board anymore is to move a pt. Once they are in the hospital we are taking them right off the board for a multitude of reasons (they serve no purpose, they interfere with xrays, they cause pressure sores, etc). You are probably more likely to limit spinal movement by placing them on the stretcher mattress than you are on a long board because they will be much more comfortable and not move around as much.

As has been said, follow your local protocols but if you want to educate yourself, look up the NEXUS criteria and the Canadian C-Spine Rules.

I wouldn't generalize all providers as a decade behind the literature. NYS is in an awkward transition phase where the providers know whats best but the state doesn't allow it yet. It doesn't mean the providers don't know best or aren't ignoring common sense.

 

[adamNYC]

I was just glad the hospital was 5mins away so he wasn't too uncomfortable for too long

 

[ERDoc]

I wouldn't generalize all providers as a decade behind the literature. NYS is in an awkward transition phase where the providers know whats best but the state doesn't allow it yet. It doesn't mean the providers don't know best or aren't ignoring common sense.

I wasn't trying to imply that all providers are that way, but most in the areas I am familiar with are. I also wouldn't generalize all providers as knowing what's best, since the OP has shown this is not true. I know lots of providers who want to provide better care but are limited because of the antiquated system but there are also a lot of the old guard who say, "This is the way we have always done it so why change it," and unfortunately they are the ones that run the system. Again, this is based on the parts of the state I am familiar with so your mileage may vary.

 

[adamNYC]

Keep in mind I'm a December EMT school grad and been working txp two months

 

[Trauma Queen]

Connecticut has recently updated it's spinal immobilization protocols. ALS can clear c-spine under certain circumstances. If there is any altered mentation, intoxication, distracting injuries, etc, the patient requires a LBB. Otherwise, they can be cleared of everything. BLS, if we arrive on scene and the patient is ambulatory, we don't need to put the patient on a LBB. So goodbye to the nonsense standing takedown.

We're definitely moving in the right direction.

 

[RedAirplane]

maybe I'm missing something, but why did you board and collar him? last I checked, eating lunch wasn't criteria for c-spine precautions....

Many fast food sandwiches cause multi-system trauma...

 

[NYBLS]

I wasn't trying to imply that all providers are that way, but most in the areas I am familiar with are. I also wouldn't generalize all providers as knowing what's best, since the OP has shown this is not true. I know lots of providers who want to provide better care but are limited because of the antiquated system but there are also a lot of the old guard who say, "This is the way we have always done it so why change it," and unfortunately they are the ones that run the system. Again, this is based on the parts of the state I am familiar with so your mileage may vary.

Agreed, I shouldn't have generalized. Hopefully science and quality clinicians can pave the way (and knock the old guard) to providing better care.

 

[ERDoc]

The problem is that the old guard is creating the new providers the same way.

 

[TF Medic]

Keep in mind I'm a December EMT school grad and been working txp two months

From one new guy to another, when you get conflicting information from partners:

1.) Read the protocol
2.) Ask someone who has proven trustworthy
3.) If #2 is unavailable, see #1

What do your protocols say?

 

[NYBLS]

From one new guy to another, when you get conflicting information from partners:

1.) Read the protocol
2.) Ask someone who has proven trustworthy
3.) If #2 is unavailable, see #1

What do your protocols say?

Protocols are guidelines for treatment. We are talking about people following guidelines on here too strictly and hurting patients.

 

[TF Medic]

Protocols are guidelines for treatment. We are talking about people following guidelines on here too strictly and hurting patients.

Guidelines, exactly. And without knowing them, we have no idea how close or how far his partners are to following said guidelines.

 

[Chewy20]

He fell, hit his head, and it was bandaged. Fall wasn't witnessed. Pt was found by us in the middle of lunch all bandaged up and ready to get checked out.

Good points on the palpating the neck and spine. Will do on next fall as part of trauma assessment.

That should already be apart of your trauma assessment.

 

[EMTinCT]

Longboards are a good way to cause a lot of damage, especially to the elderly. Be kind to your patients and never use them for anything other than moving a PT. If you fear c-spine damage then use a collar but place them on the stretcher without a longboard.

Longboard=not supported by the literature

 

[RocketMedic]

They are great for adding table space, and the collar can make a good salad-bowl holder.