Board & Collar for Nursing Home Falls

[NomadicMedic]

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

Or, follow your protocols. If his protocol says "LSB/collar" that's a better idea and he'll stay out of trouble. It's certainly better than saying "some guy on the internet says "never use a longboard for anything than moving a patient".

This forum tends to attract more educated (and opinionated) providers, but at the end of the day you've got to DO WHAT THEY TELL YOU TO DO, until you have the experience and education to defend your position.

 

[EMTinCT]

Or, follow your protocols. If his protocol says "LSB/collar" that's a better idea and he'll stay out of trouble. It's certainly better than saying "some guy on the internet says "never use a longboard for anything than moving a patient".

This forum tends to attract more educated (and opinionated) providers, but at the end of the day you've got to DO WHAT THEY TELL YOU TO DO, until you have the experience and education to defend your position.

OK here are the protocols and they say no longboard. If you use one for anything other than moving a patient then you've done bad.

 

[LACoGurneyjockey]

OK here are the protocols and they say no longboard. If you use one for anything other than moving a patient then you've done bad.

Except the OP is not in CT...

 

[RedAirplane]

Side question: wouldn't a back board be needed for a patient like this?

 

[LACoGurneyjockey]

Side question: wouldn't a back board be needed for a patient like this?

I'll just start quoting DE on all my responses.

Or, follow your protocols. If his protocol says "LSB/collar" that's a better idea and he'll stay out of trouble...

...DO WHAT THEY TELL YOU TO DO, until you have the experience and education to defend your position.

Why do you think that would require a backboard more than another call?

 

[RedAirplane]

I'll just start quoting DE on all my responses.



Why do you think that would require a backboard more than another call?

He can't move, there is visible spinal injury, loss of distal CSM, and I (perhaps wrongly) am afraid that moving him any other way will just snap whatever is left of his spinal column.

Since he is seated I might argue the KED if I had one.

 

[RedAirplane]

And yes, I follow protocols. This question is just for my knowledge/understanding.

 

[LACoGurneyjockey]

Once our new protocols take effect, I would slide him onto a backboard and use that to move him to the gurney. In terms of transport, his spine is more secure seat belted to the padded gurney than strapped to a hard plastic board. So no, the only patient I want to transport on a board is CPR in progress.
The issue isn't whether or not we're sure he has a spinal injury. It's that a board isn't more secure for a spinal injury, whether that's a major trauma or a ground level fall doesn't matter.

 

[Brandon O]

And yes, I follow protocols. This question is just for my knowledge/understanding.

It's a good question. Your reasoning is the reasoning that most folks are using nowadays. In other words, it's predicated on the idea that "unstable spinal injuries" (those with the potential to neurologically deteriorate due to movement occurring after the initial trauma) are rare, but they do exist. Since they're rare most folks are starting to move away from prophylactically immobilizing every Tom, ****, and Harry who sneezes -- the NNT is too high -- but since they're real, patients with clear spinal injury or especially those ALREADY exhibiting neurological compromise have a much better risk/benefit. So they buy the plastic stuff.

That's the most common thinking at this point, anyway. Whether this phenomenon is actually real remains something of a mystery, and whether we can prevent it remains wholly so.

 

[TF Medic]

his spine is more secure seat belted to the padded gurney than strapped to a hard plastic board.

Do you have a link to a study confirming this? I am not doubting you, just would like to read the data. Thanks.

 

[Jim37F]

The tractor patient would definitely have been collar and boarded here (I'll imagine a construction accident with one of those big cable spools here due to lack of farms)....but there is a big difference in being crushed by a hay bail with multiple trauma complaints over a ground level slip and fall in a nursing home where the patient is calmly eating lunch upon arrival

 

[EMTinCT]

Except the OP is not in CT...

This is just the CT adaptation of the national standards.

 

[LACoGurneyjockey]

This is just the CT adaptation of the national standards.

Umm, no. As much as it should be, a c-collar and position of comfort for traumatic neck/back pain is not the national standard. CT may be spot on, but that doesn't mean everywhere else is.

 

[EMTinCT]

Umm, no. As much as it should be, a c-collar and position of comfort for traumatic neck/back pain is not the national standard. CT may be spot on, but that doesn't mean everywhere else is.

It definitely is the national standard. If individual states choose not to be on board then that's them abrogating the standards.

 

[LACoGurneyjockey]

Show me where the NREMT says that. Or whoever you're choosing to use as your national standard. More relaxed c-spine criteria, maybe. But as you said earlier, using a backboard for patient movement only and transport on a board was always contraindicated? I'd love to see a source to that national standard.

 

[EMTinCT]

Show me where the NREMT says that. Or whoever you're choosing to use as your national standard. More relaxed c-spine criteria, maybe. But as you said earlier, using a backboard for patient movement only and transport on a board was always contraindicated? I'd love to see a source to that national standard.

NREMT doesn't make the standards. They are simply a testing agency.

 

[LACoGurneyjockey]

NREMT doesn't make the standards. They are simply a testing agency.

Let me say it again,

Or whoever you're choosing to use as your national standard. More relaxed c-spine criteria, maybe. But as you said earlier, using a backboard for patient movement only and transport on a board was always contraindicated? I'd love to see a source to that national standard.

Where did you find that "National standard" then? Please show us some sources so we can be so enlightened.
I'm not arguing that backboards are the way to go. But you can't just say...

no longboard. If you use one for anything other than moving a patient then you've done bad.

And...

It definitely is the national standard. If individual states choose not to be on board then that's them abrogating the standards.

And then not have any sources to back that up. I'm not talking about your state protocols, you wanted to call it a national standard.

 

[EMTinCT]

You seem pretty convinced. Gramma told me to never fight with someone who knows they're right.

 

[Flying]

NREMT doesn't make the standards. They are simply a testing agency.

From page 30 of the NHTSA "National Scope of Practice Model".

What our "national standard" mandates as the necessary minimum is behind the times.

 

[LACoGurneyjockey]

You seem pretty convinced. Gramma told me to never fight with someone who knows they're right.

Hey, I'm ready to be shown I'm wrong. But you don't want to do that.
No ones saying it's not behind the times and the evidence. But national standards aren't just what you want them to be because gramma said so.