Clearing C-Spine in the field

[trauma1534]

I am interested in knowing who agrees with the new thing of clearing c-spine in the field? That seems to be a big thing at a local agancy where I come from. As for my opinion, I don't like it. However, I thought it would be a good topic starter.

 

[Fedmedic]

I think clearing C-spine in the field is a good thing. We started clearing C-spine in the field in 1999 with my previous EMS agency, and we never had any incidents of negligence. Also, the amount of patients with c-collar and LSB probably got reduced by 70%. The key to clearing C-spine in the field is having good providers that know what they are doing and having good protocols to fall back on in case you have a patient that wasn't boarded that should have been. Clear c-spine protocols are pretty cut and dry as to who gets boarded and who doesn't, you just have to have good medics with common sense, because that is what it all boils down too. Just my .02 worth and that is about all it is worth.

 

[trauma1534]

Fed, I agree with you! And I don't like clearing c-spine in the field for that very reason. You have too many yahoo medics in that area who don't know what they are doing. I feel that it is a good thing if it is done right and they know what they are doing. But the few who claim to know and don't unfortunatly messes it up for me for the rest of them who do know what they are doing.

 

[Ridryder911]

Field clearance is perfectly sound on most of the time, if it is "performed properly" like others described. I do not which one is worse improper immobilization or none at all ? Very few times I see C-collars applied properly. Most do not realize, even applying a cervical collar, it really is not an immobilization device, rather more a splint, reminding us there is a "potential" injury.

Mechanism of injury, pain, should automatically be the precursors of immobilizing.

Just like many other treatments, we do not justify performing much of what we do. Healthy patients falling with no indication of other pain or injuries, but most EMT's will LSB, CID etc.. again, no reason or justification why it is done except .."this is what we were taught".. Traditional treatment has been handed down for years. Even the reason for us immobilizing in the field was from the study of the "white papers" (origination of EMS) of "ambulance attendants.. pulling patients from cars and through windows thus spinal injuries occurring"...Not realizing years later, that LSB can actually produce damage as well, as preventing potential injuries.

One has to have sound guidelines, experience, and proper education of assessment in clearing C-spine, much rather error on the patient if any suspicion C-spine injuries.

Here is a article in regards of studies and discussion of field clearance.

http://www.emsresponder.com/publication/article.jsp?pubId=1&id=3350

R/r 911

 

[Epi-do]

We have protocols which allow our medics to clear c-spine in the field. It is very clear cut as to what is required to clear a patient. If even one of the contraindications to clearing are met, that patient has just bought a c-collar and the use of a backboard until the ER determines it is no longer necesary.

The medics I work with are all really good about not abusing the protocol. While there have been several patients that they have cleared, there have probably been just as many that they have not. Even if the patient meets all criteria for clearing, if the medic just feels as if something isn't right and they need to be boarded, that is the way we go.

As previously stated, as long as the protocols are clear cut and you have good medics working under those protocols, I think that doing this in the field is a good thing.

 

[Pablo the Pirate]

i think being able to clear C-spine in the feild can be a great thing when done properly. but i also think how many pt's will you be able to clear really when you think about it. i mean when you think the pt has to be A&Ox3, no distracting injurys, low MOI, and what not it doesn't seem like you'd be able to clear that many. but i haven't done that much research on it. I brought the idea before our former director cuz i thought it would be a good tool and knowledge to have esspecially since we do standbys at a motorcross track. However she didn't like the idea because of to many variables about well the pt has to be this and that and liabilty and blah blah blah. I said ok and left. but personally i was thinkin well thats why you have a class on it. but whatever i was just a know nothing basic as compared to her 20+ year paramedic.

 

[Medivixen]

We use the BTLS standards in terms of spinal management: we don't look for reasons to immobilize trauma pts, we require reasons not to.

 

[jeepmedic]

This is where I disagree with alot of my coharts I think that anyone C/O pain from Head to toe. That is on the back side of the body needs LSB and C-Spine. Thats just me. Not always right but right to me.

 

[fyrdog]

We have in our Paramedic protocols a procedure to clear spine. It's been in there for about 3 years. The protocol is based on Maine's where they did a huge study (in the 1000's) and found that there were 4 patients who had spinal fractures that DID NOT affect the spine column.

I am conservative but I do clear the c-spine. If a paramedic clears the c-spine the patient can not be turned over to a BLS crew for transport, the way the protocol is written.

 

[ffemt8978]

I know I've posted this a couple of times before, but our protocols state that we are NOT to board and collar a patient based upon mechanism of injury alone. I would change this to allow c-spine precautions based upon mechanism of injury or medic gut-feeling.

Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:

1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury

 

[jeepmedic]

I have seen in the past where a pt. was walking talking and not complaining of any pain and had a neck Fx. so I am very cautious of this. I do not have x-ray vision so I will not clear one in the field.

 

[jeepmedic]

Also I have seen to many times when I worked on an ambulance that we would get a call from the ED telling us to go pick John/Jane Doe and bring them to the ED for a Fx. in the Neck. This was after they were released from the ED with a clear c-spine. And they have x rays.

 

[ffemt8978]

I agree with you, which is why I wish our protocols would be changed to allow c-spine based upon MOI or gut feeling, but I can only do what my protocols allow.

 

[trauma1534]

What do you protocols allow?

 

[ffemt8978]

I know I've posted this a couple of times before, but our protocols state that we are NOT to board and collar a patient based upon mechanism of injury alone. I would change this to allow c-spine precautions based upon mechanism of injury or medic gut-feeling.

Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:

1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury

This is what our protocols state

 

[fyrdog]

FFEMT8978,

In Hartford our guidelines are very similar to yours but it is considered an elective procedure. I agree that you should be able to backboard someone becuase of MOI or gut feeling.

Dave

 

[Pablo the Pirate]

I think some people could probably be cleared in the field but i think that it should happen very rarely. MOI is a big deal and SHOULD be considered. And even though falling down from standing height probably wont hurt you or me, my 94yo grandma with osteoporosis broke her hip, probably her humerous, and if she hit her head on anything on the way down...possibly even her neck. It would do us all some good to remember that.