Collar, or no collar? Gsw to the head.

[ITBITB13]

So you show up, PD let's you in, and you have a girl with multiple gsw's with one being in the head, in the right temple area. Using a backboard is obvious. However, A couple shifts back I was told to stop, while putting on a c-collar.
I always put c-collars on. What gives? Have I been doing something wrong all along?

What's the rationale for putting on/not putting on a collar in this situation?

 

[Jim37F]

Just out of curiosity, why a collar and board? Is there any indication of spinal trauma? Why are you wanting to splint the neck?

Personally, the only reason I'd even consider an LSB in this case is to simply move the patient from the ground to the gurney, and then only if it was a large/heavy patient I had to carry up/down stairs, through narrowing hallways etc to get to the gurney, otherwise with an engine company on scene it's a lot quicker and easier to just GS them to the gurney. Save some time from having to head back to the ambulance, grabbing a board, going back to the patient, and then securing them to the board, not to mention saving from having to decon the board later.

 

[DesertMedic66]

Backboarding a patient like this will take a lot of time to do correctly on scene. So it is just delaying the time before the patient gets to the hospital.

A GSW to the head is not very likely to cause a C-spine injury from my knowledge.

And the whole backboard thing is found to not benefit patients at all and new recommendations are saying backboards should only be used as a means to moving the patient to the gurney and then removed immediately.

 

[irishboxer384]

Possible case for using c-collar/spinal immob is an entry wound with no exit wound due to the round possibly being in proximity to the spinal column. Depends on your county protocols blah blah etc. The guys here have stated the reasons for not using and is the more accepted method of treatment/patient extrication now

 

[teedubbyaw]

Where are her other GSWs?

 

[TransportJockey]

Only reason I'd put a collar on this patient is to aid in maintaining a patent airway after ETI or placing an SGA. Only reason you need a board is ti assist in moving them

 

[jrm818]

Agree with above.

This is the situation for which there is the best evidence of harm from backboardimg: not just pain/airway difficulty etc., but actually a suggestion of increased mortality.
Follow your protocols, but if they say immobilize penetrating trauma without evidence of neuro defects, than they are pretty...eh...sub-optimal...

Wouldn't normally link to jems but this is free and gives a good overview

http://m.jems.com/article/patient-care/research-suggests-time-change-prehospita

Also look at the naemsp position paper on cervical immobilization...can't make link work on phone, but easily found via google

 

[ITBITB13]

Where are her other GSWs?

Patient was unresponsive, with another gsw to the flank, and pelvic area. No exit wounds visible.

 

[Chewy20]

Trauma is a time dependent case, your best bet for them to live is to get them to the hospital so they can go into surgery. Doesn't sound like there's a reason for spinal percausions here, so don't waste time doing them unless reasons stated above.

You say you put a collar on everyone. Why?

 

[Angel]

I wouldn't. Had a call just like this and all he got was a board to help extricate.

 

[CALEMT]

Like everyone else is saying back boarding just adds time to an already critical situation so I wouldn't backboard in this situation. However I would use a backboard to move the patient as I think Jim37F has already pointed out the uses for it.

 

[Handsome Robb]

Did she have a pulse? If the answer is no then there's no reason for any action, at all.

 

[RocketMedic]

^Agreed.

With that being said, a board isn't horrible for movement. Immobilization doesn't matter, but a board does make it easier to move the body in a lot of cases.

A collar isn't really necessary, but honestly, there's not really anything medical to be done here. No EMS intervention with the possible exception of airway/breathing will matter.

 

[RedAirplane]

Protocols vary, and as I am learning on this website, the backboard is not the cure for all ailments.

However, I believe the NHTSA standards (from which state protocols may choose to deviate) calls for spinal immobilization with trauma to the head, neck, or spine. A GSW to the head sounds like trauma to the head. I would immobilize to be safe rather than sorry unless I had protocols to the contrary.

 

[teedubbyaw]

Patient was unresponsive, with another gsw to the flank, and pelvic area. No exit wounds visible.

I wouldn't consider it a fault in this case, then, but, realistically, like others said, it's delaying pt care if the pt is still viable. Kind of like applying full spinal precautions to someone in a car engulfed in flames.

 

[Shishkabob]

What do your protocols say?


Is a c-collar needed or beneficial? No. However my protocols say "Significant trauma above the clavicles", and I'd argue a GSW is pretty significant... so per my protocols they are to get a c-collar.

 

[ITBITB13]

To those that say a collar is a waste of time, I understand where you're coming from, but when you have 3+ emts on a scene, and 2+ paramedics, I don't see putting on a collar as being a problem.

 

[teedubbyaw]

What do your protocols say?


Is a c-collar needed or beneficial? No. However my protocols say "Significant trauma above the clavicles", and I'd argue a GSW is pretty significant... so per my protocols they are to get a c-collar.

Exactly. 3 GSW's to the torso and head is significant trauma and many protocols dictate spinal precautions.

 

[PotatoMedic]

As many have said... If I have time would he end up on a backboard with a c collar. My main concerns are ABC's. Everything else can wait. If I get a chance then yeah I'll get a collar on him.

 

[DesertMedic66]

In most systems (especially in SoCal) a C-Collar = backboarding which does take several minutes to do correctly. Those several minutes are better spent enroute to definitive care