Fall from 3 ft

[Medic Tim]

Under PHTLS guidelines unless there is a significant MOI, if the pt is A&0x4 walking and talking and no LOC there is no need to backboard or collar this pt…. However if upon arrival on scene you find a pt walking and talking with a significant head injury and stating neck or back pain a standing take down should be done….. Always checking neuro after each intervention….

I thought phtls went away from the standing takedown in its latest update.( what I was told in mine a few months ago)

 

[bmedic1681]

They may be moving away from that in the non symptomatic pt, however when you suspect significant MOI you may still do so…. Just did it 6 months ago…. 3 feet off a ladder may not be significant for some but if you are up and walking around when I get there but express numbness in extremities or confusion I will take you down as opposed to moving you further…. PHTLS is moving more towards the MOI and the provider evaluation as opposed to a generic protocol

 

[Medic Tim]

They may be moving away from that in the non symptomatic pt, however when you suspect significant MOI you may still do so…. Just did it 6 months ago…. 3 feet off a ladder may not be significant for some but if you are up and walking around when I get there but express numbness in extremities or confusion I will take you down as opposed to moving you further…. PHTLS is moving more towards to the MOI and the provider evaluation as opposed to a generic protocol

Doesn't really matter for more and more services as they are finally catching up to the evidence and only use a board as an extrication device. C collar and position of comfort is the new immobilization ... Some are just taking a bit longer to catch up

 

[bmedic1681]

I am not disputing the fact that standing take downs are the norm….. Every situation is different…. I had a pt who was in a car accident and in confusion automatically went to get out of the car she stated neck pain and lower back pain…. I stopped her from moving and used the standing take down…. found out after getting her to the trauma center she had C6 fx along with lumbar fx had she been left to walk around she would have been at the very least a paraplegic if not a quad ER doctor agreed with assessment…. I work in a very aggressive agency when it comes to treatment… I do not think I would have handled it any other way…. my pt who went down the stairs also exhibited signs that had they been allowed to move freely would have had more significant injury. While I understand that this method is not the norm, no situation is the norm either and it is case by case

 

[Medic Tim]

I am not disputing the fact that standing take downs are the norm….. Every situation is different…. I had a pt who was in a car accident and in confusion automatically went to get out of the car she stated neck pain and lower back pain…. I stopped her from moving and used the standing take down…. found out after getting her to the trauma center she had C6 fx along with lumbar fx had she been left to walk around she would have been at the very least a paraplegic if not a quad ER doctor agreed with assessment…. I work in a very aggressive agency when it comes to treatment… I do not think I would have handled it any other way…. my pt who went down the stairs also exhibited signs that had they been allowed to move freely would have had more significant injury. While I understand that this method is not the norm, no situation is the norm either and it is case by case

Just because there was a fx doesn't mean the board saved them. If anything it put them at more risk. This is supported by numerous studies.

It is going to take a big culture shift as we are so used to doing it. Add the fact that myth is passed on from generation to generation ex. an instructors cousins friends roommate whose dad was an Emt was sued or killed someone for not boarding / or the piece of magic plastic prevented a fx from paralyzing their pt.

It is also hard as so many providers do not keep up with research and study. They do the minimum ceu and follow protocol not always understanding it.

 

[bmedic1681]

No SEVERAL FX's cervical and lumbar…. I am NOT an advocate on back boarding those that need not be but you CANNOT get complacent and blanket ALL trauma as not needing to be immobilized unless of course you have potable x-ray machines on your unit to rule out spinal injury

 

[Medic Tim]

I can tell I am not going to change your mind but I can only hope you look into the research and welcome it when it comes to your area.

 

[bmedic1681]

As for my required CEU???? AMLS PHTLS PALS CPR ACLS ABLS…. as well as work at at agency that trains regularly and has initiated the RICE protocol for rapid cooling in cardiac arrest pts. test ran and implemented the auto pulse in cardiac arrest, did studies in using synthetic plasma as opposed to saline in trauma… We may disagree on this topic but lets not knock each other…..

 

[Medic Tim]

As for my required CEU???? AMLS PHTLS PALS CPR ACLS ABLS…. as well as work at at agency that trains regularly and has initiated the RICE protocol for rapid cooling in cardiac arrest pts. test ran and implemented the auto pulse in cardiac arrest, did studies in using synthetic plasma as opposed to saline in trauma… We may disagree on this topic but lets not knock each other…..

That comment was not directed at you . It was a generalization . It is great that your service offers this. It is much more than many do.

 

[bmedic1681]

I will do what is always in the best interest of my pt…. Never anything less…. while we don't agree on this topic I am sure we both feel the same about our pts

 

[Medic Tim]

I will do what is always in the best interest of my pt…. Never anything less…. while we don't agree on this topic I am sure we both feel the same about our pts

I absolutely agree. I hope you don't think I was attacking you. It can be very difficult to take a persons tone from a web forum. This is just a subject I am passionate about.

 

[bmedic1681]

Not at all….. Pleasure to meet you…. I find that debating in this fashion keeps one on their toes…. one can never learn to much when it comes to caring for others

 

[Tigger]

I am not disputing the fact that standing take downs are the norm….. Every situation is different…. I had a pt who was in a car accident and in confusion automatically went to get out of the car she stated neck pain and lower back pain…. I stopped her from moving and used the standing take down…. found out after getting her to the trauma center she had C6 fx along with lumbar fx had she been left to walk around she would have been at the very least a paraplegic if not a quad ER doctor agreed with assessment…. I work in a very aggressive agency when it comes to treatment… I do not think I would have handled it any other way…. my pt who went down the stairs also exhibited signs that had they been allowed to move freely would have had more significant injury. While I understand that this method is not the norm, no situation is the norm either and it is case by case

This is why backboarding will never go away. So many desperately cling to these anecdotes where they claim spinal motion restriction "saved" the patient. It didn't. Our current SMR procedures do absolutely nothing to immobilize the cervical spine except serve as a reminder to the patient to avoid undue movement. That can also be done by telling the patient not to move, which has the added benefit of not causing harm to the patient, which backboards are proven to do. Additionally MOI is not a proven indicator of injury. It tells you were to look but does not tell you what you'll find. Making any clinical decisions based MOI is foolish at best. If we assessed patients and treated out findings, EMS would be able to take many steps forward.

The plural of anecdote is not evidence. Provide evidence to back up your assertions, without it they're just another story. Medicine isn't based on stories or experiences.

 

[bmedic1681]

Tigger, please do not get me wrong, I DO NOT backboard every pt that has a traumatic event…. my judgement as to whether I do or not is based on my ENTIRE evaluation of my patient…. from the reason for the fall, (dizziness beforehand or accidental) to their level of consciousness to the mechanism of injury. Now the MOI is not all I go off of.. my apologies if I suggested that, however in the case of the MVA I had, based on the complaint of the pt and the areas of discomfort, I felt it in her best interest to board her… as it turns out the pt CAN walk today and although her career in the military was cut short she is upright and mobile.. Yes we must all have an open mind to advances and changes in EMS however sometimes you have got to think outside the box and just because "new findings" arise does not always mean that they are steadfast and end all be all…. I look at all treatment options for my patient old or new and do what is right for each person based on my findings

 

[chaz90]

Just because your patient survived and wasn't paralyzed doesn't mean she wasn't paralyzed <b/>because<b/> of your treatment. Correlation does not prove causation. In all likelihood, this patient wouldn't have been paralyzed by her C6 fracture simply by minimizing movement without a board, regardless of what the ED doc believed from outdated information.

 

[Carlos Danger]

The plural of anecdote is not evidence.

I like that.

 

[rescuepoppy]

Bottom line on this is first know your protocol. Do a thorough assessment then use your findings to guide you on what to do. I was in a situation a few years back where I suffered a broken neck in a motor vehicle crash, the area I was in did not collar and board everyone I presented atypical in the fact that I had no pain only a feeling of "not right" in my neck. I had to argue to get c-spine precautions, that being said I still advocate clearing in the field . Remember listen to your patient they know more about their bodies than we do. We will still make mistakes we will miss things every now and then but I feel that the accident that caused the injury will be more likely to cause any permanant damage than we will by failing to collar and board.

 

[chaz90]

I feel that the accident that caused the injury will be more likely to cause any permanant damage than we will by failing to collar and board.

Your feeling is refuted by evidence to the contrary. Your opinion that you were helped by a C-Collar and backboard is no different than the anecdote above where someone believed their patient was saved from paralysis with a LBB.

Seriously people, we can talk about feelings and anecdotes all day, but they don't mean anything in the practice of medicine or evidence based science.

 

[Tigger]

Tigger, please do not get me wrong, I DO NOT backboard every pt that has a traumatic event…. my judgement as to whether I do or not is based on my ENTIRE evaluation of my patient…. from the reason for the fall, (dizziness beforehand or accidental) to their level of consciousness to the mechanism of injury. Now the MOI is not all I go off of.. my apologies if I suggested that, however in the case of the MVA I had, based on the complaint of the pt and the areas of discomfort, I felt it in her best interest to board her… as it turns out the pt CAN walk today and although her career in the military was cut short she is upright and mobile.. Yes we must all have an open mind to advances and changes in EMS however sometimes you have got to think outside the box and just because "new findings" arise does not always mean that they are steadfast and end all be all…. I look at all treatment options for my patient old or new and do what is right for each person based on my findings

You felt it was in the patient's best interest to board her, yet you are unable to provide any evidence that current spinal motion restrictions provide any benefit to patients. Don't go looking for it, I've already done it. There is nothing out there showing that current SMR procedures stabilize unstable cervical spine fractures, nothing. So now what? Are you going to stick to your guns on this one and say that you feel it still helped? How will you prove it?

I wouldn't advise going down that road, that's for sure.

And don't use PHTLS as your justification either. It is one group of people that still call for the silly use of standing takedowns, despite the sea of evidence to the contrary and that many other prehospital research groups have come down hard on the use of such techniques.

I like that.

I wish it was mine. I also realized that the original is "The plural of anecdote is not data."

 

[Brandon O]

But.. But. ... My instructors brother Is friends with a guy who is cousins with a medic that didn't board someone and they died..... So board = magical force field that prevents injury.

The sad thing is I have heard similar from many providers..... Minus the magical force field part.

Just as a working note, a few of us are doing a systematic review hunting for cases of this mysterious phenomenon, and so far it's been rather light. Nothing in the prehospital period except some cases of "he was fine when we loaded him up but not when we arrived." No sudden boom due to precipitating movement.