New Consensus Statement On Care Of The Spine-Injured Athlete

[hops19]

The National Athletic Trainers' Association has announced an update of the "Consensus State For The Care of The Spine-Injured Athlete." Would be interested in your thoughts?

http://www.nata.org/sites/default/files/Executive-Summary-Spine-Injury.pdf

 

[NomadicMedic]

This is my favorite part:

Recent publications have expressed concern related to the use of the long spine board due to potential harmful effects to the patient if the patient remains on the long spine board for an extended period of time. However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other immobilization device be used for transport.

In other words, we hear it's bad... but do it anyway.

 

[hops19]

This is my favorite part:

Recent publications have expressed concern related to the use of the long spine board due to potential harmful effects to the patient if the patient remains on the long spine board for an extended period of time. However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other immobilization device be used for transport.

In other words, we hear it's bad... but do it anyway.

The couple of times I've gone with an athlete to the hospital, one of the first things they did in the ER was to remove the backboard. At our national convention yesterday, I heard a talk from one of the authors where this was discussed. She believed it was important to use the spine-board, but to remove the patient from it as soon as possible. Is it going to do harm in the 20 minutes it takes to get from the field to the hospital? Probably not. But if the doctors were to simply leave the patient on the board for hours like that patient may spend in the ER, then there may be a problem...

 

[Akulahawk]

This is my favorite part:

Recent publications have expressed concern related to the use of the long spine board due to potential harmful effects to the patient if the patient remains on the long spine board for an extended period of time. However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other immobilization device be used for transport.

In other words, we hear it's bad... but do it anyway.

I read that passage as: "use the board, we know it can cause damage if used long-term, so get the injured athlete off the board as soon as possible." Probably the biggest change in the statement, to me, actually is removing the protective equipment prior to transport. My stance on this has always been that you either remove all the equipment or none of it. The equipment can be "shot through" by plain film x-ray but remember that much of the protective equipment may not fit into a CT scanner and if it does, could cause a LOT of artifact.

 

[Melbourne MICA]

Hi all,

What interests me is the unsubstantiated orthodoxies that develop in EMS. One is how the flat board has become the generic term (and type) for all lifting and patient transfer problems. If you look at studies i.e. the evidence, its clearly a less than ideal choice for trauma/spinal but is so well marketed, with so many units in circulation that nobody stops to think of alternatives any more. According to the studies, the scoop stretcher is the perfect trauma platform for the lift and transit to stretcher as well as the transport to ED element. This is because securing the patient involves virtually no handling such as the potentially disastrous rolling manoeuvre needed for the flat board. (see the UK Royal College of Surgeons Consensus Statement on Spinal Immobilisation 2013).

And to address the quotes from the trainers paper, there is no time frame for securing the supine patient on the scoop because there are virtually no pressure point due to its contoured shape. An example of the orthodoxy problem is Australian Rules footballers (in Australia funnily enough) who have to be stretchered off. In days gone by the doctors would use the scoop and remove the patient as found. Believe it or not you CAN position a patient in a side position with a collar on. (Its worth checking out the "ideal position for the spinal patient" in the evidence and the definition of the (spinal) "neutral" head position as other orthodoxies). The docs now use the flat board and roll all the head injured/spinal/trauma/unconscious onto the board. Unbelievable - the docs are not using evidence based practice!!!!!!!

Just my take on the issue.

Melbourne MICA

PS The reason I looked at the evidence was our organisation was going to get rid of the scoop and KED because staff weren't using them. I was assigned the job of finding out - my conclusions - don't get rid of the scoop - madness.

 

[EpiEMS]

The National Athletic Trainers' Association has announced an update of the "Consensus State For The Care of The Spine-Injured Athlete." Would be interested in your thoughts?

http://www.nata.org/sites/default/files/Executive-Summary-Spine-Injury.pdf

So, the ATs expect us to use boards even though they're rarely (if ever) indicated for anything other than moving the patient to a stretcher? Seems a little backwards to me -- even NYS is getting rid of the LSB for "immobilization".

 

[hops19]

So, the ATs expect us to use boards even though they're rarely (if ever) indicated for anything other than moving the patient to a stretcher? Seems a little backwards to me -- even NYS is getting rid of the LSB for "immobilization".

What y'all seem to be missing is this statement is not only from the National Athletic Trainers' Association. There were many groups involved including sports medicine doctors, spine surgeons, trauma surgeons, ER doctors, EMS groups, etc. That's why it is called a "Consensus Statement." The NATA is the one who announced it at our national convention this year.

 

[EpiEMS]

What y'all seem to be missing is this statement is not only from the National Athletic Trainers' Association. There were many groups involved including sports medicine doctors, spine surgeons, trauma surgeons, ER doctors, EMS groups, etc. That's why it is called a "Consensus Statement." The NATA is the one who announced it at our national convention this year.

I appreciate that point, but I question the soundness of the statement. Routine spinal motion restriction has been widely panned by many a qualified critic, and several states have removed the LSB from protocols (I realize the latter is less than convincing "evidence"), so I am curious why this consensus statement seems to be behind the science, even as EMS is broadly moving into scientific consensus, that the LSB is broadly contraindicated, and indeed, on balance, causes more harm than good.

 

[hops19]

I appreciate that point, but I question the soundness of the statement. Routine spinal motion restriction has been widely panned by many a qualified critic, and several states have removed the LSB from protocols (I realize the latter is less than convincing "evidence"), so I am curious why this consensus statement seems to be behind the science, even as EMS is broadly moving into scientific consensus, that the LSB is broadly contraindicated, and indeed, on balance, causes more harm than good.

I don't have the research handy, but there is quite a bit of research done out of the University of Florida on this topic. I heard one of the ATs from there discussing this back in June and she said they conducted a study to test the spinal movement where they actually attached sensors onto the vertebral bodies themselves in cadavers. They brought in 8 paramedics and tested a handful of different methods of transfers onto the stretcher and the 8-person lift and slide was found to be the least movement. They also allowed the paramedics to test a couple of their own theories including lifting the cadaver onto the stretcher without anything, which resulted in significant movement.

This lady is the speaker that I heard from...

http://www.ortho.ufl.edu/horodyski

 

[Akulahawk]

While the 8 person lift and slide causes the least movement, we also must remember that a person needs to be off the board as soon as possible. That means reminding the ED staff of that, especially in the smaller facilities that don't deal with this kind of trauma much.