Pre-hospital Spinal Immobilization

[ksmith3604]

Just prefacing this entire post by saying I'm not asking anyone to do my homework or my research for me....im just looking for some insight.

Im doing a research paper on pre-hospital spinal immobilization. There is tons of research out there and there are tons of people who say yes and tons of people who say no. Whats your opinion? Also if you feel very passionately either way and you're cool with it and I make sure its okay I'd love to put a few quotes in my paper from every day, street medics and EMT's. Thanks everyone.

 

[mycrofft]

Not to be brusque, but use search on this one.

We ran over this repeatedly this year, and there were some studies cited. You want scientific studies, not opinions.

That having been said, drunks fight off spine boards and cervical collars, so for many MVA patients the prehospital regimen is useless or worse, unless they can be safely sedated and their airways protected...and then you find it was unnecessary.

 

[Handsome Robb]

Look up NEXUS.

There's no reason to fight someone onto a board, if they do have an injury you'll just make it worse by wrestling with them.

Do I like using a board all the time? No. Do I like my job? Yes. I'll keep using it per protocol as a CYA until the standard of care changes.

 

[emtmomof2]

Our squad now has refusal forms. If they are drunk and combative, I agree it's not worth wrestling with them for fear of causing more injury. I tell my squad members to document document document.

 

[BEorP]

There is tons of research out there and there are tons of people who say yes and tons of people who say no.

Does any of the research you've found say "yes" or is that just people with no evidence?

 

[systemet]

Go take a look at Pubmed, enter some search terms:

http://www.pubmed.com

Look for NEXUS and the Canadian C-spine Rule.

There's a good article out there where they look at patients with GSWs to the head, and show a near-zero incidence of associated C-spine fracture. I think it was out of PA about 15 years ago.

There's another interesting paper where they compare a major US city and somewhere in... maybe Indonesia? I can't remember, and look at the incidence of C-spine injuries in people transported without C-spine precautions (although you can imagine these are probably different mechanisms of trauma). This is probably about 15 years old as well.
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My opinions

* We C-spine way too many people, probably driven by way too much medical malpractice law.

* We probably shouldn't be c-spine'ing people who are able to walk around who don't have neck pain and don't have high mechanism, and aren't confused / distracted / altered.

* We probably don't need to c-spine people with stab wounds to the abdomen / back, unless they have other injuries or deficits. It's highly unlikely that these injuries are unstable.

* C-spine compromises airway management, increases ICP, and negatively affects ventilation.

* But, most of our patients are probably at minimal risk of serious injury from being c-spine'd.

 

[medicnick83]

In South Africa, the HPCSA can take your license away so easily so we (I) would just rather C-spine someone at the slightest hint they need it.

Even with MOI I'd do it. I will never let anyone take my license to practise away.

 

[Tigger]

In South Africa, the HPCSA can take your license away so easily so we (I) would just rather C-spine someone at the slightest hint they need it.

Even with MOI I'd do it. I will never let anyone take my license to practise away.

Why would you lose your license for choosing not to provide a treatment that is not indicated? Wouldn't it be more likely that you would lose your license for performing a treatment that is not indicated?


Sent from my out of area communications device.