# Fall from 3 ft



## zeektheman (Jan 16, 2014)

I work in a region with a fairly liberal spinal immobilization protocol.  The protocol does have some restrictions though ( age greater than 65 and significant MOIs).  I have a scenario I want to run by you guys.

I responded for a 50 year old male who fell about 3 ft off of a ladder.  The male stated that he lost his footing resulting in the fall.  The patient was CAOX4 and denied any LOC.  The patient presented with a possible break to his lower right arm as well as a one inch laceration to his head.  I conducted a thorough assessment and found that the patient did not complain of any neck/back pain, numbness and tingling, palpation of spine was normal and no pain upon ROM of the neck.  I deferred spinal immobilization.  But when I got to the ED the nurse practically died when she saw that the patient did not have spinal precautions in place.  She stated that a  "fall from 3 ft that involves any head trauma should be immobilized!"    What do you guys think about immobilizing this patient?


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## NomadicMedic (Jan 16, 2014)

No. I would not have put him on a board.


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## mycrofft (Jan 16, 2014)

Another story featuring a nurse yelling at someone.

Report her, that is not professional behavior.


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## MrJones (Jan 16, 2014)

If your treatment of the patient was appropriate and in accordance with your service's protocols (and it appears that it was), ignore her. Or do as I do in such situations; stare at her w/ a blank look on your face while she scolds you, then turn around and leave without saying a word in response.


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## Fire51 (Jan 16, 2014)

I wouldn't c-spine this patient either. My grandpa slipped of a ladder, He had a broken rib. We had a paramedic, nurse and AEMT that were all in our family. We didn't c-spine him, we actually walked him to car and drove him to the hospital. C-spine is not for every patient with some sort of trauma. Some believe you need to c-spine these patients, so you will but heads with them, don't worry about it if you followed your protocols and did a good assessment.


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## medicsb (Jan 16, 2014)

Going by NEXUS criteria, some might argue that the arm fracture could be a distracting injury.  

Going by the Canadian C-spine Rule, you're patient would rule in for imaging of the c-spine via "dangerous mechanism": fall from height of "≥3 ft/5stairs".

The Canadian C-spine rule has been shown to have a better sensitivity, so I'd prefer it over NEXUS.  (http://www.ncbi.nlm.nih.gov/pubmed/23048086)

Be that as it may, in the ED the patient would get a c-collar and imaging.  I think it would be appropriate to only place a C-collar if he was already ambulating.


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## CentralCalEMT (Jan 16, 2014)

Many nurses are so used to paramedics placing everyone who has more than a paper cut on a board, so when a thinking medic, in accordance with protocol, does not use a board they flip out. In my system, no we would not c-spine and we do not c-spine nearly as much as surrounding counties tho due to our protocols leaving a lot of it up to physical assessment and paramedic discretion rather than a black and white protocol.


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## TheLocalMedic (Jan 17, 2014)

I don't like to board people unless it's warranted, so I run into this kind of crap all the time.  Just explain your findings (no neck pain, no pain on ROM, no paresthesia, no injury) and then ask the nurse if they could justify strapping that patient to a board.  Do it calmly and respectfully, and with all the authority you can muster.  

And you get bonus points for explaining this in front of a doctor, because they'll generally tell the nurse, "Duh, why would you ever backboard someone like this?"


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## ZombieEMT (Jan 17, 2014)

No board or collar.


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## johnrsemt (Jan 17, 2014)

Look at how many people that fall off ladders, get up and drive themselves and their broken arm to the ED.   None of them are c-spined,  few of them get yelled at by the nurses.

  We had a gentleman walk into the ED after falling off a 2nd story roof, onto a pile of trash lumber.   picked himself and the 2X4 that he had stuck himself to with 3 nails   walked over to a saw  cut it short enough so that he could get in a truck and was driven to the ED.     Triage freaked out    but he was calm about it.   "I knew that I wasn't supposed to remove impaled objects".


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## RebelAngel (Jan 17, 2014)

My Captain told that unless they deny, immbolize. She said if you do not the ED will chew you out.

Sent from my XT557 using Tapatalk 2


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## usalsfyre (Jan 17, 2014)

RebelAngel said:


> My Captain told that unless they deny, immbolize. She said if you do not the ED will chew you out.
> 
> Sent from my XT557 using Tapatalk 2



The ED chewing you out is not a valid reason to do or not do anything.


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## RocketMedic (Jan 17, 2014)

RebelAngel said:


> My Captain told that unless they deny, immbolize. She said if you do not the ED will chew you out.
> 
> Sent from my XT557 using Tapatalk 2



The ***-chewing you will receive for treating inappropriately far exceeds the ***-chewing you'll get from a nurse with a wrong idea.


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## RebelAngel (Jan 17, 2014)

RocketMedic said:


> The ***-chewing you will receive for treating inappropriately far exceeds the ***-chewing you'll get from a nurse with a wrong idea.



I'll be sure to discuss that with my Captain.


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## CentralCalEMT (Jan 17, 2014)

Remember, just do not do anything that blatantly violates local protocol. I am fortunate enough to have lenient c-spine rules. However if you have a restrictive protocol, your options are limited. As others have said, follow protocol, act in the patient's best interest, and do not do something simply because the ER will yell at you.


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## unleashedfury (Jan 18, 2014)

zeektheman said:


> I work in a region with a fairly liberal spinal immobilization protocol.  The protocol does have some restrictions though ( age greater than 65 and significant MOIs).  I have a scenario I want to run by you guys.
> 
> I responded for a 50 year old male who fell about 3 ft off of a ladder.  The male stated that he lost his footing resulting in the fall.  The patient was CAOX4 and denied any LOC.  The patient presented with a possible break to his lower right arm as well as a one inch laceration to his head.  *I conducted a thorough assessment and found that the patient did not complain of any neck/back pain, numbness and tingling, palpation of spine was normal and no pain upon ROM of the neck.*  I deferred spinal immobilization.  But when I got to the ED the nurse practically died when she saw that the patient did not have spinal precautions in place.  She stated that a  "fall from 3 ft that involves any head trauma should be immobilized!"    What do you guys think about immobilizing this patient?



You performed a thorough assessment and proved that C-Spine can be deferred based upon your findings. 

How was the patient presenting when you arrived? Was he Sitting UP? Was he lying supine or was he up and walking around probably holding his injured arm or applying pressure to the head. 

I can easily see justifying deferring C-Spine I presume the arm injury was a defensive injury since he may have placed his arms out to break his fall. 

Unfortunately a lot of nurses can"t understand the "thinking Pre-hospital provider" where you perform a assessment find relevant findings and treat/transport accordingly. Most are used to he fell on his own two feet. bruised up his hands and needs to be C-spined cause I can't think for myself I need a Nurse to do that for me.


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## medicsb (Jan 18, 2014)

So, what do your protocols actually say, OP?  Those of you voting to defer c-spine precautions, what do your protocols say?  Most protocols for C-spine clearance that I have seen are either based on the Canadian C-spine rule or NEXUS criteria.   

Just as an example, Delaware BLS protocols use NEXUS criteria plus some additional and then Canadian C-spine Rule as "modifiers" for immobilization (http://statefireschool.delaware.gov/pdfs/BLSStandingOrders2013.pdf).  

Maine uses NEXUS (http://www.maine.gov/ems/documents/2013_Maine_EMS_Protocols.pdf).

Wake Co. NC basically uses NEXUS.  

Generally, EM physicians will use the criteria or rule that I have mentioned.  They have been tested and validated.    Deviating from those should be done very cautiously.  It seems many are using general gestault or only using some of the criteria.

Anyhow, my point is that you could argue that the patient in the scenario warrented immobilization.  Definitely by the Canadian C-spine rule and maybe by NEXUS (if one argues he had a distracting injury).  The nurse was not definitively wrong.


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## zzyzx (Jan 20, 2014)

"Be that as it may, in the ED the patient would get a c-collar and imaging. "

Not in the ED that I work in. Not for a 50 y/o. That would be madness.


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## Handsome Robb (Jan 20, 2014)

medicsb said:


> So, what do your protocols actually say, OP?  Those of you voting to defer c-spine precautions, what do your protocols say?  Most protocols for C-spine clearance that I have seen are either based on the Canadian C-spine rule or NEXUS criteria.
> 
> 
> 
> ...




We use NEXUS.

I didn't see anything glaring that would make him fail it. The arm could be argued as distracting but if he's calm and cooperating with my assessment and not freaking out about that arm it's not a distracting injury.


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## Brevi (Jan 20, 2014)

usalsfyre said:


> The ED chewing you out is not a valid reason to do or not do anything.



This is a great quote


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## Tigger (Jan 20, 2014)

Robb said:


> We use NEXUS.
> 
> I didn't see anything glaring that would make him fail it. The arm could be argued as distracting but if he's calm and cooperating with my assessment and not freaking out about that arm it's not a distracting injury.



Exactly. The mere presence of an additional injury does not make it distracting. Assess your patient and you know, use critical thinking.


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## mycrofft (Jan 20, 2014)

Brevi said:


> This is a great quote



Second that as long as you are right and they are wrong. 
Is that frequent?

Again, I will bet no one is assigned the job of yelling at the ambulance guys and ladies. Ask your boss who is supposed to be yelling at you.

I'll wait. Go on.


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## NomadicMedic (Jan 20, 2014)

I find that nurses in the ED who may not be familiar with current EMS protocols are the ones that get the most huffy. Usually it's a traveler or a floater. Once one of our "regular" nurses explains what's going on, the nurse static disappears. 

However, I have no issues with explaining to some snarky nurse why I did what I did. 

I got 99 problems, but a nurse ain't one.


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## unleashedfury (Jan 20, 2014)

DEmedic said:


> I got 99 problems, but a nurse ain't one.



Should have thought of that before, the last two gf's I had were nurses... 

I've noticed that the ones that are more in touch with EMS or the regular EMS guys that show up at the ED usually don't give us grief. its the Green Nurses whether fresh out of schools. or new to the ED.


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## Brevi (Jan 21, 2014)

mycrofft said:


> Is that frequent?



Getting yelled at or my right:wrong ratio?


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## zzyzx (Jan 21, 2014)

Just like there are cookbook paramedics, there are cookbook nurses and doctors.


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## mycrofft (Jan 21, 2014)

Brevi said:


> Getting yelled at or my right:wrong ratio?



Yes. 

:lol:


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## tim120865 (Feb 25, 2014)

*I agree with nurse*

Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .


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## NomadicMedic (Feb 25, 2014)

tim120865 said:


> Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .










So, apparently you learned this in 1986? Not "every fall" is a trauma, and putting a fall patient in CSpine on the side of caution is simply wrong. 

If you practice this way, you're in serious need of reeducation.


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## Medic Tim (Feb 25, 2014)

tim120865 said:


> Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .




Please don't spread myth and dogma.
Do some reading on smr and Cspine injuries . Many places are goin away from back boards completely. The majority of services have some sort of Cspine rule out. Trauma does not =  Cspine injury. Back and neck pain does not = spinal injury. There is overwhelming evidence showing smr does not work. More recent studies are showing it does more harm than good.

Don't be that guy who regurgitates your protocols or what your instructor said and take it as the only way to do something.


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## mycrofft (Feb 25, 2014)

However, follow protocols where you work. And maybe work to change them.
=================================================
I was thinking. (grinding noise and smoke explained).

Here's a question: _*what does it matter if a nurse or someone at the ED "yells" at you because they disagreed about treatment?*_

 Holding their opinions highly is probably a good idea, but….if you were a responding nurse you'd only be concerned about political fallout if, after discussion, you still knew you were in the right and following protocols.


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## chaz90 (Feb 25, 2014)

tim120865 said:


> Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .



Continuing on that line, fall=trauma=immobilization=prevent patient movement=RSI. 

Seeing any flaws here? I seriously hope no one anywhere is automatically trying to ineffectively immobilize every single fall. Caution has nothing to do with applying a worthless and harmful intervention when it's not even indicated by the already dubious standards we have! 

Realistically, aren't backboard and C-Collar use the only thing that separates EMT from FR in a lot of locations? New plan. I now want a FR taking care of me over an EMT that doesn't know better and tries to backboard me after I stub my toe.


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## mycrofft (Feb 25, 2014)

But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.

(Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:


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## Medic Tim (Feb 25, 2014)

mycrofft said:


> But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.
> 
> 
> 
> (Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:




In those situations a board can make a great extrication tool. So can a scoop depending on its design. Once on the stretcher the boar is removed. 

I want a no SMR tattoo. Haha

Seriously though. If I am ever in a wreck the responding crews will have a fight on their hands if they try to put me in smr.


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## Medic Tim (Feb 25, 2014)

chaz90 said:


> Continuing on that line, fall=trauma=immobilization=prevent patient movement=RSI.
> 
> Seeing any flaws here? I seriously hope no one anywhere is automatically trying to ineffectively immobilize every single fall. Caution has nothing to do with applying a worthless and harmful intervention when it's not even indicated by the already dubious standards we have!
> 
> Realistically, aren't backboard and C-Collar use the only thing that separates EMT from FR in a lot of locations? New plan. I now want a FR taking care of me over an EMT that doesn't know better and tries to backboard me after I stub my toe.




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.


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## chaz90 (Feb 25, 2014)

mycrofft said:


> But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.
> 
> (Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:



Nope. Take my unconscious self out on a board as an extrication device, then leave a C-Collar on as a reminder only, and gently lift me on to the cot while minimizing movement as much as possible. Still less movement than sliding around on a slippery board that doesn't immobilize anything. Also, my spinal cord is probably already damaged or not, and nothing you are going to will change that.


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## mycrofft (Feb 25, 2014)

And there are some crappy extrication tools, too.
No I'm not referring to EMT's as tools. Well, not all...:glare:

I was tapped to teach a vollie crew about using their bendable scoop board once, the type you could lock into a chair like configuration to "safely" extricate someone from a sitting position without resorting to a short board before the long board (It was 1981, go figure. I don't find them via google anymore).

So they sat me up in a pickup truck and tried to extricate me. They had thrown potlucks and pancake breakfasts to buy this, and someone had hand-sewn a naugahyde carrier for it. But once it was on, and this was before steering columns swung or telescoped (without fatal impact), they were unable to get me out without removing the bottom part, hence making it a short board.

They then showed me their KED, and left me in it for a minute. Good lesson about a good tool, but a little scary after I'd debunked their aluminum god.

Learn the tools, but never revere them.
(Emerald NE vollies, sorry if any of you are still out there!).


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## pdxems (Feb 28, 2014)

I'd agree with making the best judgement on whether or not the injuries are distracting as it's tough to say from a paragraph. If he's up and walking with no spinal tenderness, why strap him down (especially considering lengthy transport times)?


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## mycrofft (Feb 28, 2014)

pdxems said:


> I'd agree with making the best judgement on whether or not the injuries are distracting as it's tough to say from a paragraph. If he's up and walking with no spinal tenderness, why strap him down (especially considering lengthy transport times)?



Because they hate him? (haha)

HI from Molalla


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## bmedic1681 (Mar 13, 2014)

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….


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## Medic Tim (Mar 13, 2014)

bmedic1681 said:


> 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)


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## bmedic1681 (Mar 13, 2014)

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


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## Medic Tim (Mar 13, 2014)

bmedic1681 said:


> 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


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## bmedic1681 (Mar 13, 2014)

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


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## Medic Tim (Mar 13, 2014)

bmedic1681 said:


> 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.


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## bmedic1681 (Mar 13, 2014)

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


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## Medic Tim (Mar 13, 2014)

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.


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## bmedic1681 (Mar 13, 2014)

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…..


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## Medic Tim (Mar 13, 2014)

bmedic1681 said:


> 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.


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## bmedic1681 (Mar 13, 2014)

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


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## Medic Tim (Mar 13, 2014)

bmedic1681 said:


> 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.


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## bmedic1681 (Mar 14, 2014)

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


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## Tigger (Mar 14, 2014)

bmedic1681 said:


> 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.


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## bmedic1681 (Mar 14, 2014)

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


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## chaz90 (Mar 14, 2014)

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.


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## Carlos Danger (Mar 14, 2014)

Tigger said:


> The plural of anecdote is not evidence.



I like that.


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## rescuepoppy (Mar 14, 2014)

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.


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## chaz90 (Mar 14, 2014)

rescuepoppy said:


> 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.


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## Tigger (Mar 14, 2014)

bmedic1681 said:


> 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. 



Halothane said:


> I like that.



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


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## Brandon O (Mar 14, 2014)

Medic Tim said:


> 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.


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## rescuepoppy (Mar 16, 2014)

chaz90 said:


> 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.



Not saying that collaring and boarding helped me, just saying that the doctor who treated me removed his name fro several papers advocating field clearing. We all know that every case is different I only try to advocate thinking and not becoming overly dependent in using a cookie cutter approach.


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