# New? Questions? The EMTLife Abstracts Service



## Meursault (Apr 10, 2009)

The search function: your best friend, but perhaps not the only resource you have. As I've learned from the experience of others here, complaining about its underuse doesn't do much except make you unpopular, and even when you do use it, you can sometimes end up with pages of results to sort through.

Therefore, I've decided to compile a list of good threads and frequently asked questions for the benefit of our newer members. This is a work in progress; there will be more posts with more topics as I think of and compile them.

*HAY GUISE I'M NEW!*
The introduction thread  is here: http://www.emtlife.com/showthread.php?t=9731
To post your photo, go here: http://www.emtlife.com/showthread.php?t=7877​
*I'm taking the National Registry test tomorrow and...*
Look over your notes quickly and go to bed. Nothing we say or you do can help you at this point. Get some sleep and trust that you've done enough studying.​
*I'm shopping for a lightbar for my POV. Any recommendations?*
http://www.emtlife.com/showthread.php?t=833 The definition of "whacker".
http://www.emtlife.com/showthread.php?t=11443 Differing opinions on lights for POVs, and why you shouldn't start another thread.
http://www.emtlife.com/showthread.php?t=11420 This thread deals more generally with the use of sirens and code 3 driving.
http://www.emtlife.com/showthread.php?t=3035 Rid shares his opinion on POV lights
http://www.emtlife.com/showthread.php?t=5240 Fatalities related to speeding in a POV.
http://www.emtlife.com/showthread.php?t=6905 15 additional pages of this argument.​


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## Meursault (Apr 11, 2009)

Feel free to PM me topics I haven't covered. I'm still working on most of the big ones.

*So how do you feel about drugs?
*http://www.emtlife.com/showthread.php?t=7802 Why you shouldn't start another thread on it; Flight and I go toe-to-toe with LE-EMT and Vent; much mud is slung. 
http://www.erowid.org/psychoactives/testing/ Erowid is, in general, a good resource on psychoactives. Their “Testing Basics” page is a straightforward explanation of what most drug tests cover. However, you'll have to deal with questionably accurate user-contributed sections, like everything about “beating” drug tests.
http://www.emtlife.com/showthread.php?t=4953 Testing for nicotine?! 
As for your individual state/county/company, it's best that you check with them if you have legitimate questions about testing. Most of the time, users here don't know better than they do.​
*All these flamewars depress me. I need some humor:*
http://forums.studentdoctor.net/showthread.php?t=257985 This is SDN EM's “Things I Learn from my Patients” thread. Well worth the read.
http://www.emtlife.com/showthread.php?t=4141 Dispatchers Say the Darndest Things.
http://www.emtlife.com/showthread.php?t=10452The unwritten rules and laws of EMS.
There are a lot more threads in the humor forum. Browsing by thread length is a good way to find the interesting ones.​


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## Shishkabob (Apr 11, 2009)

Someone was bored tonight!


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## Meursault (Apr 14, 2009)

Since it just came up; I'll deal with C-spine clearance later.

*Prehospital C-spine stabilization:* 
http://www.emtlife.com/showthread.php?t=12256 Sasha finds some studies; MSDeltaFlt weighs in
http://www.emtlife.com/showthread.php?t=11148 A scenario where boarding may or may not be indicated.
http://www.emtlife.com/showthread.php?t=3386 A scenario where boarding wasn't indicated... or was it?
http://www.emtlife.com/showthread.php?t=8830 KEDs and why you should use them; 
http://www.emtlife.com/showthread.php?t=5551 Tips for the KED on the practical exam and in the field.
http://www.emtlife.com/showthread.php?t=10368 Head immobilization methods
http://www.emtlife.com/showthread.php?t=2484 Securing patients: spider straps, quick clips, or webbing?
http://www.emtlife.com/showthread.php?t=6968 ED staff removing patients from the board and why it's sometimes justified.
http://www.ncbi.nlm.nih.gov/pubmed/17613902 How well are devices being applied?
I'm not going to cite all the studies, but a quick Pubmed search indicates that immobilization on long boards frequently causes pain, that the pain can take time to develop, and that padding the boards doesn't relieve the pain or prevent further symptoms very well.
http://www.ncbi.nlm.nih.gov/pubmed/15748015 A  lit review: prehospital “immobilization” techniques do reduce movement, but they produce a number of well-documented adverse effects.​


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## fortsmithman (Apr 14, 2009)

How about EMS wearing police type badges.  EMS buying trauma bags.  EMS going to scenes in POV.  EMS that is fire based.  I can't think of anything else.


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## Meursault (Apr 20, 2009)

Thanks for the sticky, mods.

*Trauma bags, jump kits, and personal equipment in general:*
http://www.emtlife.com/showthread.php?t=12323 A recent thread on the topic; anecdotes and opinions; theft from EDs; emt.dan sums it up on the first page
http://www.emtlife.com/showthread.php?t=11811 Flashlights
http://www.emtlife.com/showthread.php?t=3376 Knives; Rid and others on why you shouldn't carry one;  tips from DT4EMS on page 3; the more tactically-minded members discuss theirs.
http://www.emtlife.com/showthread.php?t=4774 Oxygen; emt.dan on his (diving) setup; questions to ask yourself.
http://www.emtlife.com/showthread.php?t=5271 Trauma kits; Vent outlines some legal issues associated with oxygen
http://www.emtlife.com/showthread.php?t=783 POV equipment, lights, and loadouts, if you were still curious about what a true whacker's vehicle looks like.
http://www.emtlife.com/showthread.php?t=21 What members carry on their person; the lowest thread number you're likely to see here; radios and communication equipment.
http://www.emtlife.com/showthread.php?t=8649 Things you and your ambulance probably don't need

There are innumerable stethoscope threads, all saying largely the same thing. I'll break it down by certification level:
Student/below EMT-B: Take what you're given, and wait a bit before buying anything.
EMT-B or equivalent: How clearly do you need to hear those Korotkoff sounds? Get something reasonably-priced.  I use an ADC ADSCOPE 630 which cost me about $30. It's heavier and slightly less comfortable (stiffer earpieces) than the Littmann scopes I've had a chance to use, but it's more than adequate for my needs. Littmann lightweights are also in the <$100 range. The consensus is to stay away from dual-tube (Sprague-Rappaport-style) scopes, which aren't to be confused with dual-lumen scopes. 
ALS providers: Why would you be listening to my lowly opinion?
For identification, get a color that doesn't look completely ridiculous, but isn't black or navy blue. Put your name on it securely; Littmanns have tags, one poster suggested attaching an ED patient bracelet with your name on it, and there are always Sharpies (my method) and tape. 

Even if you have equipment in your POV, there are a host of practical, legal, and ethical issues related to providing care while off-duty. The legal issues vary by location, ethical discussions on this forum are always terrible, and several discussions of the practical issues have been inconclusive. This issue probably merits a separate abstract, but it's low on my list.​


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## ffemt8978 (Apr 20, 2009)

MrConspiracy said:


> Thanks for the sticky, mods.



You're welcome.  I think this is better than telling somebody to use the search feature.


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## mycrofft (Apr 21, 2009)

*How about a thread about MrConspiracy's Guide to EMTLIFE?*

Right on!!


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## Meursault (Apr 24, 2009)

*Addenda and Miscellaneous Notes:*


Forgot to include this for stethoscope shopping: http://www.forusdocs.com/reviews/Acoustic_Stethoscope_Review.htm Even if you already own one, check it out. The authors did both lab and field testing of several popular models. It seems I should have spent a bit extra after all.

Journals and resources for our more academically-minded members (read: bored college students with institutional access to basically everything). There are a few EMS-oriented journals, like Prehospital Emergency Care, but I don't have access and they're fairly infrequent. JEMS is sort of a joke, except for the columnists. A lot of research on prehospital treatment is published under the auspices of EM journals anyway, so search first. When in doubt, try PubMed. 

EMS-related blogs I read:
Siren Voices
Random Acts of Reality
A Day in the Life of an Ambulance Driver
Street Watch: Notes of A Paramedic


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## el Murpharino (Apr 24, 2009)

could we get an "official" BLS vs. ALS thread?


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## ffemt8978 (Apr 25, 2009)

el Murpharino said:


> could we get an "official" BLS vs. ALS thread?



Sure...the thread would consist of one post and then would be locked.


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## medicdan (Apr 27, 2009)

Conspiracy-- as I have said to you before, this is enormously helpful, thank you! I am going to start linking to this, or when I cannot, I'll email you additions...


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## Meursault (May 10, 2009)

By request, NREMT exam stuff. I'd like to be able to put more in here, but the overwhelming majority of the threads in that forum are about the same things and don't last more than a few posts. EMT students in general will get another topic

*How do I study for the NREMT-B?*
The NREMT forum has a number of helpful stickies. Read those first, then come back. Having at least looked at all 302 thread titles and postcounts, there's not much else in there to help you.​
*I just got out of the exam...*
Wait for your results, and please don't post another thread simply to state that. If you have a specific concern, I have a feeling it's somewhere in the 16 pages of threads. I could extract every question from there, but I don't care nearly enough. 

http://www.emtlife.com/showthread.php?t=7121  If you're wondering about your test stopping, go here​
*I just failed the NREMT. What do I do?*
You're not the first person. If it was the CBT, it's unlikely that your situation is unique, so read back a bit on the forums.
http://www.emtlife.com/showthread.php?t=11599 A big thread; Rid weighs in quickly, AJ Hidell has an especially useful bit of advice that I'll reproduce here: “Fail once: your school sucks. Fail twice: you suck.”

http://www.emtlife.com/showthread.php?t=10979 The practical; one person's experience and advice from that; debate on whether finding out why you failed is a good thing, even if it's possible.

http://www.emtlife.com/showthread.php?t=12467 You probably shouldn't do this. Though if you keep posting about it, I might secretly wish it.​


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## Meursault (May 26, 2009)

*BLS vitals:*
http://www.emtlife.com/showthread.php?t=5997 and http://www.emtlife.com/showthread.php?t=5909 Tips for taking BP and other vitals in the back of an ambulance
http://www.emtlife.com/showthread.php?t=5474 Another thread about automatic BP monitoring; reasons why you shouldn't rely on it
http://www.emtlife.com/showthread.php?t=12749 BP and mastectomies
http://www.emtlife.com/showthread.php?t=12656 A short thread on dialysis graft/fistula sites. Useful if you work for a private.

Pulse points: I've seen a few short threads, but I'll summarize. Practice when not at work, and if you're really unsure and they don't look dead, auscultate (over the heart, that is). For practice, it helps to start with someone skinny and, once you know where everything is, to try a variety of patients. 

Understanding _how _vital signs are produced and _why_ they change can be very helpful. If you haven't already, taking a college-level A&P course will help with that. 
For a quick, basic review/overview, try the “Vital Signs: A New Look” presentation here: http://www.911learning.com/course_materials​
EKGs and other ALS assessment tools will require another abstract (and possibly another author; experience helps).
http://www.emtlife.com/showthread.php?t=10990 An ETCO2 thread with lots of good links.​


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## Meursault (Jun 28, 2009)

I haven't died or gotten too busy to post, yet. We'll see in a few months, when I'll have a work-study job and an internship, be working per diem for a private service, going up for crew chief in a volunteer service, and taking a reasonable courseload. Before that happens, it's time to tackle some of the big stuff.
*
Volunteer vs. Paid EMS:*
This is a pointless argument repeated ad nauseam. I'll provide a few examples, but let me summarize the arguments:
Side A: “Prehospital care needs to be provided by professionals. Volunteer services frequently set lower standards of professionalism and attract precisely the sort of people that are not qualified to deliver emergency care. EMS, just like fire and police departments, is a service that communities should be prepared to pay for. Likewise, EMS is not a hobby. If you are dedicated and professional enough to provide prehospital care, you should be willing to treat it as a career. The services of an emergency medical professional should be worth something. 'Giving them away for free' disrespects the profession and hurts those people who have chosen to make their living in EMS.”
Side B: “The financial and logistical situation in many communities makes full-time paid EMS impractical. Moreover, if people are willing to devote the time and effort required to provide competent prehospital care, and they're willing to do it for free, why should we stop them? Suggesting that they need to be paid insults their motives. [obvious whacker defensive polemic about needing the gear in their trunk and being first on scene when off-duty snipped]”
Side C: “HAY GUISE LET'S ALL BE FRIENDS”
The handful of reasonable people: “By the Manes, another thread about this? No one's changing any opinions.”

http://www.emtlife.com/showthread.php?t=4438 lol, New Jersey.
http://www.emtlife.com/showthread.php?t=9454 Toasty!
http://www.emtlife.com/showthread.php?t=12524 Rid gets a bit snarky; toes get stepped on
http://www.emtlife.com/showthread.php?t=9454 Volly chest-thumping; KEVD18 mounts the “drunken soapbox” to deliver what sounds suspiciously like a balanced take on the issue. Those posts, at least, are worth reading.

I should really do a literature search on this. I'll post anything I find.​


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## Meursault (Aug 3, 2009)

Still haven't done that lit search. 

*Abbreviations:*
Google is, as in all things except privacy, your friend here, but there's a faster way.




http://www.emtlife.com/showthread.php?t=11290 A great list of the common abbreviations, courtesy of tydek07.​
Shortest abstract EVAR.

*"Hai guise I'm new..." part 2: The EMT-B Student*
http://www.emtlife.com/showthread.php?t=13820 Some advice from forum members. Please don't start another thread like this, the enthusiasm is almost painful.

http://www.emtlife.com/showthread.php?t=10778 The big, meandering thread for fellow EMT-B students.

"What should I buy?": I've seen a few of these, and I'd suggest that you buy absolutely nothing that isn't required. Some good pens, maybe.

http://www.emtlife.com/showthread.php?t=6489 Some of the deficiencies of EMT-B education. This is a common theme, and if you stick around, you'll see many of these same posters elaborating on it. Pay attention.

Honestly, there's not much to add. I've covered the NREMT, vitals, and sundry other things you might find interesting. Please search before starting a thread about anything having to do with this topic. More specifically, before starting a thread about the grading of your last test, your performance on it, or your issue with your instructor/classmates, consider whether people here can help you. If you need to vent, try the students thread above. If you need advice, I suspect someone else has been in the same predicament and did start a thread. If you're afraid the answer will be "I'm sorry that your school's terrible, and that you're out $800.", it probably will be. ​


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## Meursault (Aug 25, 2009)

*Fire Departments, Volunteers, Third Services, and You: *A Very Special Word from MrC
I could have, in keeping with my original format, dredged up a representative sample of the innumerable threads about third-service vs. fire-based EMS, volunteer vs. paid services, private contract-based 911 coverage vs. a public safety model, and all the other nasty dichotomies.

However, the threads I recall don't really contain any useful information or any particularly cogent arguments. At this point, it's worth remembering something one of my American Healthcare lecturers tried to impress on me: The US, let alone the world, is a very diverse place. One solution is not going to work for every city, town, township, county, or miscellaneous other municipality. It's entirely possible that there's a place for properly-constructed versions of all of these systems. Well, except for combined LE/EMS. That's just silly. (No, really, there are legal, ethical, and practical conflicts if you don't separate the two duties).
Posters are still going to discuss these things, though, and with good reason. So I've written something more general.​




*How to Make a Decent Argument:*

Form a coherent opinion. If you don't understand how you feel about an issue, who will?
Narrow your scope. Arguing over generalities doesn't work for these issues. If you can't come up with a useful argument that avoids the exceptions, try defining the exceptions.  E.g. "Volunteer departments are an acceptable feature of rural EMS, but their use should be limited to areas of  low population density and limited local funding, and they need a combination of expanded scope, strict QI, and plans for definitive care to work properly."
Research. Feel free to regale the board with tales of how your department totally saves lives and stuff, but back it up with something meaningful. Pubmed and Google Scholar are good for this. If you need access to a journal, try your library system or a college library.
Don't butcher the English language. If it's your first language, you'll look like the idiot you probably are. If it's not your first language, you'll be somewhere between an annoyance and an object of pity.
Address criticisms. Try not to let the fact that there are gaping holes in your argument wound your pride. You are, after all, only/barely human. I've spent a surprising amount of time having my carefully crafted, finely honed, nearly airtight arguments shredded by professors in front of the class. Now it's time for an ICS-style miniquiz! 
*The proper response to criticism is:*
A. Personal attacks.
B. Screaming your fury to the stony skies and refusing to participate in the discussion.
C. Taking the time to think about the criticism and come up with counter-arguments.​
Learn when to quit. Clearly, I haven't.


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## Hyperlight381 (Aug 10, 2011)

*Noob*

Hey everyone, new to this site and was wondering if anyone worked up in the San Francisco/Bay area??? Do you like it??? Considering moving up there in a year and curious about the companys up there


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## MrBrown (Aug 10, 2011)

*What teh heck is this thing Brown and why does it haz Cat in the Hat hat?*

Brown defies all logical understanding of the space time continuum, laws of physics as well as known and experimental science and religion.

It is best to just not pay attention to it or the funny words it says like:

- Bugger
- Bloke
- Scrote
- Ambo
- Resus
- Adrenaline
- Drip
- Suxamethonium
- Nunngered
- Bikkies
- Cuppa
- Shav

... oh and ignore that thing called Mrs Brown


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## wolverine (Aug 19, 2011)

It always make me scratch my head when kids 17 or 18 year old volunteer in EMS or FD so they can put strobe light&drive crazy getting to their station to respond to a call of someone who twisted their ankle like a bat out of hell light&sirens on. Are U Kidding Me??? I work in 1 of the highest crime city in Northern NJ and sometimes I don't even turn on the siren if I am responding to a medical call that's not critical.


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## Meursault (Oct 4, 2011)

Gods, you leave a thread alone for a couple years and people wander in and :censored: all over it. It's funny how many things I've mentioned that completely didn't happen, by the way. Time to briefly address the HIPAA-related knowledge deficit.

*
Are you a lawyer? Can I trust your advice?*
No and no. But I'm pretty much regurgitating what the agency charged with enforcing HIPAA says about it. If _you_ happen to be a lawyer, and I've made a mistake, correct me.

*What is HIPAA, and what does it mean for me?*
The Health Insurance Portability and Accountability Act is a typically long and unclear law governing what health care providers, insurers, and the like do with a broad class of patient information. The most comprehensive source on HIPAA I've found so far is http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html. Try the privacy rule summary.
Here's the most important quote, from the FAQ:


> The Privacy Rule does not require you to obtain a signed consent form before sharing information for treatment purposes. Health care providers can freely share information for treatment purposes without a signed patient authorization.



*I'm being told that I can't (look at a patient's chart, take any paperwork with me, get an oral report, etc.) because it would be a HIPAA violation. What do?*
These cases seem to be due to one of three things: complete ignorance about what HIPAA actually mandates (hint: did they spell it "HIPPA"?), absurdly restrictive compliance policies adopted when the law first went into effect, or laziness, malice, and dishonesty. If it's one of the first two, you might benefit from speaking to a supervisor and/or confidently and repeatedly explaining that disclosures for treatment are permitted. Realistically, though, you can't fix any of these. If it's an organization you deal with regularly, see if your employer can do something about it. 

*Any interesting threads on this forum? Other sources?*
Remember how I mentioned a "HIPAA-related knowledge deficit"? But here's what I dredged up:
http://www.nytimes.com/2011/09/09/u...7713966-aPWs2HDMsgou0r9XdcRkGA&pagewanted=all Some actual HIPAA violations that resulted in fines, via ffemt8978.
http://www.ama-assn.org/ama/pub/phy...ability-act/hipaa-violations-enforcement.page A detailed explanation of the punishments for HIPAA violations.
http://www.emtlife.com/showthread.php?t=10554 Several of the regulars use a press conference about a celebrity death to discuss patient privacy, legal and ethical duties, and how to talk to the media. Great advice from karaya. I'll return to this if I get around to ethics.
Beyond that, the only thing you'll get from searching are examples of people's misconceptions about HIPAA and patient privacy in general.


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## Meursault (Dec 14, 2011)

As my Christmas gift to the forum, I think I'll be adding some abstracts on waste and inappropriate interventions.
I should reiterate that I'm just some guy with several levels of Google-fu and too much free time. This isn't justification for disregarding law, protocol, policy, or ethics. More importantly, though, I have nowhere near a comprehensive education and I do make mistakes. If something in here doesn't make sense or seems dubious, do your own research and/or ask someone, but please don't clutter up this thread with questions.

*What's all this about helicopter overuse?*
The prevailing opinion among experienced providers here and EMS experts seems to be that helicopter transport is overused. The argument is that, since helicopters are risky and expensive, they should be used only when they effect a meaningful reduction in transport time for patients that will benefit greatly from it. The critics hold that EMS greatly overtriages patients to air transport and that, in many cases, flights don't save enough time over ground transport to make any difference. 
I don't have enough information to give a good summary of a different argument, which centers on helicopters as a means of delivering advanced providers and equipment to scenes and sending hospitals in order to stabilize patients in the field.

http://www.emtlife.com/showthread.php?t=16068  The forum responds to Dr. Bledsoe's strongly-worded critique of HEMS
http://www.emtlife.com/showthread.php?t=18012 A shoddy scenario turns into a discussion of the appropriateness of cancelling HEMS and how to interact with them in general.
http://www.emtlife.com/showthread.php?t=9523 Repost of a letter from the chief at Maryland's Shock Trauma Center defending their HEMS program.
http://www.emtlife.com/showthread.php?t=25063 "Helicopter shopping"*, competition among services, ETAs, and what happens when you call to request a helo. 
*"Helicopter shopping" is, roughly, the dangerous and unethical practice of calling multiple services to get a flight in bad weather without sharing weather information or the fact that you've already been turned down.​http://www.emtlife.com/showthread.php?t=21211 Maryland-bashing, plus some interesting discussion between flight medics. 
http://www.emtlife.com/showthread.php?t=21105 An example of the rarest sort of threads: intelligent, in-depth discussion of a study. This one is on the impact of HEMS on survival. It died of neglect within four posts.
http://www.emtlife.com/showthread.php?t=14476 usaf rants about obstacles to HEMS safety improvement.
http://www.emtlife.com/showpost.php?p=101412&postcount=10 MSDeltaFlt interrupts another crash discussion to caution people with no experience about "jumping on a bandwagon" and speculating.

If you're curious about the number of aeromedical deaths, look at the National Aeromedical Memorial. It doesn't have rate per thousand transports, but I'm sure you can find that somewhere.


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## mycrofft (Dec 17, 2011)

*I forget this was here, and it is a sticky. Sorry.*

:unsure:


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## Meursault (Dec 27, 2011)

*Back to the spine.*

I figured I should pull out all the stops for post #500. Sorry about the US-centric approach, and if you have corrections, additions, or better sources, let me know as soon as possible. Also, I have only the faintest idea of statistics, let alone Bayesian statistics. If anyone could contribute something on the low pre-test probability of c-spine injury and its effects on the accuracy of decision rules, please do. Finally, I consistently ignored distinctions among spinal injury, spinal fractures, and spinal cord injury, though I try to report which was measured. I don't think it's relevant enough to justify the added headache.
*
Why are so many people here critical of spinal immobilization?*
 It's not just here; haven't you ever taken a patient into the ED and seen them off the board before you left the room? To summarize, spinal injuries aren't that common, occult spinal injuries are quite rare, EMS immobilizes a very large number of people, there are indications that long spine boards do very little good and some harm, and there are rules that can be used to more accurately determine which patients may have spinal injuries. Very few people argue against attempting to immobilize known or likely spinal injuries; more commonly, it's claimed that we're not doing a very good job of it.

*How common are traumatic spinal injuries?*
The National Spinal Cord Injury Statistical Center reports a US incidence of around 40/million/year nonfatal spinal cord injuries, which it says is a composite of estimates from several studies. The publications I've found are either extrapolations from a nationwide sample or studies of smaller areas. One study  using the National Trauma DataBank found a rate of 1.99/100,000/year spinal cord injuries in US children. At the opposite end of the spectrum, a prospective study of ~6000 men over 65 found a rate of 2.2/1000 person-years. A single-year study in Beijing identified 60.6/million/year cases of spinal cord injury.  Norway  is going strong at an average 21.2/million/year over the last decade. 

What we'd really like to know, of course, is how many falls/MVAs/etc. result in spinal injury. I was equally unsuccessful in turning up very much research on that, but one study of 1335 patients with blunt head trauma identified 13 c-spine injuries, for a rate of 0.7%. As a surrogate for the total number of people suspected of having spinal injury, the authors of the NEXUS study (below) estimate that 800,000 c-spine studies are ordered each year in the US.  In the NEXUS study, 2.4 percent of the sample, all of whom presented to the ED after blunt trauma, had spinal injuries. 

Even patients otherwise injured don't seem to have very many spinal injuries.  To quote a meta-analysis, "Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability".  "Clinically unevaluable" here means that they're unconscious or have distracting injuries. In the previously-mentioned blunt head trauma study, neither decreased GCS scores nor "severe facial trauma" were associated with c-spine injury (though there were only 13 c-spine injuries). A study of patients with GSWs to the head, neck, or torso found 327/4204 (7.78%) spinal column injuries.

*Can we accurately determine which patients have spinal injuries?*
Textbooks and my sample of state EMS protocols direct providers to immobilize patients for a great number of criteria, notably "significant mechanism of injury." For instance, step one of the MA protocols for head trauma is "Ensure cervical spine stabilization and immobilization"; the protocol defines head trauma to include "Superficial injury...". The MA protocols for most traumatic injury direct providers to "[a]ssume spinal injury when appropriate and treat accordingly". 

There are two ways to look at this: either EMS providers and their medical/legal oversight are terribly overdiagnosing spinal injuries, or they've completely abandoned the concept of forming a working diagnosis before treatment in this case. I suspect the latter, but for the sake of argument and my remaining tatters of idealism, we'll assume the former. 

A certain amount of caution is necessary in the treatment of patients with possible spinal injury; occult spinal injuries do happen. A retrospective review  of patients with thoracolumbar fractures found 10/537 (0.19%) cases of asymptomatic fracture in "reliable" patients. In the NEXUS study (yes, I'll link to it shortly), 8 of the 34,069 c-spine injuries were cleared by the criteria they used. There are a ton of other papers around, but I believe the point is clear. 

*Is there a better alternative to mechanism of injury?*
A group of researchers were so unimpressed with the standard "board, collar, and image everything" approach that they developed a simple, specific set of rules to determine when patients with blunt trauma don't have c-spine injuries. They're known as the NEXUS criteria after the study. Some areas, notably Maine now allow EMS providers to perform "selective spinal immobilization" using criteria based on the NEXUS trial. In Canada, a field trial of a different rule with a similar approach went fairly well and the authors want to use it more broadly. Another study in the US was similarly optimistic.

The NEXUS and Canadian criteria require judgment in their application. What is a distracting injury? What does it take for a patient to be intoxicated? How altered is altered mental status? To quote the authors, "[W]e believe that evidence of intoxication and the level of alertness are best evaluated on the basis of clinical judgment, rather than laboratory tests or uniform criteria. " The Canadian study noted that paramedics tended to apply the rules more conservatively than indicated, but we could imagine inappropriate underapplication as well. 

The NEXUS criteria only cleared 12.6% of patients. The authors point out that this is still a considerable savings in time, money, and exposure to ionizing radiation, but inappropriately conservative use could wipe out the benefit entirely. In any case, applying the criteria in the field isn't going to cause a disappearance of backboards.  But...
*
Do long spine boards provide a significant benefit? Can they be harmful?*
Go back a couple of pages for my first post on this. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143405 An expert panel looks at the literature and comes up with some poorly-explained recommendations. They conclude in favor of using a C-collar and padded board for all suspected spinal injury.

http://www.ncbi.nlm.nih.gov/pubmed/20065766 In stark contrast, this study (abstract only for me) looks at penetrating trauma and finds that the number needed to benefit from immobilization is 1032, the number needed to harm is 66 (!), and patients immobilized prehospitally have an OR of death of 2.06 (!!).

http://www.ncbi.nlm.nih.gov/pubmed/21610441 This abstract from a small cadaver study reports that log-rolling patients off a board creates appreciable movement in an unstable c-spine, even with experienced people providing manual stabilization. 

http://www.ncbi.nlm.nih.gov/pubmed/21183526 The irony was too good to pass up.

*Weren't you originally supposed to be collating forum threads?*
Yes, but in cases like this, it makes a lot more sense to go to the research first. I might follow up with threads, but right now it's 0532 and I'm out of shiraz and full of cookies. For now, think, stay safe, and please don't screw around boarding unstable shooting victims.


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## epipusher (Dec 27, 2011)

nice sticky, well done


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## avendano09 (Jan 5, 2012)

*Just the Begining*

Hey guys! Am very new to this thread! This is a great site, and I'm so happy I found it! I'm in Arizona, just applied to CAC (Central Arizona College). I'm starting school this monday, for EMT basic! I am really passionate about people in general, and I've always wanted to be an EMT. How long does this first course last? And yes, I have chosen to keep going with career, eventually going on to Paramedics. I'm nervous and excited, and could use a little advise! Thank you!

Ash


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## DClemons (Feb 4, 2012)

*cheers..*

Nice link collection on this post - thanks!


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## rndtuet (Feb 21, 2012)

Just replying so I can chat


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## rndtuet (Feb 21, 2012)

*enough is enough*

Enough is enough


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## ffemt8978 (Feb 21, 2012)

rndtuet said:


> Just replying so I can chat


I wouldn't continue to do that if I was you.


rndtuet said:


> Enough is enough


So correct.  From our rules


> Participants may not bump threads. Bumping can refer to posting useless information, making corrections or updates in a new post, posting one-liners or any other action to deliberately keep a thread hot or to bring it to the top of Recent or Today's Posts. Community Leaders will use their discretion, depending on the nature of the post, as to whether to take action or not.



http://www.emtlife.com/showthread.php?t=8721


> EMTLife.com is, and always has been, committed to being the #1 Online Forum for EMS Discussion. We're constantly striving to improve ourselves, and provide our members with a place that they can come to and discuss anything related to EMS in an environment that is unique.
> 
> We've had our growing pains over the years, but have managed to deal with them on an individual basis. As many of you are aware, we've had some issues in the chat room recently that were a little bit too much to deal with individually. This has caused us to take another look at the chat room. During this process, we solicited input from you, our members, and have come up with the following changes.
> 
> ...


Relevant portions are highlighted.


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## titmouse (Aug 14, 2014)

I hope you were on the clock, cause that's worth monetary compensation.


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## chaz90 (Aug 14, 2014)

Are these links bringing people to the wrong threads or is it just me? Wondering if it's a result of the new forum.


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## vcuemt (Aug 14, 2014)

It's ironic that the last post in this thread prior to @titmouse 's untimely (and probably accidental) bump was about bumping zombie threads.


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## chaz90 (Aug 14, 2014)

Yeah, but this thread is one that remains valid today.


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## Meursault (Aug 14, 2014)

chaz90 said:


> Are these links bringing people to the wrong threads or is it just me? Wondering if it's a result of the new forum.


Everything I've clicked looked correct. PM me anything that seems off.


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## titmouse (Aug 14, 2014)

vcuemt said:


> It's ironic that the last post in this thread prior to @titmouse 's untimely (and probably accidental) bump was about bumping zombie threads.


lol i did not notice the date mark at all


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## Rescuelou123 (Oct 26, 2014)

Hey I'm wondering if anyone  took the fdny exam and got a number for the next step.
If so can anyone tell me what I can do next.


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## Chimpie (Oct 26, 2014)

Louie Patrizi said:


> Hey I'm wondering if anyone  took the fdny exam and got a number for the next step.
> If so can anyone tell me what I can do next.


Over 2,300 responses in this thread: http://emtlife.com/threads/fdny-ems-candidates.35404/


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