# New C_Spine Precautions - Southwest CT



## dmfinn (Jul 19, 2013)

Hey all,

Southwest OEMS of CT is getting new spinal precautions soon. I've had a little experience with them riding along with the Paramedics out of Yale-New Haven (they're doing a sort of "beta test"), and it's pretty crazy. Essentially there's no C-spine at all. Toss a collar on the guy, have him walk and lay down on the gurney, no board, no nothing. The research 100% backs it, and honestly it's going to make my job a lot easier, but just wondering what all of you thought about it.

Anybody have new similar protocols in place?


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## the_negro_puppy (Jul 20, 2013)

dmfinn said:


> Hey all,
> 
> Southwest OEMS of CT is getting new spinal precautions soon. I've had a little experience with them riding along with the Paramedics out of Yale-New Haven (they're doing a sort of "beta test"), and it's pretty crazy. Essentially there's no C-spine at all. Toss a collar on the guy, have him walk and lay down on the gurney, no board, no nothing. The research 100% backs it, and honestly it's going to make my job a lot easier, but just wondering what all of you thought about it.
> 
> Anybody have new similar protocols in place?



We do not even carry backboards.

We use c-collars and stretcher. If the person is supine , collar and scoop them to the stretcher. There is no point collaring a person then walking them to the stretcher. If the are walking around on scene have them lay down on the stretcher / apply collar or sit on stretcher apply collar then gently lower them.

Obviously for MVA's etc you collar them whilst inside the vehicle and use your approved extrication boards/ technique to transfer them to a stretcher.


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## LEB343 (Jul 22, 2013)

the_negro_puppy said:


> We do not even carry backboards.




What do you use if you have to do CPR?


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## Jambi (Jul 22, 2013)

the_negro_puppy said:


> We do not even carry backboards.
> 
> We use c-collars and stretcher. If the person is supine , collar and scoop them to the stretcher. There is no point collaring a person then walking them to the stretcher. If the are walking around on scene have them lay down on the stretcher / apply collar or sit on stretcher apply collar then gently lower them.
> 
> Obviously for MVA's etc you collar them whilst inside the vehicle and use your approved extrication boards/ technique to transfer them to a stretcher.



I just died a little bit inside because I'm jealous.


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## Jambi (Jul 22, 2013)

LEB343 said:


> What do you use if you have to do CPR?



My Stryker offers plenty of support for CPR without a backboard, or at least I've not had an issue before...that and everyone is hot on the Autopulse around here.


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## Medic Tim (Jul 22, 2013)

LEB343 said:


> What do you use if you have to do CPR?



the ground

many places do not transport cardiac arrests anymore unless there is ROSC. Some services carry cpr boards and the cot mattress' everywhere I have worked were ok to do cpr on.


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## LEB343 (Jul 22, 2013)

Medic Tim said:


> the ground
> 
> many places do not transport cardiac arrests anymore unless there is ROSC. Some services carry cpr boards and the cot mattress' everywhere I have worked were ok to do cpr on.




Didn't realize that. We always get a board right away.


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## EpiEMS (Jul 22, 2013)

dmfinn said:


> Hey all,
> 
> Southwest OEMS of CT is getting new spinal precautions soon. I've had a little experience with them riding along with the Paramedics out of Yale-New Haven (they're doing a sort of "beta test"), and it's pretty crazy. Essentially there's no C-spine at all. Toss a collar on the guy, have him walk and lay down on the gurney, no board, no nothing. The research 100% backs it, and honestly it's going to make my job a lot easier, but just wondering what all of you thought about it.
> 
> Anybody have new similar protocols in place?



Just saw the revised SW OEMS protocol and I was so excited...then I realized that I'm not in SW CT anymore. But it is a huge, huge upgrade from being berated for not boarding non-significant trauma patients.


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## Bullets (Jul 22, 2013)

LEB343 said:


> What do you use if you have to do CPR?



The ground is usually hard enough. How do you get them on the board? If they are in a bed, just move them to the ground


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## EpiEMS (Jul 22, 2013)

Problem is, SW CT usually seems to transport arrests...including traumatic arrests that have been worked on scene extensively.


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## KellyBracket (Jul 24, 2013)

dmfinn said:


> Southwest OEMS of CT is getting new spinal precautions soon ...



Certainly New Haven is using the "ambulating on scene" protocol, as is Hartford, and a few other hospitals in CT. I haven't heard of any hospitals in SW CT going to this just yet, though.


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## Christopher (Jul 24, 2013)

EpiEMS said:


> Problem is, SW CT usually seems to transport arrests...including traumatic arrests that have been worked on scene extensively.



Wouldn't want survival to discharge to get in the way of L&S transports


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## KellyBracket (Jul 25, 2013)

Turns out I don't always know what's going on next door! It seems that both Stamford and Norwalk are using the "Yale" protocol now for patients that are ambulatory on EMS arrival.

That is to say, ambulatory patients at the scene of a trauma get a collar, and sit on the stretcher. As I understand it, however, non-ambulatory patients still get the whole enchilada; board, straps, headblocks, and tape.


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## dmfinn (Jul 26, 2013)

EpiEMS said:


> Problem is, SW CT usually seems to transport arrests...including traumatic arrests that have been worked on scene extensively.



That, sir, is very true. It'll be interesting to see how that plays out. Norwalk officially starts sponsoring the new guidelines August 1st, haven't had a code in almost 3 weeks so one is overdue.


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## Raptor (Jul 26, 2013)

As of late, I find myself doing the whole "board and collar" more to get the patient to not have an excuse to sue me... it's a sue-happy world, it's cheaper for us to waste the collar and straps.


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## Christopher (Jul 26, 2013)

Raptor said:


> As of late, I find myself doing the whole "board and collar" more to get the patient to not have an excuse to sue me... it's a sue-happy world, it's cheaper for us to waste the collar and straps.



Why would they sue you if you did not board and collar them?


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## Raptor (Jul 26, 2013)

Christopher said:


> Why would they sue you if you did not board and collar them?



Sure, they say they're fine now...but they don't refuse transport. Then they get to the ER with newly discovered aches and pains (paving the way to sue everyone, from the guy that tapped their bumper, to my grandmother). Then they tell their lawyer that I told they don't need a collar. Next thing I know, I'm in the Supervisor's office.


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## Medic Tim (Jul 26, 2013)

Raptor said:


> Sure, they say they're fine now...but they don't refuse transport. Then they get to the ER with newly discovered aches and pains (paving the way to sue everyone, from the guy that tapped their bumper, to my grandmother). Then they tell their lawyer that I told they don't need a collar. Next thing I know, I'm in the Supervisor's office.



do you have a selective immobilization protocol or rule out? or are you guys expected to board every trauma every time?


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## Raptor (Jul 26, 2013)

Medic Tim said:


> do you have a selective immobilization protocol or rule out? or are you guys expected to board every trauma every time?



There is a decided lack of protocol..."CYA" is the rule most of us run with. Obviously, within reason, but I was not able to find concrete rules as to when and where boarding is called for, from the agency's perspective. To be honest, we don't do a whole lot of trauma...it's mostly medical calls.


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## Christopher (Jul 26, 2013)

Raptor said:


> There is a decided lack of protocol..."CYA" is the rule most of us run with. Obviously, within reason, but I was not able to find concrete rules as to when and where boarding is called for, from the agency's perspective. To be honest, we don't do a whole lot of trauma...it's mostly medical calls.



This is a poor attitude and does not serve your patients. If you do the right thing for your patient, you cover their ***. This is how you "CYA" (such a silly phrase; I suggest you drop it).

If your physical exam does not correlate with an unstable SCI you have no business placing them in a C-collar and strapping them to an extrication device. "CYA" is not an indication I've ever seen for any procedure.

Crews who do this sort of immobilization at our service are given remedial training, which can lead to disciplinary actions if they do not improve performance.


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## Raptor (Jul 26, 2013)

Christopher said:


> This is a poor attitude and does not serve your patients. If you do the right thing for your patient, you cover their ***. This is how you "CYA" (such a silly phrase; I suggest you drop it).
> 
> If your physical exam does not correlate with an unstable SCI you have no business placing them in a C-collar and strapping them to an extrication device. "CYA" is not an indication I've ever seen for any procedure.
> 
> Crews who do this sort of immobilization at our service are given remedial training, which can lead to disciplinary actions if they do not improve performance.


I suppose I can only bring the focus back to the nature of the agency's calls...they never bothered to focus on boarding, when we have so few of them. As it were, I'm not with that agency anymore...Not that it changes the fact that they really should sit everyone down with a protocol book.


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## Medic Tim (Jul 26, 2013)

Raptor said:


> As of late, I find myself doing the whole "board and collar" more to get the patient to not have an excuse to sue me... it's a sue-happy world, it's cheaper for us to waste the collar and straps.





Raptor said:


> I suppose I can only bring the focus back to the nature of the agency's calls...they never bothered to focus on boarding, when we have so few of them. As it were, I'm not with that agency anymore...Not that it changes the fact that they really should sit everyone down with a protocol book.



If you are not working for a service why are you boarding people?
if you work for another service why did you answer the question using the policy (or lack there of) of a former employer?


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## Raptor (Jul 26, 2013)

Medic Tim said:


> If you are not working for a service why are you boarding people?
> if you work for another service why did you answer the question using the policy (or lack there of) of a former employer?



I apologize, I misspoke...I was referring to that the last few boardings I've done. I don't currently work for any service, I was just mentioning my experiences of board-and-collars.


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## Medic Tim (Jul 26, 2013)

Raptor said:


> I apologize, I misspoke...I was referring to that the last few boardings I've done. I don't currently work for any service, I was just mentioning my experiences of board-and-collars.



ahh ok, that makes more sense 

I encourage you to search around the forum a bit. This topic pops up quite a bit and there are some good discussions and studies kicking around.


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## Rhyse (Jul 31, 2013)

We are using the same protocols in Northern CT (Hartford County) and in Southern CT (Middlesex County)...Ambulatory on scene = collar and no board. 

And last i heard (a few days ago), Backboards are going to be disappearing and its going to be "consider using a C-collar"


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## Bullets (Aug 7, 2013)

Anyone have the actual text of YNH or the regional protocols? Google is failing me


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## KellyBracket (Aug 7, 2013)

Bullets said:


> Anyone have the actual text of YNH or the regional protocols? Google is failing me



At the top of page 63:

http://www.sponsorhospital.org/protocols/Paramedic%20Protocols%202008%20NHSHP.pdf


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