# first spine boards now the c-collar?



## Veneficus (Jul 2, 2010)

Does anything in EMS actually work?

"Study prompts worries that cervical devices may harm some patients"

http://www.emsresponder.com/publication/article.jsp?pubId=1&id=13772


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## MrBrown (Jul 2, 2010)

Veneficus said:


> Does anything in EMS actually work?



Not on our budget 

This doesn't strike me as being much different than other things ambos did which turned out to maybe not be the best; D50 vs D10, secondary brain injury caused by intubation and hyperventilation, spine boards, MAST pants ...


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## SeeNoMore (Jul 2, 2010)

It is so depressing I want to jump out of the back of a moving vanbulance. 

But all in all I guess it's good that we know. What terrifies me is how many EMS people I know that don't even have the barest hint of interest in studies like these. 

EMS needs national oversight, and we need a new way of doing things. There are so many systems that use outdated ways of thinking and methods, and seem in no danger of getting better. 

Make me hate this field.


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## reaper (Jul 2, 2010)

Not something to really worry about. Very small number of pt's.


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## adamjh3 (Jul 3, 2010)

This quote was particularly interesting to me, I'll do a little more research and come back with an opinion on it



> Additional research published by the _Journal of Trauma_ also found higher mortality in victims of penetrating trauma who were spine-immobilized.


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## Stephanie. (Jul 3, 2010)

There is now a company making the 'X COLLAR' which allows you to stabilize the head and spine in any position found. They say that it should be less compromise when holding c-spine.

http://www.xcollar.com


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## adamjh3 (Jul 3, 2010)

Stephanie. said:


> There is now a company making the 'X COLLAR' which allows you to stabilize the head and spine in any position found. They say that it should be less compromise when holding c-spine.
> 
> http://www.xcollar.com



As I understand it, the C-collar was designed to limit flexion of the neck and to keep the weight of the head from compressing the cervical spine. So "immobilizing" (it's really restriction, there is no way to obtain full immobilization in the prehospital setting) the neck in the postion it was found seems hardly beneficial. Someone correct me if I'm wrong?


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## terrible one (Jul 3, 2010)

Have you ever had to be "immobilized" with a c-collar and LSB? 
Not surprised they can do more harm than good at all. In fact I'd like to see a study where it shows just how effective they really are.


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## FLEMTP (Jul 5, 2010)

adamjh3 said:


> This quote was particularly interesting to me, I'll do a little more research and come back with an opinion on it
> 
> 
> 
> > Additional research published by the Journal of Trauma also found higher mortality in victims of penetrating trauma who were spine-immobilized.



The reason is because these patients need an OR for repair of their injuries... putting someone in spinal motion restriction takes time...and time is the one thing that these patients do not have when dealing with penetrating trauma


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## rhan101277 (Jul 5, 2010)

Here, if no nuerologic deficits or complaints are found for a penetrating injury then spinal immobilization is not indicated.


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## firetender (Jul 5, 2010)

One of the most amazing aspects of publishing my book 25 years after leaving EMS was that MOST if not all of the drugs and procedures I was dependent on to save lives back then have been debunked if not banned!

But I saved lives. Sure, not as many as they told us we'd be able to save using these new-fangled procedures, but taking action in the ways we did sometimes worked. This, then, becomes an exploration into the Great Mystery. 

Because throughout history, EVERY quack cure has cured SOMEONE, maybe many ones until they were de-bunked, or in so many cases trampled by competing economic interests.

Think I'm kidding? The AMA took precedence in our health care system because it literally "beat out" the lobbying and advertising efforts of Homeopathy and Chiropractic, two different schools of thought. 

Drugs and surgery became the treatments of choice not because of their proven value but because of the economic support of those corporations who provided the practitioners with the tools. The sad part of the gig, though, was most often the tools don't work. But because other corporations are set up to develop other tools that just "might", they  keep up a supply of things to try. Just look at medications in EMS. Perhaps the minimization of the other philosophies was based on their lack of "toys" to create. Essentially our medical system, headed by Physicians, became a true "Delivery" system. 

These corporations are still guiding us, especially in EMS. Death is still winning; no matter what we throw at it. Trust me, most of what YOU are using will have been found marginally effective, if not banned, 25 years from now.

Think I'm kidding? How about this; the ONLY thing I offered back then that has been proven to REALLY makes a difference is rapid intervention with defibrillation!


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## Aidey (Jul 6, 2010)

The longer I do this, the more I have come to dislike c-collars (and backboarding in general). We take these hard, unforgiving things and try and make our patients conform to them...it just doesn't make any sense to me. I would love to see some sort of malleable foam pieces that could be cut or molded to fit each patient exactly. Or even a mold with a foam spray if you want to get really crazy. It wouldn't work to well for patients lying down, but for those sitting up with 360 access it could have potential.


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## sdadam (Jul 6, 2010)

I've been preaching this for years! And been yelled at and called stupid for doing so a lot of the time.

Here is a thread from a while back where a lot of good info was posted about both backboards and c-collars:

http://www.emtlife.com/showthread.php?t=15864


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## Melclin (Jul 6, 2010)

Not suprised.

I hate spinal immobilization. Have done ever since I got fully immobilized in class and realized how little it prevents movement and how much extra pressure and strain its causes. I was not surprised when I discovered this was supported in the literature. 

I don't think that spinal immobilisation should be too formula based. I think things like collars and and KEDS and boards should be used to augment the whole process of minimizing movement. But they do not in themselves offer a perfect answer. Regarding the issue of multi-trauma, if providers were educated enough to properly understand the physiological state that a patient is in, and the real medical priorities for that patient, then I don't think you would find any increased mortality in trauma pts simply because a collar was used. Instead however, you have idiot 1 fumbling with the O2 regulator trying figure out why his NRBM will not inflate, while idiot 2,3 and 4 take 10 minutes to immobilize the patient based on MOI exactly as the "EMT for idiots" text says, ignoring the fact that they are actually moving the pts neck more because of it. Once the pt is out, idiot 2 takes 10 minutes to start an IV, and run fluids wide open into a patient with penetrating chest trauma.


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## Ravemtech (Jan 6, 2011)

Hi Melclin,

When you were immobilised in class,  did the person immobilising you correctly follow Ambulance Victoria's (AV) WI 5.1.11 (ie padding under the torso, head and lumbar).  Most people fail to pad and this leads to pain and pressure sore development.  Strapping is also often done incorrectly thus allowing too much movement.

The attached document below (which also includes WI 5.1.11) is with Ambulance Victoria at the moment and reviews multiple studies on padding Boards, and the significant difference it makes.

Anything is dangerous when done incorrectly, or to a poor standard, or inappropriately.  Research clearly supports Boards are comfortable when used correctly. There are no studies that demonstrate Boards are dangerous when used correctly, but many studies do show complications with Boards when used incorrectly.  

But as you said,  there is no perfect answer,  but since AV introduced the Board in the mid 1990's,  we are significantly better off than without.  It is just too many have forgotten what it was like before we had Boards and too many fail to use the Board correctly leading to problems.


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## Melclin (Jan 6, 2011)

Melclin said:


> I don't think that spinal immobilisation should be too *formula based*. I think things like collars and and KEDS and boards should be used to *augment the whole process of minimizing movement*. But they do not in themselves offer a perfect answer.



Bolded for emphasis.

The formulas I was getting at were things like, "All trauma pts are boarded, collared and strapped. FULL STOP". "All falls are immobilized" etc. Being as it is that MOI is a poor indicator of occult injury.  



Ravemtech said:


> When you were immobilised in class,  did the person immobilising you correctly follow Ambulance Victoria's (AV) WI 5.1.11 (ie padding under the torso, head and lumbar).  Most people fail to pad and this leads to pain and pressure sore development.  Strapping is also often done incorrectly thus allowing too much movement.
> 
> The attached document below (which also includes WI 5.1.11) is with Ambulance Victoria at the moment and reviews multiple studies on padding Boards, and the significant difference it makes.
> 
> ...



Yeah it was done to the letter of the law on account of the fact that it was the first time we'd had the procedure demonstrated. Took forever. Never seen it done that way on the road though, which, I suppose echos your point.

Don't get me wrong. I think spinal immobilisation has a role. The derisive tone in my post above was not directed at Australian practices, but rather at the American obsession with boarding everyone. 

My objection to certain uses of the long board is not based on my experience of it being uncomfortable. It was just an anecdotal introduction to my point.  

Thank you for that document. Very interesting indeed. I have to admit I was not familiar with the extent of research into improving comfort. I've been a massive fan of vacuum mattresses for a while too. None the less, what the research says to me is that boards are _less uncomfortable_, not _comfortable_ per se. That means that if a person is pointlessly immobilized, then they may still have iatrogenic back pain, albeit less according to a VAS. The fact remains that when an otherwise perfectly healthy person roles into ED after being on a board for 45 mins, and are asked if they have back pain, they will still say yes, regardless of reductions in VAS, which will then lead to the various pointless investigations. My point is that spinal immobilization is not benign and it should only be applied when indicated, as I'm sure you agree with, and not used in "all trauma" or "all falls" as is still the case in some parts of the US.  

The other thing I was getting at when I said 'augment' is that in a non compliant pt who is intoxicated etc, the lesser of two evils may be just to put them on the stretcher and coach them to lay still (+/- a collar, +/- strapping etc,) rather than wrestling them all the way to the ED while they do themselves a great deal more damage despite being 'immobilized'. That approach seems common here, but I couldn't count the amount of times I've heard stories on this forum about pts being sat on while they swing punches. 

Additionally, I have a big problem with seriously ill trauma pts and sometimes medical pts (paging Vene to beat me over the head for making that distinction  ) being immobilized without indication at the expense of timely transport. Pt experiences syncope of apparently cardiac origin, no indications for spinal immob, clear inferior STEMI, cardiogenic shock, 15 minute scene time blow out because of a "fall" from standing hight. But its okay because they're being "treated for shock" by the firefighter who is holding their legs in the air. That's what I have a problem with.


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## Akulahawk (Jan 6, 2011)

Cervical collars are basically a reminder tool. They generally remind the patient to NOT move their neck. Nothing you can do prehospitally is going to completely immobilize the neck. In fact, the patient him or herself is far more capable of minimizing spinal movement as long as they have motor control over that area than any external device we have available in the field.

Placing someone in full spinal precautions is not a benign event. Unless they're well padded and supported or you can get the patient off the board fairly quickly, you just bought them a stage 1 decub or a few within a relatively short time (like less than an hour). Fortunately, those heal rather quickly. I'm a huge fan of vacuum splints simply because they do fill voids well and allow good weight distribution and support. They can delay onset of decub ulcers for a long time. 

Really, it's little wonder why the ED takes the patient off the board as soon as they can. Done right, those boards do help with patient transfer, remind the patient not to move, contain gross movement... but get them off as soon as possible.

Something to remember: No injury can happen without a mechanism. Not all mechanisms will lead to injury. If you know the mechanism and body/injury kinematics, you can get a pretty good idea where you'll find an injury and where you're not likely to find an injury.

In other words, with traumas, the MOI will tell me where to look and what to be suspicious for. I won't triage to a trauma center based on MOI alone.


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## Melclin (Jan 6, 2011)

Akulahawk said:


> Something to remember: No injury can happen without a mechanism. Not all mechanisms will lead to injury. If you know the mechanism and body/injury kinematics, you can get a pretty good idea where you'll find an injury and where you're not likely to find an injury.
> 
> In other words, with traumas, the MOI will tell me where to look and what to be suspicious for. I won't triage to a trauma center based on MOI alone.



Definitely. If you smack your arm against against a sign post, I'll look at your arm. This often comes up a lot and I'm sure I'm not telling you anything akulahawk, but just to clarify my position and for those playing at home:

There is a difference between targeting your assessment based on mechanism to look for certain types of injuries, and assuming that because of the mechanism, there must be injuries. In the absence of injuries on examination that are indicated by mechanism, 'extremity' of MOI alone is a poor indicator of occult injuries as far as I know.


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## emt_irl (Jan 6, 2011)

Aidey said:


> The longer I do this, the more I have come to dislike c-collars (and backboarding in general). We take these hard, unforgiving things and try and make our patients conform to them...it just doesn't make any sense to me. I would love to see some sort of malleable foam pieces that could be cut or molded to fit each patient exactly. Or even a mold with a foam spray if you want to get really crazy. It wouldn't work to well for patients lying down, but for those sitting up with 360 access it could have potential.



there is such thing. A vaccum mattress, there only new enough in our system but in our spinal cpg it says lsb or vaccum matters. it moulds around them and fully immboalises/splints their entire body


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## zmedic (Jan 6, 2011)

Speaking on MOI, I understand the spinal cord is one long piece, but it still doesn't make sense to me that someone who is shot in the chest needs a c-collar. I haven't been convinced that moving the head really moves the spinal cord in the chest/lumbar region much. The converse also goes for whiplash injuries. Those patients leave the hospital in a c-collar, walking. So I don't understand why someone who gets rear ended at 20 MPH, has neck pain but no back pain needs a board. Just collar them. I know that hasn't been proven with research but someone should get on it.


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## usalsfyre (Jan 6, 2011)

zmedic said:


> Speaking on MOI, I understand the spinal cord is one long piece, but it still doesn't make sense to me that someone who is shot in the chest needs a c-collar. I haven't been convinced that moving the head really moves the spinal cord in the chest/lumbar region much. The converse also goes for whiplash injuries. Those patients leave the hospital in a c-collar, walking. So I don't understand why someone who gets rear ended at 20 MPH, has neck pain but no back pain needs a board. Just collar them. I know that hasn't been proven with research but someone should get on it.



Your asking for some part of spinal immobilization to make sense. Good luck with that.


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## JPINFV (Jan 6, 2011)

zmedic said:


> Speaking on MOI, I understand the spinal cord is one long piece, but it still doesn't make sense to me that someone who is shot in the chest needs a c-collar. I haven't been convinced that moving the head really moves the spinal cord in the chest/lumbar region much. The converse also goes for whiplash injuries. Those patients leave the hospital in a c-collar, walking. So I don't understand why someone who gets rear ended at 20 MPH, has neck pain but no back pain needs a board. Just collar them. I know that hasn't been proven with research but someone should get on it.



...because it's all connected. The spinal cord is a continuous chain of joints and the muscles that move those joints often span multiple joints. The reason why a patient who meets immobilization criteria (using standards such as NEXUS, not just a, "Whoa, look at that mechanism of injury") should be completely immobilized until imaging is the same reason why when immobilizing a bone anyplace else you immobilize the joints above and below the injury. You need to not only stabilize that segment, but also all of the surrounding joints that are controlled by muscles that are anchored on that bone.


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## Akulahawk (Jan 6, 2011)

JPINFV said:


> ...because it's all connected. The spinal cord is a continuous chain of joints and the muscles that move those joints often span multiple joints. The reason why a patient who meets immobilization criteria (using standards such as NEXUS, not just a, "Whoa, look at that mechanism of injury") should be completely immobilized until imaging is the same reason why when immobilizing a bone anyplace else you immobilize the joints above and below the injury. You need to not only stabilize that segment, but also all of the surrounding joints that are controlled by muscles that are anchored on that bone.


Exactly. When "they" say "it's all connected" it's really meant. And the vertebral column is made up of many small bodies, the muscles and ligaments of which do span multiple bodies and joints. Here's an example. From a standing position, bend over as if to touch your toes. Look at the wall in front of you and then try to look at the ceiling by looking under your armpit. You should feel a light tug not only along the back of  your neck, you should also feel a tug further down your back, possibly as far down as the small of  your back. It's all connected.


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## JPINFV (Jan 6, 2011)

usalsfyre said:


> Your asking for some part of spinal immobilization to make sense. Good luck with that.




Personally, I will accept that in a small fraction of patients spinal immobilization may be beneficial. However, how it is currently practiced in the US doesn't make any sense.

1. Too many patients are needlessly being immobilized. There are clinical evaluation tools available to cut down on the number of people being immobilized and they need to be used. Until that happens, any study not being significantly controlled to cut out the "20 mph MVA negative NEXUS criteria" (i.e. doesn't need to be x-rayed) patients, any research is meaningless. It would be like trying to validate the efficacy of naloxone by administering it to everyone who is altered without regard to the etiology of the altered mental state. Just like spinal immobilization isn't going to change the outcome of a patient who doesn't have a vertebral injury, naloxone isn't going to help a patient who is altered because of infection or hypoglycemia. 

2. Better tools need to be implemented. The spine is curved for a reason. Strapping something that is naturally curved to something flat does not work on any level of thought. Just because the tools aren't designed properly doesn't mean that the underlying concepts are flawed.


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## JPINFV (Jan 6, 2011)

Akulahawk said:


> Exactly. When "they" say "it's all connected" it's really meant. And the vertebral column is made up of many small bodies, the muscles and ligaments of which do span multiple bodies and joints. Here's an example. From a standing position, bend over as if to touch your toes. Look at the wall in front of you and then try to look at the ceiling by looking under your armpit. You should feel a light tug not only along the back of  your neck, you should also feel a tug further down your back, possibly as far down as the small of  your back. It's all connected.




This is why certain manual medicine techniques found in physical therapy and osteopathic manipulation looks weird from the outside. For example, manipulating the upper thoracic vertebral column (T1-T4) via muscle energy (for clarification, "manipulating" is more than 'cracking' joints) or articulatory techniques uses the head as the lever using the connecting joints and ligaments.


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## hocomedic (Jan 6, 2011)

I personally think that a lot of these researchers don't have anything else to do excepts scrutinize everything and make them look bad because they have phd at the end of their name. my question is since c-spine collars are so "bad" what are they going to have us use next. i personally like them because they may be uncomfortable but at least they restrict some head movement.


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## firetender (Jan 6, 2011)

Stephanie. said:


> There is now a company making the 'X COLLAR' which allows you to stabilize the head and spine in any position found. They say that it should be less compromise when holding c-spine.
> 
> http://www.xcollar.com



Having read the rest I think this might be a good time to re-post this. I think these guys are on to something. In observing the placement of the device, it appears you have much more control to work WITH the person where they are at...and at their level of comfort...much more easily and WITHOUT needing to manipulate. (If you must manipulate to align the head to fit into the device then the device is NOT appropriate; towels and duct tape will do fine!)

Its ability to adjust front and rear allows you to establish the exact angle you want to maintain manually and then incrementally adjust the front and rear to match. Even looking at the patient and seeing the primary immobilization force is on the chin and chest appears to provide stability without rigid implementation.

My 2 centavos


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## Sandog (Jan 6, 2011)

Here is a good read on this subject. 
http://static.spineuniverse.com/pdf/traumaguide/1.pdf


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## mycrofft (Jan 6, 2011)

*I'd comment but "five is still four". Oh, what the crock.*

*Blanket orders *for spinal immobilization date back to lowest common denominator/fastest dissemination days starting up EMS. Long board (and we used to be required to additionally use a short board as well for extrications or whenever you rotated the patient, remember?) can be made and operated by anyone with a saw, a pencil, 3/4 to 1 inch plywood and access to  screws, screwdriver, and automobile seatbelts. Sandpaper, varnish and auto paste wax optional but so much better.

"Blanket orders" for anything are for ignoramuses, rookies, and people intent on busting other people's chops. Teach people the range of meaures and when to use them and let the art catch up to the science.
OK, back to my corner.


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## zmedic (Jan 7, 2011)

Look, if "everything is connected" then why do patients with known neck fractures walk out of the hospital and live their lives in a neck brace, but no back brace? Why aren't they on bed rest? Because bending their back isn't hurting their neck. Similarly people who fracture a lumbar vertebra are sent out of the hospital with no C-collar, because they don't have a neck injury. 

I know in the field we often aren't sure what is hurt so we immobilize the whole thing. But if patient's who have known fractures are not living life on a spine board with a c-collar on, you have to ask if we really have to immobilize everything if there is a mechanism that makes a fracture of only a part of the spinal column likely. 

As far as the researchers who are out to show "everything is bad," it's more like we recognize that the treatments we do often aren't benign, and that there has been little evidence that they help. Therefore one should be critically examining everything we do.


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## jrm818 (Jan 7, 2011)

I don't have it in front of me now, but I believe either NEXUS or a related studies (or maybe a CT vs xray study) reported a very high incidence of second fractures once a single fracture was identified, and that many of the second fractures were occult and at different levels of the spine.  If I'm remembering properly (and, of course, "I think I read in some study somewhere" is pretty poor evidence), would that perhaps give some support to the idea that, in truly high risk patients, total immobilization may be prudent until more definitive examination is possible (probably CT, maybe MR)?


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## usalsfyre (Jan 7, 2011)

hocomedic said:


> I personally think that a lot of these researchers don't have anything else to do excepts scrutinize everything and make them look bad because they have phd at the end of their name. my question is since c-spine collars are so "bad" what are they going to have us use next. i personally like them because they may be uncomfortable but at least they restrict some head movement.



So somehow having PhD at the end of your name is bad now? This is one more example of field providers somehow thinking the medicine they practice is different from medicine in any other setting. The fact of the matter is c-collars as currently available suck. If you can't get them on without manipulating the neck, then they're useless. "What they need to give us next" is something that works, not a useless piece of plastic that clings to the old days.


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## phildo (Jan 7, 2011)

Back in the 80's in Port Arthur, Texas, we had 2 piece extrication collars that were the best I've used before or since.  You put the front on first, then ran the velcro strap behind the head.  Then you put the back part on. It was taller than the front by quite a bit. and it rendered the wearer incapable of turning their head.  I tried it, couldn't do it.  We had cardboard headbeds that taped to the board, then had a velcro strap for the forehead, and a piece of tape for the chin.  You could carry 20 in your trauma bag and still have room for plenty of other stuff.  Can't remember the brand of the collar.  dang.


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## phildo (Jan 7, 2011)

Necloc!!thats it!!


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## JPINFV (Jan 7, 2011)

zmedic said:


> Look, if "everything is connected" then why do patients with known neck fractures walk out of the hospital and live their lives in a neck brace, but no back brace? Why aren't they on bed rest? Because bending their back isn't hurting their neck. Similarly people who fracture a lumbar vertebra are sent out of the hospital with no C-collar, because they don't have a neck injury.


...because they've been imaged and know what's broken, what's not broken, and where those are. Not every fracture is an unstable fracture. Not every fracture needs a ton of immobilization, but some do. Unlike clinical criteria for immobilization such as NEXUS, if you do immobilize, you need to immobilize everything pending imaging.


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## enjoynz (Jan 7, 2011)

Bring back the sand bags...or maybe a bean or wheat bag is a softer option!

Enjoynz


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## Aidey (Jan 7, 2011)

JPINFV said:


> ...because they've been imaged and know what's broken, what's not broken, and where those are. Not every fracture is an unstable fracture. Not every fracture needs a ton of immobilization, but some do. Unlike clinical criteria for immobilization such as NEXUS, if you do immobilize, you need to immobilize everything pending imaging.



If you need to immobilize everything pending imaging how come so many patients in the ER get taken off the board with the c-collar left on almost as soon as we put them on the bed?


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## Veneficus (Jan 7, 2011)

JPINFV said:


> ...because they've been imaged and know what's broken, what's not broken, and where those are. Not every fracture is an unstable fracture. Not every fracture needs a ton of immobilization, but some do. Unlike clinical criteria for immobilization such as NEXUS, if you do immobilize, you need to immobilize everything pending imaging.



For legal reasons or medical ones do you think?


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## JPINFV (Jan 7, 2011)

Aidey said:


> If you need to immobilize everything pending imaging how come so many patients in the ER get taken off the board with the c-collar left on almost as soon as we put them on the bed?



1. Hospitals generally don't bounce around.

2. There are better options than backboards, such as firm mattresses that don't bounce around. 

3. Too many patients are being needlessly immobilized by EMS systems that still go after having any mechanism instead of basing it off of a physical exam.


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## JPINFV (Jan 7, 2011)

Veneficus said:


> For legal reasons or medical ones do you think?



I'd argue both for the reasons I put forth earlier. I won't necessarily say that the concept of spinal immobilization is useless, just useless to the majority in the current patient population that it is applied to.


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## ParaPrincess904 (Jan 8, 2011)

rhan101277, Where is here? I find that pretty interesting.


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## Veneficus (Jan 8, 2011)

JPINFV said:


> I'd argue both for the reasons I put forth earlier. I won't necessarily say that the concept of spinal immobilization is useless, just useless to the majority in the current patient population that it is applied to.



I don't think the concept is useless, but there seems to be a big problem with the implementation.

I think it is difficult to adapt physical exam as the determining factor because in order to do a proper exam you have to know not only the psychomotor skill but what to expect and when. 

Without going back to the old dead horse argument, which we alredy know, do you see a practical way to transition from the current mechanism based protocols to an exam based protocol usable by all levels?


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## zmedic (Jan 8, 2011)

You could just do something like the NEXUS study. Look at at 20,000 MVAs, see if there are criteria which if were all met, the patient would have a 0% chance of having a thoracic or lumbar fracture. So maybe something like:

1: Minimal damage to car
2: Complaint isolated neck pain, no other injuries
3: Denies back pain
4: No back tenderness bellow clavicals
5: No ETOH or drugs
6: No neuro deficits

if all true apply C-collar, help patient out of car and have sit on stretcher.

Just to be clear, this has in no way been validated. But if you had a big enough database and could show that if such criteria were true you could avoid backboarding those patients. And it's no more exam difficult than the NEXUS exam.


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## Veneficus (Jan 8, 2011)

zmedic said:


> You could just do something like the NEXUS study. Look at at 20,000 MVAs, see if there are criteria which if were all met, the patient would have a 0% chance of having a thoracic or lumbar fracture. So maybe something like:
> 
> *1: Minimal damage to car*2: Complaint isolated neck pain, no other injuries
> 3: Denies back pain
> ...



That alone would eliminate any chance of reducing over triage and applying a LSB.

The very design of today's motor vehicles are to absorb the force of impact, and just like a bicycle helmet or child safety seat, they are destroyed in the act.


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## Aidey (Jan 8, 2011)

But it would help with all the rear-end, rolled into a sign post in neutral, had the rear corner clipped no damage accidents. You would probably be amazed the number of minimal damage accidents that happen where the occupants still get back boarded.


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## Veneficus (Jan 8, 2011)

Aidey said:


> But it would help with all the rear-end, rolled into a sign post in neutral, had the rear corner clipped no damage accidents. You would probably be amazed the number of minimal damage accidents that happen where the occupants still get back boarded.



I don't think I would be shocked, I have seen kids who were hit in the abd.  with giant rubber playground balls and didn't even fall down backboarded and collared.

Consider the amount of focus put on spinal immobilization in EMS classes. You go with what you know right?


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## zmedic (Jan 8, 2011)

Yeah, I've seen quite a few patients who had pretty much no damage to the car and was complaining of neck pain. All of whom would have been put on a backboard under current protocols. 

I guess first you should do a study to sort out how many people get backboarded with minimal car damage and therefore might be a target of such a protocol change.


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## Veneficus (Jan 8, 2011)

zmedic said:


> Yeah, I've seen quite a few patients who had pretty much no damage to the car and was complaining of neck pain. All of whom would have been put on a backboard under current protocols..



How many would you say were "Dewey, Cheatum, and Howe" pain? 



zmedic said:


> I guess first you should do a study to sort out how many people get backboarded with minimal car damage and therefore might be a target of such a protocol change.



I'd like to see a retrospective study on total amount of people backboarded compared to actual injuries that caused secondary cord damage.

Of course the major flaw is that we have only known for a very short period of time that inflammation is the primary cause of secondary cord damage. Which means some of that might have actually been caused by the restriction of the compartments from the board.


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