I can't help but wonder under what circumstances it might be appropriate (from a practical perspective, not so much a lawsuit perspective) for an EMT-B or FR to clear C-spine. Out in the woods, perhaps? In a military setting?
1. Prolonged response time for the ambulance. For comfort reasons, who wants to be on the board unnecessarily for that long? Then there is the medical complications that we could be causing by doing so for hours on end (not everyone lives 5 minutes from a trauma center).
2. Prolonged transport time. Same reasons as above exist with the additional idea that you mentioned of "in the woods". Do you know how hard it is to carry a 200lb person down a trail for hours? If the neck can be cleared, the patient rested, and then assisted in walking out, then so much the better for us and for them. Of course, the comfort of the rescuers is not more important that proper medical care, but when it is not needed, backboarding will cause more damage to patient and rescuers in this case. Plus it ties up resources even in an urban setting.
3. Psychology. The mind is as important as the body. The result of a person being "immobilized" for hours on end lends itself to fear, anxiety, stress, and the belief that "the EMTs think something is wrong with me, my God, I might die!" People who think they will die, tend to find a way to achieve their goal.
4. "Because the protocol says so" should never be the standard for providing medical care. I have a protocol that is very limiting when it comes to selective immobilization (even for medics), and I can tell you right now, I have refused to board people because
I KNEW it would cause more harm. Later I discuss the case with Medics and ER Docs who agree that what I did was "EMSA Wrong", but Medically Right. Had one like that 2 weeks ago. Should have boarded him per protocol and MOI, but the end diagnosis was a exacerbation of a previous cord compression and boarding the overweight patient would have sent his 10/10 pain to a 20/10 pain. That is bad medicine. Oh, and medics were 45 minutes out from me and had a 60 minute transport time on mountain roads; not in the patients best interests to be boarded, so why do it?
5. Patients in pain should not have more pain inflicted by EMTs just because the SOPs from the 1980's say "this is what you have to do or else they will all be paralyzed!" I have know rock climbers to fall hundreds of feet and then be slammed into the wall without any injuries. We have all seen the patient who rolls out of bed and breaks stuff. MOI and protocol can cause more harm than good if imposed on the good and experienced provider. That said, until standards are raised for certification and training, no EMT or EMR (in general) should not be granted the ability to think for themselves without their EMS Cookbook. I shudder the thought when it comes to some of the newbies coming out of the local college.
