Back Boarding

[Handsome Robb]

Interesting stuff! What did you mean by clearing C-spine and then assisting walking? Wouldn't walking imply no C-spine problems? Or could they develop?

You can have spinal injuries that don't impinge on the cord thus causing none of the symptoms you would think. (numbness, tingling, weakness, paralysis, yadda yadda)

I had a high cervical fracture playing football in HS. Also had a wicked concussion so I don't remember much but according to the video I was doing plenty of fighting and moving even with a cervical injury. Needless to say I'm very, very lucky to have no deficits.

 

[Mountain Res-Q]

Interesting stuff! What did you mean by clearing C-spine and then assisting walking? Wouldn't walking imply no C-spine problems? Or could they develop?

Not sure what you are asking...

If you have cleared the spine, then you have decided (based on an experienced medical evaluation) that there is no spinal involvement. Therefore, if they can walk... then "Get off your *** and walk! I am not a pack mule!" :rofl: Seriously, I don't care, if you are medically able to walk, then lets hold hands and frolic along the trail, but I am not carrying someone who does not need to be, for my safety and theirs! If they 100% can't walk, then we move to plan B. As far as c-spine issues developing... if their injury did not cause the problem, not sure how they could magically develop. They were either there and were missed by the assessment or are not there; muscular problems, not spinal, which immobilization (by 2 CNAs overnight, in the middle of BF nowhere, until we could get there) will make worse..

Sorry. Wasn't thinking.

Welcome to the club... been that way for a few hours now...

 

[EpiEMS]

Gotcha, I think I get it now.

(My brain to finger filter was not operating properly.

 

[TheGodfather]

Not sure what you are asking...

If you have cleared the spine, then you have decided (based on an experienced medical evaluation) that there is no spinal involvement. Therefore, if they can walk... then "Get off your *** and walk! I am not a pack mule!" :rofl: Seriously, I don't care, if you are medically able to walk, then lets hold hands and frolic along the trail, but I am not carrying someone who does not need to be, for my safety and theirs! If they 100% can't walk, then we move to plan B. As far as c-spine issues developing... if their injury did not cause the problem, not sure how they could magically develop. They were either there and were missed by the assessment or are not there; muscular problems, not spinal, which immobilization (by 2 CNAs overnight, in the middle of BF nowhere, until we could get there) will make worse..

really?

a seemingly "stable" and asymptomatic anterior subluxation could easily progress drastically worse from even the slightest passive ROM...

 

[Bullets]

Ive looked for the nexus study, but ive come across two types of results. NEXUS v Candian, and WHAT the NEXUS is. Im looking for HOW NEXUS decided to put forth their standards.

Ive already got Cochrane

Ive also heard that is increases intercranial pressure, and i understand why, but does anyone have the reasons cited.

We are trying to write this proposal(and hopefully, protocol) to be easily accessible for some of our more...delayed providers. Not so much that we expect them to be breaking the sound barrier, but more for when our advanced (mentally) providers are working with them, we can show them the document and explain why we dont need to backboard every fall, MVC, ect

 

[TheGodfather]

Ive also heard that is increases intercranial pressure, and i understand why, but does anyone have the reasons cited.

http://www.neurospineclinic.com.au/pdfs/journal-articles/hard-collar-icp.pdf

subnote: IMO, I doubt you will be able to get your medical directer to budge even with this article due to the fact that if you have an unconscious patient with MOI significant enough to start getting you worried about the ICP, chances are you will need some type of cervical immobilization for the bumpy transport.

 

[EMS123]

It is a requirement in New York for RECERT or for the provider to take a refresher course... A LOT of training opp. are out there.

By CE's I take it you are refering to Continuing Education Credits. They don;t have to in your neck of the woods? And out here in Calif, I've deen putting out good money every year. I need to move to your state.

We all know Backboarding is overdone in general. If beefing up training is what is needed, fine. But too amny EMT's and Fr I know adhear so closely to following Step 1, Step. 2, Step 3" that they don't think for themselves. If all it takes to run EMS is the ability to follow an instruction manual, then what good ar BLS level providers. There should be criterial for backboarding, but not an overkill of everyhting gets a backboard, it is medically speaking irresponsible, and so may the training standards for certain levels of EMS in certain areas.

 

[Bullets]

http://www.neurospineclinic.com.au/pdfs/journal-articles/hard-collar-icp.pdf

subnote: IMO, I doubt you will be able to get your medical directer to budge even with this article due to the fact that if you have an unconscious patient with MOI significant enough to start getting you worried about the ICP, chances are you will need some type of cervical immobilization for the bumpy transport.

the issue myself and others have is that our protocols are written in such a way that MOI dictates when we provide SMR

"Spinal Immobilization should be provided to any patient experiencing a traumatic incident, including but not limited to: Motor Vehicle Incidents, Falls, Blunt Traumas, or other events that where the mechanism of injury could indicate a possible injury to the spinal column. Spinal Immoblization should also be considered for patients who present with...(NEXUS criteria basically)"

We want to remove that first part, specifically the word "SHOULD". We also want to change the language to say "Spinal Motion Restriction" instead of Spinal Immobilization. We have suggested to basically apply the NEXUS formula and bump MOI consideration to secondary and only if a the provider can state why.

 

[Mountain Res-Q]

really?

a seemingly "stable" and asymptomatic anterior subluxation could easily progress drastically worse from even the slightest passive ROM...

Progress being the operative word; the injury was already there and could become worse with or without backboarding. Me? I would prefer to not be strapped to a board with no control over what happens to me; but be allowed to walk or be assisted in walking with control over my actions. Comfort and control play a role here. Also, remember that my scenario was based on an "in the woods" idea without a known transport time, trail condition, or "the unknowns" that typically eff up the easiest of missions.

Yes, an "in the field" exam could miss many things if you forget you x-ray goggles (in my pack), but the oversimplified explanation I was making was that the chances of causing further injury because protocol says "BACKBOARD THE MOI" are far greater than the cases of not backboarding something that needed it.

 

[DrParasite]

Can you ask him to show you the studies that say a person had a positive clinical experience when they suffered a spinal injury, which was mitigated because they were strapped to a LSB?

if he can't, maybe that should be enough justification for him to rethink their use.

 

[JPINFV]

We also want to change the language to say "Spinal Motion Restriction" instead of Spinal Immobilization.

Is there any practical difference for this request? A duck by any other name is still a duck.

 

[Mountain Res-Q]

Is there any practical difference for this request? A duck by any other name is still a duck.

Truth in advertising. Hard to call it immobilization and expect that from you when such a thing is impossible in the pre-hospital setting. How about changing "Spinal Immobilization" to "Involuntary Spinal Restriction" and changing "Back Boarding" to "Water Boarding". :rofl: