Backboard or not?

[spinnakr]

A spinal injury is not ONE in a million especially if you work in a busy ED. You may see at least one each shift and sometimes many more.

I'm staying out of this debate, but I would like to add one thing: I've worked a grand total of 24 hours in an E/R (in 2 different shifts) while doing "clinicals" for Basic. During that extremely short time I personally witnessed 3 x-ray-confirmed spinal fractures. Admittedly, only one was in the cervical region, but that doesn't change the fact that they were certainly not one-in-a-million. It's really going to depend on where you work.

 

[zmedic]

You're talking about two different samples. One is the "911 was called for someone with some transfer of energy" vs "people presenting to the ED who were given x-rays (ie they couldn't clear them without imaging." Those are two very different population.

Also I'd note that there is a big difference between "vertebral fracture" and "spinal cord injury"

Notice how people with spinal cord injury are treated in the hospital. They are in bed, maybe with a collar on, but certainly they don't live on a backboard. I think we're going to move towards people getting boarded and being removed from the backboard/uncsooped but with a collar until they can be cleared or imaged.

 

[spinnakr]

You're talking about two different samples. One is the "911 was called for someone with some transfer of energy" vs "people presenting to the ED who were given x-rays (ie they couldn't clear them without imaging." Those are two very different population.

If that was a reference to my comment then I beg to differ: these were all patients brought into the ED by EMS crews - and in fact, 2 of the three were brought in by the SAME EMS crew. Somewhere along the line, the former situation happened.

 

[VentMedic]

Notice how people with spinal cord injury are treated in the hospital. They are in bed, maybe with a collar on, but certainly they don't live on a backboard.

Of course the hospital doesn't use back boards. They have halos and tongs to stabilize before and after surgery. Many are taken to the OR within a few hours upon arrival to the ED for surgical stabilization. Then, the patient may go to their room in a cervical collar of some type since that will also vary to the degree of stabilization required.

A few nondisplaced fractures may go straight to a cervical collar which may be worn for 6 - 10 weeks for stabilization but that is only after a neuro consultant sees the patient and a few tests are done.

 

[zmedic]

What you are saying is "out of all the patients at a trauma center that I saw who were brought in by EMS backboarded and collared who got x-rays, 3 had fractures." Fine. But there is nothing in that statement says anything about how common spinal injuries are when EMS is called to a scene. For each of those patients you saw you have no idea how many people were not transported or who were transported and not boarded or who were taken off a board with no x ray.

 

[sdadam]

Did you actually read any of my posts vent?

I never said anything about the prevalence of spinal injuries. I have seen MANY they happen all the time, once again you have replied to a conversation that I didn't know we were having.

I said:

Now in reality the odds of the PT having an unstable spinal injury which any amount of movement would exacerbate is one in a million.

Meaning, not every spinal injury is unstable.

Not every unstable spinal injury causes further damage with movement.

Those that do fall into this category are EXTREMELY rare. This is the proposed reason that spinal immobilization studies repeatedly fail to show the benefit of immobilization. Which JPINFV took the time to post some examples of so I won't repeat work.

I read the article you posted.

Danger at the Door
http://www.ems1.com/ems-products/consulting-management/articles/426350-Danger-at-the-Door/

It had nothing to do with the point that I have clarified above.

You also said:

...it appears from that statement you have not even read the reference section at the end of the JEMS articles, it would truly be a waste of time to point you toward any medical search engine or post a few thousand links. Again, you need to learn the many methods out there for immobilization.

What JEMS articles are you talking about and what references? Or do you simply mean that I have not read EVERY JEMS article ever, and all of the associated references?

You have only posted one article, from EMS one, which has only one reference;

http://www.state.me.us/dps/ems/documents/spinal_assessment_book.pdf

Which is the state of Mains description of spinal assessment protocol. Which interestingly enough states:

The prehospital care of the potential spine injury patient remains a subject of continued debate. This debate has evolved around the larger theories of spine injury processes. Two major theories abound regarding spinal cord trauma. One theory suggests that initial trauma to the spine is solely responsible for cord injury with subsequent care and treatment representing minimal risk of further injury – providing that major axial or rotational loading is minimized. Proponents of this theory have argued prehospital immobilization of the spine as unnecessary due to the relative insignificance of post- injury movement forces compared to initial injury.

Now obviously this is the school of thought that I belong to. Which is in the document that YOU referenced. Now the same document continues to talk about your point of view:

The second theory suggests that energy from the initial traumatic insult is significant and that subsequent movements of the spine can result in injury exacerbation with secondary cord injury. The proponents of this view have frequently promoted immobilization as essential to prehospital secondary injury prevention.

So, since the document you posted seems to think that my school of thought has some merit, would it be possible for you to treat me like a professional with a valued opinion?

Rather than the paradigm we have been using of I'm for sure wrong and lack education and experience, which you can tell based off my opinion. And that you are absolutely right in everything you say even though you continually fail to provide documentation of anything you say, just because you're in-hospital experience as a respiratory care practitioner (according to your Avatar label (RRT)) has made you the ultimate expert in all matters.

You closed starting with:

A spinal injury is not ONE in a million especially if you work in a busy ED.

Who said that it was? Refer to my first quote of what I originally said. It is clearly NOT this.

Just out of curiosity, did you even bother to read my posts? Or are you just sure that there couldn't possibly be anything in there you don't already know?

 

[sdadam]

You're talking about two different samples. One is the "911 was called for someone with some transfer of energy" vs "people presenting to the ED who were given x-rays (ie they couldn't clear them without imaging." Those are two very different population.

Also I'd note that there is a big difference between "vertebral fracture" and "spinal cord injury"

Notice how people with spinal cord injury are treated in the hospital. They are in bed, maybe with a collar on, but certainly they don't live on a backboard. I think we're going to move towards people getting boarded and being removed from the backboard/uncsooped but with a collar until they can be cleared or imaged.

Great points! I agree.

 

[sdadam]

Correct me if I'm wrong Vent, but aren't most to all of the studies validating SSI criteria looking at what assessments correlate to spinal fractures and not whether prehosptial immbolization prevents secondary injury? In fact, are there any studies that show that spinal immobilization with a long back board prevents secondary spinal cord injuries?

Yes!

Thank you for bringing that up as well. I think you understand the point I was trying to make.

Great post, with good references! This was helpful and educational to everyone following the conversation.

Adam