Backboarding question.

reaper said:
How do you figure this? A KED is an extrication device. A LSB is for transport.
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Ambulance stretchers, well ours at least, are designed for minimal movment to allow the pt to be removed from the spine board. Have you ever been strapped to a LSB & driven around? I would suggedt that you do before you respond further.

The LSB was originally designed to assist with extrication, to provide further immobilisation of the spine, however, i would suggest that you have a real good look at a person lying on a LSB, then look at all of the naturla hollows. If we are trating this patient as suspected with spinal injuries, should we not be trying to make them more comfortable & dont try to lie & tell me you fill in those hollows for patient comfort.
 
Ambulance stretchers, well ours at least, are designed for minimal movment to allow the pt to be removed from the spine board.
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I have yet to see a stretcher, here, that allows you to remove the patient from the backboard and still maintain spinal percaution/restriction. So very sorry they're uncomfortable, but I'd take a little bit of uncomfortablness over a lifetime of paralysis any day.
 
downunderwunda said:
The LSB was originally designed to assist with extrication, to provide further immobilisation of the spine, however, i would suggest that you have a real good look at a person lying on a LSB, then look at all of the naturla hollows. If we are trating this patient as suspected with spinal injuries, should we not be trying to make them more comfortable & dont try to lie & tell me you fill in those hollows for patient comfort.
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Welcome to the good fight my friend, I have been trying to bring the uselessness of spineboards to light for years. But despite the the mounting evidence they are useless for their prescribed task and can actually cause harm, providers in the US have been programmed to believe they alone solve the spinal immobilization issue. Never mind the anatomy or physiology of paralysis. It's all about the board.

What makes it even better is if you did what was best for your Pt. and not put him on the board, you would surely lose the lawsuit filed against you, because the unyielding standard of care in the US is the LSB. So come hell or high water, we will bend the curves of the back, inhibit breathing, comprimise airways, cause cutaneous lesions, and make the patient as uncomfortable as possible so they squirm around to boot.

The US is quite ethnocentric, go over to studentdoctor.net and listen to them babble on for hours how any physician not trained at a US school is second rate. Look at how many CISD teams exist, despite the fact the British proved that is harmful. If you figure out a way to get people to stop mindlessly performing skills they have embraced like the true faith religion please let me know.
 
downunderwunda said:
Ambulance stretchers, well ours at least, are designed for minimal movment to allow the pt to be removed from the spine board. Have you ever been strapped to a LSB & driven around? I would suggedt that you do before you respond further.

The LSB was originally designed to assist with extrication, to provide further immobilisation of the spine, however, i would suggest that you have a real good look at a person lying on a LSB, then look at all of the naturla hollows. If we are trating this patient as suspected with spinal injuries, should we not be trying to make them more comfortable & dont try to lie & tell me you fill in those hollows for patient comfort.
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Plus the precursors to decubitus ulcers form in as few as 10mins in healthy, younger patients placed on the LSB. Imagine the elderly.
 
Sasha said:
I have yet to see a stretcher, here, that allows you to remove the patient from the backboard and still maintain spinal percaution/restriction. So very sorry they're uncomfortable, but I'd take a little bit of uncomfortablness over a lifetime of paralysis any day.
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How often is a LSB responsible for actually preventing paralysis? I would assume the number is rather low.
 
Veneficus said:
Welcome to the good fight my friend, I have been trying to bring the uselessness of spineboards to light for years. But despite the the mounting evidence they are useless for their prescribed task and can actually cause harm, providers in the US have been programmed to believe they alone solve the spinal immobilization issue. Never mind the anatomy or physiology of paralysis. It's all about the board.
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As I said earlier in regards to the high speed accident scenario (assuming no complaints from the patients in terms of pain, neurodeficits, etc). The logical side of my head would say probably not while the part of my brain that doesn't want to listen to my coworkers clamor on about how it doesn't hurt anyone, the patients aren't on it that long, how we don't have x-ray vision (but apparently the physician does when he medically clears the patient instead of radiologically clearing the patient), and liability concerns (because it's better to induce an injury in fear of a phantom than just ignoring the phantom).

Just remember, EBM in EMS stands for emotionally based medicine, not evidence based medicine.
 
Sasha said:
Was it an optometrist or podiatrist clearing C-Spine? They all went through medical school, but they don't necessairly see enough spinal injuries to be up to snuff with their assesments.
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I thought it was Opthamologist's who were MD's and Optometrist's are non MD's.
 
fortsmithman said:
I thought it was Opthamologist's who were MD's and Optometrist's are non MD's.
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Tomatoe tomatoe. You know what I meant.

Edit:You know... that really looses it's meaning when posted instead of spoken.
 
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JPINFV said:
As I said earlier in regards to the high speed accident scenario (assuming no complaints from the patients in terms of pain, neurodeficits, etc). The logical side of my head would say probably not while the part of my brain that doesn't want to listen to my coworkers clamor on about how it doesn't hurt anyone, the patients aren't on it that long, how we don't have x-ray vision (but apparently the physician does when he medically clears the patient instead of radiologically clearing the patient), and liability concerns (because it's better to induce an injury in fear of a phantom than just ignoring the phantom).

Just remember, EBM in EMS stands for emotionally based medicine, not evidence based medicine.
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HVLA is not injurious. ;) sorry, couldn't resist.

EMS providers are focused more on subluxation rather than all the mechanisms of paralysis. I cannot recal a subluxation that didn't present with deficit. (and I have seen quite a few) The amount of musculature holding the spine in place is considerable. A lot of it has evolved specifically to. Can anyone realistically say putting somebody on a board stopped a potential paralysis? How about cause paralysis when it limits the potential space for swelling shutting off circulation to the cord? (inquiring minds want to know)

BTW, that is my favorite spineboard study.
I am still waiting for my xray vision, I haven't gotten it yet. But I have had a healthy dose of anatomy that reminds me how pathetic LSBs are.
 
downunderwunda said:
Ambulance stretchers, well ours at least, are designed for minimal movment to allow the pt to be removed from the spine board. Have you ever been strapped to a LSB & driven around? I would suggedt that you do before you respond further.

How do you move your pt once at the hospital? Yes. I have been on plenty of LSB! So I do know how it feels.


The LSB was originally designed to assist with extrication, to provide further immobilisation of the spine, however, i would suggest that you have a real good look at a person lying on a LSB, then look at all of the naturla hollows. If we are trating this patient as suspected with spinal injuries, should we not be trying to make them more comfortable & dont try to lie & tell me you fill in those hollows for patient comfort.
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Yes, I do pad my pt's on the LSB. I have been on to many and know what is needed to make them more comfortable.



The LSB was designed to imobilize, not extrication. Does it do a perfect job, NO. Do we need them as often as they get used, NO. Until the MD's step up and put an end to imobilizing every mvc or fall, we have no choice. So you must do the best with what you have.

We can argue the use of them all day long on here. It makes no difference. The MD's are the ones that make that decision and I don't see them changing it as a standard, any time soon. They are all worried about the liability issues involved.
 
Even in our area, a call like that would have me backboarding and collaring. We even have to go into the state penn infirmary ready to do all that even though there's a doc there. But our hospital is small enough that the clinic is right there and the docs are our trauma docs. Both of them would have the pt "packaged". I know it seems sometimes like a hassel, but there is always that off chance,,,
 
911cwgrl said:
but there is always that off chance,,,
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Hate to jump on you since you're new, but phrases like this gets thrown around all too often in EMS. The off chance of what, the patient may be a zebra and have an injury? Again, do we splint limbs just because a patient fell on that limb even if there is no sign ir symptom of injury? Do we wear N95 masks on all patients on the off chance that they have TB? At what point do we make the decision that no signs/symptoms just means that there's nothing wrong?
 
Thanks for the Help

You guys told me what I already knew, We should have took c-spine precautions. My partner and Discussed this in length and have decied that anyone within a 24 hour period will get c-spine precautions s/p a fall. Maybe longer if they are c/o pn. As far as the MVC with Pt amb at scene, I may want to lbb the Pt, but that is the Pt decision, not mine. Refusal is what this person will sign if they don't want a board.
Thanks with the help.


Farva
 
Hate to result down to the "It's in the protocol" answer, but be honest. It doesn't matter how much you despise backboarding every trip and fall, but if it's in your protocol to backboard patients with MOIs that have the potential to cause neck/back injury even without a complaint of neck or back pain, are you going to go against it? Are you ready to accept all responsibility and libaility that comes with violating your protocol?

If your protocol allows you to clear C-Spine, however, by all means, clear it 'til your heart's content.
 
As amazing as it might sound, Orange County, CA did not (and, for the most part, currently do not) have written protocols for EMT-Bs and there is no automatic criteria for C-Spine restriction in Mass (there is a list following this clause though "When evaluating for possible spinal injury and the need for immobilization, consider the following factors as high-risk:"). As much as I find a lot of what Massachusetts does bass aackwards, their protocols have a significant amount of wiggle room if you (generic "you") are willing and able to justify your actions.

Let's be honest, though, you can't enact the Nuremberg defense ("I'm just following orders") in terms of treatment. Providers accept responsibility for their treatments regardless of if they are following protocol (strict reading or liberal reading) or blatantly ignoring protocols. Every treatment and omission should be able to be justified by the provider, regardless of what the protocol says.
 
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JPINFV said:
As amazing as it might sound, Orange County, CA did not (and, for the most part, currently do not) have written protocols for EMT-Bs and there is no automatic criteria for C-Spine restriction in Mass (there is a list following this clause though "When evaluating for possible spinal injury and the need for immobilization, consider the following factors as high-risk:"). As much as I find a lot of what Massachusetts does bass aackwards, their protocols have a significant amount of wiggle room if you (generic "you") are willing and able to justify your actions.

Let's be honest, though, you can't enact the Nuremberg defense ("I'm just following orders") in terms of treatment. Providers accept responsibility for their treatments regardless of if they are following protocol (strict reading or liberal reading) or blatantly ignoring protocols. Every treatment and omission should be able to be justified by the provider, regardless of what the protocol says.
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It is easier to justify your actions if you have protocols to support. I'm not saying to blindly follow them with no question. Of course. If you have a patient who forever reason cannot be backboarded, refuses, can't breathe lying down, etc. don't go strapping them to a backboard, but don't use "Well.. They weren't complaining of pain!" as an excuse to blatantly ignore your protocol every time. You might get away scratch free for a long time, but if and once you have a patient who may not have been complaining of pain but backboarding could have made the difference for, you don't have a leg to stand on.
 
...now we're back to the old debate, though, of what constitutes an injury that justifies c-spine restriction and how recent that event needs to be absent of any clinical signs indicating a potential c-spine injury.
 
It's ok to jump on me,,, just don't sqwish me. :) We do have protocals in place for a reason here. The doc used to be a paramedic in colorado and had found where many a times the pt shoulda been under c-spine precautions. To this day she still will say "there's that off chance where something might have happened". I do what I'm told by her for a reason. BUT, I don't see the protocals as a ceiling of care that I give my pt, I see it as a base to build on. We may not be in a vastly populated area, but we take what we do to heart. We work with QRU's and they are the same way. We all have our own opinions, listening to each other should help us all. :blush:
 
JPINFV said:
...now we're back to the old debate, though, of what constitutes an injury that justifies c-spine restriction and how recent that event needs to be absent of any clinical signs indicating a potential c-spine injury.
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It's a vicious circle :]
 
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