Boarded another patient today. Found the geriatric pt lying on his right side. Pt was alert, and seemed ok -- but once we boarded and collared him he started to cry and moan about the pain in his neck. Is it me or is boarding and collaring a very uncomfortable/painful experience? *We collared first, then log rolled onto the board maintaning in-line stabilization. This ist he 2nd time a geriatric started to cry AFTER we boarded/collared. Are we doing something wrong?
Boarding a pt (Round 2)
- Thread starter redbull
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It is an uncomfortable position to be in, especially for the geriatric patient, who is more likely to be kyphotic or otherwise have a less-than-flat spinal position. Do you pad all the voids after you put the patient on the board?
The LBB is possibly one of the basic interventions that has the worst combination of time required/potential to be harmful/potential to be helpful. Hopefully the mountain of evidence against it will one day lead to it going the way of the dodo.
The LBB is possibly one of the basic interventions that has the worst combination of time required/potential to be harmful/potential to be helpful. Hopefully the mountain of evidence against it will one day lead to it going the way of the dodo.
Shishkabob
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Except there really isn't a "mountain of evidence" against it. There's one oft quoted study from a 3rd world country being compared to a single ems location stating that there might be some increase in morbidity/mortality.
One study, and a non-reproducable one at that without controls and other guards, does not make a scientific conclusion.
Is it always good? No. But until doctors in first world countries are willing to gamble based on limited information to try more studies, you can't claim its always bad or uncalled for either. (For spinal immob. In general, not just lb)
Use your brain on scene and get your med control to adopt field clearence.
One study, and a non-reproducable one at that without controls and other guards, does not make a scientific conclusion.
Is it always good? No. But until doctors in first world countries are willing to gamble based on limited information to try more studies, you can't claim its always bad or uncalled for either. (For spinal immob. In general, not just lb)
Use your brain on scene and get your med control to adopt field clearence.
Ehhh, well, sorta...
There's only one retrospective, possibly poorly designed study saying it may increase morbidity and mortality. However there is a growing body of evidence saying that being on a board itself is harmful. Pressure sores, pain, heck even the Baylor study about cervical displacement is all evidence against boarding.
What is completely and totally unproven is how HELPFUL spinal precautions are. Everything is speculative, and because some jackass designated immobilization as the standard of care it's darn near immpossible to get liability shy physicians and IRBs to approve real, meaningful studies where outcomes of boarded vs non-boarded patients. So as you say, it may actually prove to be helpful in certain circumstances, but it's clearly not the benign treatment it's made out to be in intial EMS education. Chances are we'll never know how helpful it is because the liability involved in randomized trial is MASSIVE....
I agree with you on C-spine clearance though, it's hard to argue with NEXUS and/or the Canadian rules.
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Shishkabob
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True true... but I can't ever be against something when the argument against it is "It's never been proven to be helpful"... you can't prove what did not happen, only what did. There is just no logical way to go "Well, if we didn't use a backboard he wouldn't have sustained further injury either".
Really, all the most recent studies about BBs really support is more padding and different methods to reduce the sores, and maybe ways to adjust where the support is.
Tempur-pedic backboards anyone?? Dibs on the copyright!
Really, all the most recent studies about BBs really support is more padding and different methods to reduce the sores, and maybe ways to adjust where the support is.
Tempur-pedic backboards anyone?? Dibs on the copyright!
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With the elderly, they often have a bit of a kyphosis. Sometimes that can be very, very pronounced, especially in elderly women (Dowager's Hump). Putting them on a LSB can be quite painful if you try to force them supine. Much padding is required to keep their spine in a neutral position for their condition. Pressure sores can also be a huge problem down the road. A spine board that's properly padded will not cause the sores because the patient won't have any one particular pressure point and they'll be taken off the board before long anyway.
Done right, proper immobilization won't cause or contribute to further harm... Done wrong... at best, the patient gets a painful ride.
Done right, proper immobilization won't cause or contribute to further harm... Done wrong... at best, the patient gets a painful ride.
emtchick171
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Being in full-spinal immobilization isn't comfortable when you're not in pain (i.e. when you practice in class)...and it's even less comfortable when you're actually injured. In fact, when I was immobilized after my wreck...it felt like my spine was digging into the backboard...and the transport being bounced around in the back of the ambulance was bad too!
I couldn't imagine how bad it must be for a geriatric pt. Just be cautious when you spinal immobilize an elderly pt...and if you think they would be better off without the spinal precautions, check with your medical direction or paramedic on scene and see if they will grant spinal immobilization clearance.
I couldn't imagine how bad it must be for a geriatric pt. Just be cautious when you spinal immobilize an elderly pt...and if you think they would be better off without the spinal precautions, check with your medical direction or paramedic on scene and see if they will grant spinal immobilization clearance.
I was more getting at spinal immobilization being of doubtful use than it being hurtful. But since that's already been mentioned, I'll leave it be.
No field clearance protocols here, by the way, even for medics. Though there are certainly times we get to the ER and they're handing us our board back on the way out.
No field clearance protocols here, by the way, even for medics. Though there are certainly times we get to the ER and they're handing us our board back on the way out.
emtchick171
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That's interesting to know, here as a medic you can clear spinal precautions without any medical direction, but sometimes they call anyway just as a "CYA" thing.
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Maybe I missed something, but why did you board him?
Second, put on a c-collar and have somethings strap you to a board. At the very least it's uncomfortable, but when you're elderly and frail, being affixed to the board can be downright painful.
I'm not saying you shouldn't have done it, and it could have been the right thing to do, but what was the mechanism of injury?
Second, put on a c-collar and have somethings strap you to a board. At the very least it's uncomfortable, but when you're elderly and frail, being affixed to the board can be downright painful.
I'm not saying you shouldn't have done it, and it could have been the right thing to do, but what was the mechanism of injury?
Believe me don't take the word of people you never have met, you will have to answer to your medical director if he isn't on board with the c-spine clearance in the field. Recognizing that there is evidence there to suggest it isn't beneficial is one thing free wheeling in the street because you read it on a forum is another.
Speak with your medical director, get his thoughts on it. ACLS has never been proven effective either in cardiac arrest but no one is ballsy enough to put that to the test and have to face the rath of their medical director, you shouldn't either.
You can learn a a lot her but you have to keep it in perspective, you still have to operate in the system that has been provided for you.
the Happy Medic
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The most important thing to keep in mind with C-spine and long spine board application is that they force the body into a non-natural position. i have been boarded for an injury before and I actually suffered a worse injury because of it. I was at a recent lecture here in the East Bay (email me for a link) which cited sources finding 1 in 1066 had an injury that MAY have benefited from precautions while 1 in 60 suffered harm as a result.
However, we have few other tools and protocols that let us deal with unique presentations.
We could "what if" your scenario over and over again to establish the indications for the board, but in the context you mentioned, yes, the board does cause pain and discomfort quite often.
I dislike them but am required to use them.
Justin
However, we have few other tools and protocols that let us deal with unique presentations.
We could "what if" your scenario over and over again to establish the indications for the board, but in the context you mentioned, yes, the board does cause pain and discomfort quite often.
I dislike them but am required to use them.
Justin
I think I'm on sound ground with the national curriculum by giving this advice - if you have a geriatric patient, make sure to pad the voids between them and the board so that they aren't uncomfortable.
You should long board under whatever circumstances your protocols require you to longboard people. Usually, falls and certain traumatic injuries. We can gripe all we want about why those protocols are bad, but they are what they are right now.
You immobilize them the same way you would any other patient, padding voids and trying to make it as comfortable as possible for the patient. All the while understanding that backboarding patients with no evidence of spinal injury is one of the more brutal, idiotic and pointless things EMS does. Then you work to change a ridiculous protocol when your not attending to patient care, with well researched evidence presented to your medical director.
You could always call med control and make a case to break protocol.
I heard somewhere MD stands for "makes decisions"
Actually, after throwing the spine board into the main rotor you would hear shutdown, a door opening and a copious amount of cursing as the pilot got out and stomped a mudhole into Brown and proceeded to walk it dry...
iamjeff171
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i had almost this exact patient last night. found right lateral on ground, stated they just got tripped up and fell, but was complaining of neck and lower back pain in the same locations that they normally have it in, no worse then normal, significant kyphosis. CAOx4 and no neuro deficits. hip was stable.we did some more assessment, but those are the high points. we did not backboard the patient.
we can clear c-spine if: no AMS, no LOC, neuro intact, no etoh/drugs, no pain along spine, and no distracting injurys.
another thing to consider is that a patient can refuse to be put on the backboard.
i hate doing procedures just to "CYA," i think there should always be a justification for your actions beyond, "just because." however, as was stated earlier, if you really question the appropriateness of any intervention you do or do not want to perform, you can always take it out of your hands and call medical direction.
i dont know about the facilities that y'all transfer to, but it is rare for a PT at our level 1 trauma center to be on a backboard for more than a few minutes after our arrival. most of the time the staff starts removing it as soon as the pt is moved to the bed...
we can clear c-spine if: no AMS, no LOC, neuro intact, no etoh/drugs, no pain along spine, and no distracting injurys.
another thing to consider is that a patient can refuse to be put on the backboard.
i hate doing procedures just to "CYA," i think there should always be a justification for your actions beyond, "just because." however, as was stated earlier, if you really question the appropriateness of any intervention you do or do not want to perform, you can always take it out of your hands and call medical direction.
i dont know about the facilities that y'all transfer to, but it is rare for a PT at our level 1 trauma center to be on a backboard for more than a few minutes after our arrival. most of the time the staff starts removing it as soon as the pt is moved to the bed...