http://www.seattlepi.com/health/414631_Neck25.html
Every time I've seen a spinal immob, it seems impossible to apply the collar without moving the head. Doesn't that kind of defeat the purpose?
C-Collars On Their Way Out?
- Thread starter Noodle
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http://www.seattlepi.com/health/414631_Neck25.html
Every time I've seen a spinal immob, it seems impossible to apply the collar without moving the head. Doesn't that kind of defeat the purpose?
I think c-collars are made to minimze movement in the head, but preferably you don't want to move the head at all. I think the problem is that if you don't put on a c-collar on a pt., it is more likely the head is going to move a lot more than what it would have compared to as you're putting it on. So... it's like the lesser of two evils, you either move a lot (w/o c-collar), or you move a little (w/ c-collar), or hopefully you don't even need to move it at all when you put on a c-collar.
JPINFV
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Of course does anyone have a study that even begins to suggest that spinal immobilization protects against secondary spinal cord damage?
I agree that c-collars help more than they hurt, but I was wondering if you guys might have any alternatives.
For example, with the big Ferno blocks, you can also wedge them between the patient's hips and the cot rail to keep the body from flopping around.
Nice to meet you all, by the way!
For example, with the big Ferno blocks, you can also wedge them between the patient's hips and the cot rail to keep the body from flopping around.
Nice to meet you all, by the way!
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Lifeguards For Life
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The debate of risk versus benefit has been going on for some time. Attached is a brief summary detailing one study. There is another study that claims prehospital application of such devices were not applied correctly in most cases.
Hauswald M, Ong G, Tandberg D, et al: "Out-of-hospital spinal immobilization: Its effect on neurologic injury." Academic Emergency Medicine. 5(3):214–219, 1998.
http://www3.interscience.wiley.com/journal/120143495/abstract
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lightsandsirens5
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Excellent info lifeguard.
I have been taught that a person is their own best spinal immobilizer and the collar is an aid to both the pt and the board/headblocks. I would think, in theory at least, that is securing to a longboard is done properly, a collar is not really needed. It merely aids with getting the pt onto the board with minimal movement.
I think there really needs to be a in-depth, long-term study of the benefits of full spinal immobilization.
I have been taught that a person is their own best spinal immobilizer and the collar is an aid to both the pt and the board/headblocks. I would think, in theory at least, that is securing to a longboard is done properly, a collar is not really needed. It merely aids with getting the pt onto the board with minimal movement.
I think there really needs to be a in-depth, long-term study of the benefits of full spinal immobilization.
JPINFV
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Spinal immobolization seems a little bit logical (like treating for shock/trendelenburg position) and also just another CYA method, but probably something under studied (like the trendelenburg position) , yeh?
Ah... Trendelenburg. Another fine medical myth.
Lifeguards For Life
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this particular issue has long since been a favorite of mine, especially since it (among other "interventions") are still all but preached in schools across the U.S
http://www.aapsus.org/ajcm/2009/summer/pdf/ajcm-summer2009-trendelenburg.pdf
http://www.jems.com/news_and_articles/columns/Wesley/the_myth_of_the_trendelenburg_position.html
http://www.caep.ca/CMS/temp/pg48(1).pdf
terrible one
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I would love to see this as well. I fail to see much if any benefit from applying a C-Collar
Yeh, that's why I mentioned it. I read the whole thing on these forums about the trendelenburg position and I figured that the c-collar could almost be in the same situation where not very much studies have gone into it, but it is still widely accepted. *shrugs*
I read the whole thing on these forums about the trendelenburg position and I figured that the c-collar could almost be in the same situation where not very much studies have gone into it, but it is still widely accepted. *shrugs*
Aidey
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What is really nuts is that people are so set in this idea of boarding and collaring every trauma patient they refuse to believe that it may not really help, and that in some patients it may hurt them more.
Case in point. 18 yo girl crashes her ATV without a helmet on. Reported several minute LOC on scene. Dad loads her up into the back seat of the car with her boyfriend and drives to the nearest fire station, nearly an hour away.
The fire station was a BLS station, and when the FFs contacted the patient she has a diminished LOC, was very combative, and wouldn't let anyone near her but her dad and boyfriend. They attempted to put on O2 and a c-collar and she freaked out. Per an EMT on scene she was yelling at them and "swatting" at them. She pulled on the c-collar and thrashed around, and yanked the O2 mask and then the cannula off and threw them. They took off the c-collar, and left her alone and she laid still in the boyfriend's lap. So they decided that since she is moving less they would just leave her alone and monitor her as best as they could while waiting for the ALS ambulance.
The medic on the ambulance FLIPPED OUT. Seriously flipped out. He is still furious about it. She ended up having a skull fracture, intracranial bleed and serious concussion, but no spinal cord injury. The medic can not be convinced that leaving the girl alone was the best thing they could do for her since she moved more when they tried to do anything. I've discussed it with him, and the fact that if she did have a spinal cord injury her moving would have made it much worse than lying still without a c-collar on. I've pointed out that agitating someone with a bleed jacks up their pulse and BP thus encouraging bleeding.
He is still in the mindset that she was a serious trauma and she should have been immobilized immediately, damn the circumstances.
I personally am a fan of Canada's system, using the full body vacuum splints rather than a hard spine board. I feel they are much more versatile, comfortable, adaptable, and they actually mold to the patient offering some support and stabilization. That crap we do on the long spine board with 4 straps is NOT stabilizing at all.
Case in point. 18 yo girl crashes her ATV without a helmet on. Reported several minute LOC on scene. Dad loads her up into the back seat of the car with her boyfriend and drives to the nearest fire station, nearly an hour away.
The fire station was a BLS station, and when the FFs contacted the patient she has a diminished LOC, was very combative, and wouldn't let anyone near her but her dad and boyfriend. They attempted to put on O2 and a c-collar and she freaked out. Per an EMT on scene she was yelling at them and "swatting" at them. She pulled on the c-collar and thrashed around, and yanked the O2 mask and then the cannula off and threw them. They took off the c-collar, and left her alone and she laid still in the boyfriend's lap. So they decided that since she is moving less they would just leave her alone and monitor her as best as they could while waiting for the ALS ambulance.
The medic on the ambulance FLIPPED OUT. Seriously flipped out. He is still furious about it. She ended up having a skull fracture, intracranial bleed and serious concussion, but no spinal cord injury. The medic can not be convinced that leaving the girl alone was the best thing they could do for her since she moved more when they tried to do anything. I've discussed it with him, and the fact that if she did have a spinal cord injury her moving would have made it much worse than lying still without a c-collar on. I've pointed out that agitating someone with a bleed jacks up their pulse and BP thus encouraging bleeding.
He is still in the mindset that she was a serious trauma and she should have been immobilized immediately, damn the circumstances.
I personally am a fan of Canada's system, using the full body vacuum splints rather than a hard spine board. I feel they are much more versatile, comfortable, adaptable, and they actually mold to the patient offering some support and stabilization. That crap we do on the long spine board with 4 straps is NOT stabilizing at all.
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It isn't about what I believe, its about what my medical director assumes responsibility for.
Its his job to stay current on evidence based medicine and publish his treatment guidelines to echo those findings. We operate under his lic. he makes the rules, he wants me to immobilize every patient I come in contact with thats his decision regardless of my beliefs and opinions.
I agree with you completely, however you doc better be on board with your decision especially in such an extreme example you presented, because if he isnt you will be the one blowing in the wind to catch the poop storm thats a coming.
viccitylifeguard
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i was told in class that 97% of the people we board and collar are put through unessary discomfort and procedures. the only other thing i was told was the c-collar is not for immobalization but only a reminder not to more your head .
makes sence to me since any semi consious person can more there head easily
just my thoughts
makes sence to me since any semi consious person can more there head easily
just my thoughts
firetender
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I'm not clear if this thread is about soft or hard C-collars, boarding and immobilizing the head/neck or full spinal immobilization, so I'll comment on most.
I don't even know if soft C-collars (maybe with a "rib" of flat plastic) are in use anymore, but when they were, we called them "reminders". The rigid, adjustables were second-generation reminders, but very limited and easy to cause more damage for the truly injured patient because of it really only being a half-step and with much adjustment needed to seat well.
As far as immobilization goes, the name of the game is cause no further harm. Translated in real terms, if the patient arrives at the hospital, is not immobilized and is found to have a spinal fracture, YOU, Sir or Madam, are screwed! I don't know that there is much choice with this one.
Yet, what the study shows is...and I'm picturing here...a Malaysian is knocking coconuts off a tree, he loses his grip, falls, lands on his head, hyperflexing his neck and loses sensation and movement below his shoulders. One of his Buddies grabs his arms, the other his legs, and head flopping, they run him to a truck, throw him in the back and speed off to the hospital. This guy does better than our guys who we fully immobilize?
He does and I'll tell you why; In the process of immobilization, untrained/unpracticed Responders while trying to immobilize, rearrange much more than the patient's body can handle.
Spinal immobilization (an EMT function, by the way), is an art. It takes a tremendous amount of practice under many different circumstances. The idea is to produce as little movement as possible WHILE you are moving, positioning and supporting the person and putting them into an anatomically balanced package where NOTHING moves.
And the hardest part, if you think about it, is getting every one around you to slow down and coordinate.
In an ideal world, somebody would develop a "Cocoon Spray"!
My point is, there IS a way (or many ways) to do that, but so often speed and expediency take the place of meticulous action. And that's what it takes; slow, deliberate, well-planned (without being micro-managed), and technically precise actions, coordinated with others IF it is clear ONE person is Director or alone if you get an inkling that your "help" are more likely to harm your patient.
It's all about "Proper" immobilization, which means a highly technique sensitive approach to all aspects of immediate intervention. This is not something you practice a couple times in class before testing. This is something worth mastering, and it's also fun to do with others, taking turns, twisting bodies and really, really evaluating. Six people, in pairs and triads with a seventh as Coach/Observer (alternating) in a room with a lot of junk (and rescue equipment and NO equipment) makes a very pleasurable afternoon.
I don't even know if soft C-collars (maybe with a "rib" of flat plastic) are in use anymore, but when they were, we called them "reminders". The rigid, adjustables were second-generation reminders, but very limited and easy to cause more damage for the truly injured patient because of it really only being a half-step and with much adjustment needed to seat well.
As far as immobilization goes, the name of the game is cause no further harm. Translated in real terms, if the patient arrives at the hospital, is not immobilized and is found to have a spinal fracture, YOU, Sir or Madam, are screwed! I don't know that there is much choice with this one.
Yet, what the study shows is...and I'm picturing here...a Malaysian is knocking coconuts off a tree, he loses his grip, falls, lands on his head, hyperflexing his neck and loses sensation and movement below his shoulders. One of his Buddies grabs his arms, the other his legs, and head flopping, they run him to a truck, throw him in the back and speed off to the hospital. This guy does better than our guys who we fully immobilize?
He does and I'll tell you why; In the process of immobilization, untrained/unpracticed Responders while trying to immobilize, rearrange much more than the patient's body can handle.
Spinal immobilization (an EMT function, by the way), is an art. It takes a tremendous amount of practice under many different circumstances. The idea is to produce as little movement as possible WHILE you are moving, positioning and supporting the person and putting them into an anatomically balanced package where NOTHING moves.
And the hardest part, if you think about it, is getting every one around you to slow down and coordinate.
In an ideal world, somebody would develop a "Cocoon Spray"!
My point is, there IS a way (or many ways) to do that, but so often speed and expediency take the place of meticulous action. And that's what it takes; slow, deliberate, well-planned (without being micro-managed), and technically precise actions, coordinated with others IF it is clear ONE person is Director or alone if you get an inkling that your "help" are more likely to harm your patient.
It's all about "Proper" immobilization, which means a highly technique sensitive approach to all aspects of immediate intervention. This is not something you practice a couple times in class before testing. This is something worth mastering, and it's also fun to do with others, taking turns, twisting bodies and really, really evaluating. Six people, in pairs and triads with a seventh as Coach/Observer (alternating) in a room with a lot of junk (and rescue equipment and NO equipment) makes a very pleasurable afternoon.
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firetender
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Hippocrates Replies
I'm not clear if this thread is about soft or hard C-collars, boarding and immobilizing the head/neck or full spinal immobilization, so I'll comment on most.
I don't even know if soft C-collars (maybe with a "rib" of flat plastic) are in use anymore, but when they were, we called them "reminders". The rigid, adjustables were second-generation reminders, but very limited and easy to cause more damage for the truly injured patient because of it really only being a half-step and with much adjustment needed to seat well.
As far as immobilization goes, the name of the game is cause no further harm. Translated in real terms, if the patient arrives at the hospital, is not immobilized and is found to have a spinal fracture, YOU, Sir or Madam, are screwed! I don't know that there is much choice with this one.
Yet, what the study shows is...and I'm picturing here...a Malaysian is knocking coconuts off a tree, he loses his grip, falls, lands on his head, hyperflexing his neck and loses sensation and movement below his shoulders. One of his Buddies grabs his arms, the other his legs, and head flopping, they run him to a truck, throw him in the back and speed off to the hospital. This guy does better than our guys who we fully immobilize?
He does and I'll tell you why; In the process of immobilization, untrained/unpracticed Responders while trying to immobilize, rearrange much more than the patient's body can handle.
Spinal immobilization (an EMT function, by the way), is an art. It takes a tremendous amount of practice under many different circumstances. The idea is to produce as little movement as possible WHILE you are moving, positioning and supporting the person and putting them into an anatomically balanced package where NOTHING moves.
And the hardest part, if you think about it, is getting every one around you to slow down and coordinate.
In an ideal world, somebody would develop a "Cocoon Spray"!
My point is, there IS a way (or many ways) to do that, but so often speed and expediency take the place of meticulous action. And that's what it takes; slow, deliberate, well-planned (without being micro-managed), and technically precise actions, coordinated with others IF it is clear ONE person is Director or alone if you get an inkling that your "help" are more likely to harm your patient.
It's all about "Proper" immobilization, which means a highly technique sensitive approach to all aspects of immediate intervention. This is not something you practice a couple times in class before testing. This is something worth mastering, and it's also fun to do with others, taking turns, twisting bodies and really, really evaluating. Six people, in pairs and triads with a seventh as Coach/Observer (alternating) in a room with a lot of junk (and rescue equipment and NO equipment) makes a very pleasurable afternoon.
I'm not clear if this thread is about soft or hard C-collars, boarding and immobilizing the head/neck or full spinal immobilization, so I'll comment on most.
I don't even know if soft C-collars (maybe with a "rib" of flat plastic) are in use anymore, but when they were, we called them "reminders". The rigid, adjustables were second-generation reminders, but very limited and easy to cause more damage for the truly injured patient because of it really only being a half-step and with much adjustment needed to seat well.
As far as immobilization goes, the name of the game is cause no further harm. Translated in real terms, if the patient arrives at the hospital, is not immobilized and is found to have a spinal fracture, YOU, Sir or Madam, are screwed! I don't know that there is much choice with this one.
Yet, what the study shows is...and I'm picturing here...a Malaysian is knocking coconuts off a tree, he loses his grip, falls, lands on his head, hyperflexing his neck and loses sensation and movement below his shoulders. One of his Buddies grabs his arms, the other his legs, and head flopping, they run him to a truck, throw him in the back and speed off to the hospital. This guy does better than our guys who we fully immobilize?
He does and I'll tell you why; In the process of immobilization, untrained/unpracticed Responders while trying to immobilize, rearrange much more than the patient's body can handle.
Spinal immobilization (an EMT function, by the way), is an art. It takes a tremendous amount of practice under many different circumstances. The idea is to produce as little movement as possible WHILE you are moving, positioning and supporting the person and putting them into an anatomically balanced package where NOTHING moves.
And the hardest part, if you think about it, is getting every one around you to slow down and coordinate.
In an ideal world, somebody would develop a "Cocoon Spray"!
My point is, there IS a way (or many ways) to do that, but so often speed and expediency take the place of meticulous action. And that's what it takes; slow, deliberate, well-planned (without being micro-managed), and technically precise actions, coordinated with others IF it is clear ONE person is Director or alone if you get an inkling that your "help" are more likely to harm your patient.
It's all about "Proper" immobilization, which means a highly technique sensitive approach to all aspects of immediate intervention. This is not something you practice a couple times in class before testing. This is something worth mastering, and it's also fun to do with others, taking turns, twisting bodies and really, really evaluating. Six people, in pairs and triads with a seventh as Coach/Observer (alternating) in a room with a lot of junk (and rescue equipment and NO equipment) makes a very pleasurable afternoon.
JPINFV
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So we shouldn't follow things like NEXUS because the person in the 10 mph simple rear end traffic accident might possibly have a spinal fracture despite displaying absolutely no clinical indication of a spinal fracture?
According to one study, yes he does better or just as well as patients who are immobilized. In cases like that, the damage is done and spinal immobilization isn't going to change or reverse that. Immobilization does not prevent or treat primary spinal cord injury and there's zero evidence that it protects against secondary spinal cord injury. After all, there's a reason why you sleep on a mattress at home and not a piece of plywood. However, EMS seems to think that the natural spinal position is flat.
How do you plan on making it so that nothing moves when the object immobilizing the majority of the body isn't contoured to shape the natural curves? The only possible way is by tightening down the straps which will cause motion in the spine as the spine flattens out.
firetender
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I suppose this is my very point. Work it, work it again and again and you'll find many ways to do the job. This is where simple scenario practice is invaluable.
You use towels, pillows, clothes, sheets, (what ever happened to sand bags?); anything you can fold and mold to stabilize the gaps and support the body in position. If common sense tells you the equipment you're given is not quite up to the task, prepare yourself to figure out your own "supplements" to make it work and make sure you have them on board.
firetender
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Well, to medics oriented toward worrying about their liability in the field (of whom there are many here on this site), NEXUS (under the circumstances of the incident) may not appear adequate for their comfort.
(I try not to say "shouldn't" to anything, to avoid having a shouldy attitude.)
JPINFV
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So why is it that paramedics are more concerned about liability than physicians in the ER?