c-spine clearance

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palmm

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I am looking for some references for c-spine clearance. I have found a few things but none mentioning having neck pain, applying a c-collar and clearing them from a backboard. Any info would be appreciated.
 
Typically as far as EMS field protocols go, if they are complaining of neck pain, you won't be clearing them in the field. Field clearance comes in the form of "Well, they were in an accident, but they have no complaints" type of thing.

I've yet to even see someone get cleared in a hospital before x-ray when they were complaining of pain or tenderness, as regardless of incidence of fracture, that's one of the zones that pretty much mandates immobilization, in all criteria I've seen.





I suggest Googling the NEXUS Spinal Clearance research done.
 
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has anyone heard of just putting a c-collar on the pt with no back board?
 
palmm said:
has anyone heard of just putting a c-collar on the pt with no back board?
Click to expand...

Yup. I do it fairly often.


I'm one of those people that likes to get a full informed consent from my patients, which means explaining stuff to them. Crazy thought, I know. :P
 
palmm said:
has anyone heard of just putting a c-collar on the pt with no back board?
Click to expand...


Excluding vacuum splints, in regards to EMS? No.
 
A suggestion is defining "neck pain". I don't know how many times I've had MVC patient's who say their neck hurts, and when you ask them to point to the pain it is actually located on the lateral neck/trapezius muscle.

As far as the topic of putting a c-collar on and not putting the patient on a board, I have never seen a protocol addressing that specific situation. I have personally done it a couple of times, in people who could not tolerate the backboard due to extreme kyphosis or respiratory problems. In those cases it was just a matter of documenting why using the backboard would be immediately detrimental to the patient.
 
Or the fact that some patients absolutely refuse the backboard but allow just a collar.
 
We defer immobilization here pretty routinely. Basically, if someone falls or is in a MVC and they are reliable without midline neck or back pain with movement or palpation, they do not get boarded.
 
Linuss said:
Or the fact that some patients absolutely refuse the backboard but allow just a collar.
Click to expand...

Aidey said:
As far as the topic of putting a c-collar on and not putting the patient on a board, I have never seen a protocol addressing that specific situation. I have personally done it a couple of times, in people who could not tolerate the backboard due to extreme kyphosis or respiratory problems. In those cases it was just a matter of documenting why using the backboard would be immediately detrimental to the patient.
Click to expand...

Both of which are significantly different than the prehospital provider saying, "Well, there's neck pain but no back pain, so we can't withhold the long hard voodoo board."
 
This of course assuming the crap that passes for cervical collars isn't VooDoo itself.

There may be a place for spinal motion restriction...but I don't see one in it's current form.
 
I think the fact that you will sometimes see people walking around with rigid collars after being discharged says something to an appropriately placed collar (not the "no necks fit everyone" stupidity). I think the biggest problem is that the net is cast way too wide.
 
I agree, an appropriately sized and applied collar works. The no-neck fits everyone minimally padded lowest-bidder adjustables don't fit that definition very often.
 
We use the C-collar, vacuum splint, and scoop.
Our protocols uses the Nexus c-spine clearance.
 
But sometimes if it quacks it isn't a duck.

Not to run down the comments above, but seen plenty of pts with a C collar only, and most often it was because the person doing the run was incompetent. They should not have applied the collar but it made them (the responders) feel better. Or, they did not examine the pt properly, and did not know what local protocol called for. Every out of jail pt I have had refuse a spineboard also ripped off the collar.
 
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