c-spine clearance
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Shishkabob
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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.
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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Shishkabob
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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.
JPINFV
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Aidey
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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.
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.
Shishkabob
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Or the fact that some patients absolutely refuse the backboard but allow just a collar.
JPINFV
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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."
JPINFV
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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.
LondonMedic
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JPINFV
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the_negro_puppy
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Yes. We never back board patients here.
mycrofft
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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.
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.