Child in MVA

[WTEngel]

+ 1 firemedic

 

[firemedic1563]

Are you including patients who meet Canadian C-Spine or NEXUS criteria to forgo spinal immobilization?

To be honest, I am not familiar with either. My protocols aside, I feel that if there is a mechanism that carries the possibility of spinal injury, than the patient should be immobilized until injury is ruled out. Keep in mind that the mechanism required is much less for infants and young children. That said, our local protocols and trauma decision tree, much debated nationally and revised following the crash of our Trooper 2, are pretty clear on who we immobilze. We are forbidden to use car seats to immobilize. And any child under the age of 8, who has sustained a "traumatic mechanism which could cause spinal injury" must be immobilized.

I am well aware of the studies. But the fact is that spinal immobilization, at least in the US is the standard of care. Much like NFPA standards and other standards, they may not be law (in many cases, like our protocols, they are), but courts will hold providers to standards of care. Now I can't speak for other areas protocols which may endorse other methods, but I truly beleive a car seat is not an acceptable method of true immobilization, and certainly limits assesment and potentially treatments

 

[Aidey]

I'm curious as to what methods people use to immobilize infants, or those too small for the pediatric back board/mummy wrap.

 

[firemedic1563]

I'm curious as to what methods people use to immobilize infants, or those too small for the pediatric back board/mummy wrap.

Excellent question. Here we carry pediatric immbilizers that I have secured as small as a 1 month to. In lieu of a cervical collar on a small infant, a horseshoe roll(blanket) can be used to wrap the sides and top of head and tape used on forehead and chin. To transfer the infant from carseat to board, lay the seat back, remove straps, place a padded board splint as a bridge between the seat and the board and slide the patient over the head of the carseat onto the board.

 

[medichopeful]

I wouldn't use them to permanently secure the child in the car seat, just on the way to the hospital if it was determined the child would remain in the car seat and the straps were cut.
Hope that makes sense...

Yes, that does make sense, but I don't think you realized what I meant. I probably wasn't clear.

If you are using cravats to secure a seat in an ambulance, and there is an accident, are those cravats REALLY going to do a good job of securing the seat?

 

[EMSLaw]

I'm curious as to what methods people use to immobilize infants, or those too small for the pediatric back board/mummy wrap.

You can use a KED for pediatric immobilization, though I'm not sure it would work for an infant.

An article on it is located here in PDF.

 

[CAOX3]

You can use a KED for pediatric immobilization, though I'm not sure it would work for an infant.

An article on it is located here in PDF.

Good point we often use the KED for immobilization of children.

We have infant devices but we use the ked for the patients that fall in between the infant immobilization device and long board.

 

[RescueYou]

I normally keep it if it passes this checklist:
~the carseat allows for good head/neck/spinal stabilization
~your stretcher allows for it
~the carseat can be safely strapped onto the stretcher
~the seat does not prevent other necessary treatment interventions
~the child is comfortable enough for a ride to the hospital in it with the injuries
~it's not going to be a super hard pain on you to get the whole contraption out of the car
~the child has good ABCs and no significant MOIs
~the scene is completely safe and allows for you to remove the carseat
~the carseat is not covered in any bodily fluids whether they be the child's or not

If ALL of those pass, then I'll normally keep them in it but it always depends on the situation.