Clearing C-Spine in the field

does your service clear c=spine in the field?

  • yes: ALS only

    Votes: 8 25.0%

  • Yes: ALS and BLS levels

    Votes: 11 34.4%

  • No:

    Votes: 13 40.6%
  • Total voters
    32
  • Poll closed .
J

johnrsemt

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how many area clear c-spine in the field?

Reason I am asking is that in Indianapolis where I just did 10 years in EMS, they have been clearing c-spine, (with 5 criteria met), for almost 5 years.

here in Utah, the ED doc's and Medical directors think that is the worst thing they have ever heard of.

I know that they have been doing it in North Carolina, where one of our supervisors came from.

Where else?
 
I can clear C-Spine in the field. Of course certain criteria must be met to even consider clearing C-Spine. Then, if the attendant feels that C-Spine can be cleared there is a process that you have to go thru in order to clear C-Spine.
 
Many AR and OK MDs think the same as well.

johnrsemt said:
how many area clear c-spine in the field?

Reason I am asking is that in Indianapolis where I just did 10 years in EMS, they have been clearing c-spine, (with 5 criteria met), for almost 5 years.

here in Utah, the ED doc's and Medical directors think that is the worst thing they have ever heard of.

I know that they have been doing it in North Carolina, where one of our supervisors came from.

Where else?
Click to expand...
 
What I have found is how educated and up to date the EMS director or ER doc's are. Those that have recently participated in the war tend to understand our job better and as well have an increased knowledge.

We recently had a emergency physician give a lecture to medics about the advantages of field clearance on limited C-spine injuries. Shameful is that he needed to also discuss this with ER and EMS physicians.


R/r 911
 
We've cleared c-spine in the field. I checked off "ALS only" because all of the trucks are mixed paramedic and basic or double paramedic, so they always have the last say.

I have to say, I've seen a few injured patients come into the ER with cleared c-spines and thought, "really?" Like the boy who was hit by a car (low speed auto vs. ped) and fell on his head. I was a little mystified that they cleared his c-spine in the field, but I wasn't there, and therefore have little place to tell.
 
One of the Pediatric Emergency Medicine Professors here is almost done with a study about clearing C-spines in the field. She is looking at whether the restriction of movement on a child, a terrifing experience, is worth it in all cases.

I remember an incident a month ago where a child came in from another facility where the other facility already cleared C-spine but didn't send the films with the child. The case attending (A PEM fellow) was ok with not re-c-spining him, but the surgery resident that came down wanted a c-collar on him with manual immobilization provided until he could look at the films. Once he discovered ther films wern't there, he ordered films, and cleared, but the surgery attending came down and wanted more views, so here we go again re c-spining the poor kid.

Was it really worth it to the kid? (and I don't have an answer for this one, its for you to decide) Sure, the outlying hospital can make a mistake, and it's our liability if we didn't c-spine him, but he was not happy about being tied down and unable to move.
 
WuLabsWuTecH said:
One of the Pediatric Emergency Medicine Professors here is almost done with a study about clearing C-spines in the field. She is looking at whether the restriction of movement on a child, a terrifing experience, is worth it in all cases.

I remember an incident a month ago where a child came in from another facility where the other facility already cleared C-spine but didn't send the films with the child. The case attending (A PEM fellow) was ok with not re-c-spining him, but the surgery resident that came down wanted a c-collar on him with manual immobilization provided until he could look at the films. Once he discovered ther films wern't there, he ordered films, and cleared, but the surgery attending came down and wanted more views, so here we go again re c-spining the poor kid.

Was it really worth it to the kid? (and I don't have an answer for this one, its for you to decide) Sure, the outlying hospital can make a mistake, and it's our liability if we didn't c-spine him, but he was not happy about being tied down and unable to move.
Click to expand...

two sided coin:

On one hand the child may have been more at ease with limited C-spine control, and actually moved around less. then trying to struggle against the restraints and causing an injury. Sedation? certainly the MOI was there to warrent full c-spine. If there was no apparrent head / neuro injury?
 
We can but only on wilderness calls. If we're in the real world then only as an ALS skill.
 
Same. I can perform it in the wilderness, not sure if I ever would... but thats a different story. Boston EMS has a waiver to allow their Basics to clear it in the case of MVAs, and I understand they boast a high success rate. I'm not sure that it's an ALS skill in MA.. I dont recall mention of it in the protocol book...
Does anyone have data on the rate of successful clearance (proper clearance when there was no indeed no injury)? How about c-spine clearance in the case of LOL slip and fall hip fx?
 
I don't know that I'd chance it. Better be safe than sorry.
 
MedicMeJJB said:
I don't know that I'd chance it. Better be safe than sorry.
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Risk what? Not doing a procedure with questionable efficacy but potential for major side effects? It's like saying we should use MAST pants on all patients just to be safe.
 
Therre will always be some boneheaded botchups, don't hobble us all.

I work under a standarized procedure set nearly three inches thick (someday they will learn to duplex copy), and still the variety of treatments occuring is sadly hilarious. I have had co-workers do their verson of C-spine immobilization on pts with no real indication just because the pt complains, then take it off and let them walk away as they should have done in the first place. The good news is that no one has actually been injured by us because the real need for C-spine in all valid cases was so apparent that it happened. Also, because no one was dropped during one of these clusterbotches.

I have a study here someplace that says field c spine clearance decisions frequently did not agree with the receiving hospital's evaluation. It did NOT indicate if there was a trend in outcomes or treatment requirements positively linked to field clearances (i.e., did field cleared patients require signifcantly longer hospitalizations, die, wind up paralyzed more frequently than those blindly C-spined?).

I've been "ragged out" four times for not doing C-spine precautions, each time initiated by a desk-driver, and twice they were not MD's. Each time I was vindicated; the pts did not experience C-spine injury. If you can trust your well-trained and refreshed people in the field, fine. If they are Bozos on your busses, then longboard every last living patient just to be safe.
 
Spinal immobilization is basically a myth. Unless there are peripheral neuro deficits with neck/back pain its useless

Clear c-spine on all levels of providers
 
How about hospitals which keep people in C spine after being admitted?

Study shows outcomes are not positively affected by continuation of spineboard once the pt has been clinically cleared. I think it was Rid noted earlier and elsewhere, there are clinical drawbacks to spineboards like decubiti. If you boarded me flat my airway would close.

C spine was invented to facilitate extrication from auto wrecks, then expanded to other venues, and the specter of the "hidden spinal fracture" hovered over all.
 
MedicMeJJB said:
I don't know that I'd chance it. Better be safe than sorry.
Click to expand...

I usually C-Spine patients more times than not. But there are those times where, based on their MOI, they fall under the "C-Spine Protocol" so after doing our thang, I will put them thru the "C-Spine Test" and clear them. An example of that is, this one lady became unconscious while playin a sport, fell and smashed her head on the ground (her head broke her fall from what I gathered) so after she came around, and we did our thang - Primary and first half of Secondary, than during the Head-to-Toe exam, I put her thru the "C-Spine Test" and cleared her from having to get boarded and spend a few hours on an uncomfortable board and tie up an ER bed, yadda yadda yadda.

If you can clear C-Spine in the field it all really comes down to your critical thinking skills. Would I have cleared a young boys C-Spine after being struck by a car? Probably not. But who knows what was going on.
 
The regional protocols for my area allow for c-spine clearance in the field if:

1. It involves blunt (not penetrating) trauma
2. GCS of 15
3. Pt does not complain of spinal pain or tenderness, there are no neurological deficits, and no spinal deformity is noted.

If the pt presents with suspected intoxication, or even admits to having ETOH that day, then we must board and collar. The "drank ETOH that day" part is pretty broad, but it's a CYA thing I guess. This protocol was suspended a couple of years ago but recently reinstated, so I think our medical director is just being careful. I would guesstimate that probably 80% of the patients that we see for this type of complaint are under the influence of ETOH (and probably 75% of them are in the French Quarter!).

Personally, I think it's a good protocol if applied CORRECTLY.
 
To board and collar patients that had a drink earlier that day...I don't even know what to say. This practice needs to stop ASAP, see my thread about talk of us being replaced by EMTs with less than 100 hours of training if we do not shape up our act and stick to evidence based medicine.
 
daedalus said:
To board and collar patients that had a drink earlier that day...I don't even know what to say. This practice needs to stop ASAP, see my thread about talk of us being replaced by EMTs with less than 100 hours of training if we do not shape up our act and stick to evidence based medicine.
Click to expand...

I agree that this is overkill. That was something that was stated verbally, not written in the actual protocols, and will obviously be taken with a grain of salt. I believe that they were trying to get across that any patient you suspect of ETOH use presenting with blunt injury to the pertinent areas should be boarded and collared.
 
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