Collar, or no collar? Gsw to the head.

I would suggest that you can roll a patient onto a board for carrying (and inspection/exposure of the posterior) without the whole immobilization rigamarole.

I get what you're saying in that there are probably plenty of hands available, but it's not like you've got other things to do while an engine company boards your patient. You probably shouldn't be doing anything but getting the heck out of there. There is almost nothing "worth doing" on scene with an uncontrolled hemorrhage.

(Obviously in this case it's all probably moot, but still...)
 
Eleventy7 said:
Anyone coming at you aggressively with, "Why isn't this patient boarded?" needs to have a better understanding of "immobilization."
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You can be the one explaining to the trauma doc/medical director why you want to argue over boarding and immobilizationwhen when its what they deem fit for the situation. Its a ship that doesn't sail far.
 
Brandon O said:
I would suggest that you can roll a patient onto a board for carrying (and inspection/exposure of the posterior) without the whole immobilization rigamarole.

I get what you're saying in that there are probably plenty of hands available, but it's not like you've got other things to do while an engine company boards your patient. You probably shouldn't be doing anything but getting the heck out of there. There is almost nothing "worth doing" on scene with an uncontrolled hemorrhage.

(Obviously in this case it's all probably moot, but still...)
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To roll someone on their side, slap a board back there and strap and go, with 6 people there, takes MAYBE ten seconds. I could be getting IV/meds ready. Prepping for intubation.
Multitasking IS a thing. And the more people, the faster things get done.


As stated, "I would not spend time boarding a pt like I would someone who fell from a ladder"

But where I work, if I didn't board, I better have a very very valid excuse. If I say I didn't have time with 6 people on scene, they are going to be less then pleased.
 
They can try to justify it as much as they want. Isn't going magically make immobilization real. Isn't going to change the fact that that very, very, very few people have an injury that would be better managed with a board, that boarding pt's with penetrating trauma show worse outcomes after boarding, that c collars don't actually prevent **** all cervical movement, that c collars can increase ICP, or that c collars can worsen high c spine injuries.
 
If you're mandated to do it in your system, then that's that. Very unfortunate since there is excellent evidence now that immobilizing penetrating trauma is clearly harmful and has no benefit.

But in a more general sense, protocols aside, I'm happiest when uncontrolled bleeding is pretty much tossed over one's shoulder and carried away like a damsel by a Viking raiding party. (Don't even park the rig...) If it doesn't absolutely have to be done on scene, it shouldn't be. A beautifully-packaged fully-ALSed gunshot victim rolling into the ED makes me strongly suspicious they could have been there ten minutes earlier.
 
Being mandated to do so by an archaic system does not mean you are doing the right thing.

Spinal precautions are not indicated for penetrating trauma with no deficits, and there really isn't much to support their use when deficits do exist. The argument that it doesn't take any extra time is silly, considering that the intervention does not improve outcomes. At all.
 
Even in L.A. County, protocol specifically says we should not spend any time applying SMR to penetrating trauma patients....I still think that in the specific case of a GSW to the neck a collar can be useful in holding everything together, but only when applied while in the back enroute to the trauma center...after airway, breathing, bleeding, shock, and other life threats are being managed.

For the original topic of a GSW to the head (and not the neck), a C-collar and LSB are generally about as useful as your traction splint...
 
Jim37F said:
Even in L.A. County, protocol specifically says we should not spend any time applying SMR to penetrating trauma patients....I still think that in the specific case of a GSW to the neck a collar can be useful in holding everything together, but only when applied while in the back enroute to the trauma center...after airway, breathing, bleeding, shock, and other life threats are being managed.

For the original topic of a GSW to the head (and not the neck), a C-collar and LSB are generally about as useful as your traction splint...
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I'd argue that even with a GSW to the neck that a collar isn't useful. It very easily could mask a dressing which is becoming saturated in blood that would indicate poorly controlled or even uncontrolled bleeding.

No one is advocating to violate your local protocols however as protocols change due to evidence against SMR I'd hope that people would change with them and not continue to do it "because that's how we always have."
 
Remember your first day of EMT class? Primum non nocere. If the choice are: follow protocols that endager my pt, or do what's best or my pt... I'm risking the lashing.
 
COmedic17 said:
But where I work, if I didn't board, I better have a very very valid excuse. If I say I didn't have time with 6 people on scene, they are going to be less then pleased.
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Would a valid "excuse" be that several studies show that SMR increases poor outcomes in penetrating trauma patients?
 
Tigger said:
Would a valid "excuse" be that several studies show that SMR increases poor outcomes in penetrating trauma patients?
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Not when it's your protocol.
I don't like backboards. I like collars for tubes. I find it easier to secure tubes with a collar on. But that's about it.
 
COmedic17 said:
Not when it's your protocol.
I don't like backboards. I like collars for tubes. I find it easier to secure tubes with a collar on. But that's about it.
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I think what most are getting at is it's not a valid excuse to site protocol as why you disagree with current evidence. If you acknowledge the evidence but continue the practice due to your protocol that's different. Also, protocols can be changed, why not bring current EBM when it comes to SMR to the attention of your medical direction?
 
COmedic17 said:
Not when it's your protocol.
I don't like backboards. I like collars for tubes. I find it easier to secure tubes with a collar on. But that's about it.
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It's technically in my protocol to immobilize all "traumatic" neck pain. I don't. I explain myself if someone is pissy (rare), and move forward. Still gainfully employed.
 
Here- collar. Unless it is a neck wound.
 
Tigger said:
It's technically in my protocol to immobilize all "traumatic" neck pain. I don't. I explain myself if someone is pissy (rare), and move forward. Still gainfully employed.
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This. Even though that isn't my protocol, is still do similar things. To me, protocols are guidelines, and not hard and fast rules to live by. If I can explain myself and provide evidence as to why I did something, my medical director has no issue with it. As he shouldn't. Protocols are in place to prevent the bad providers from killing people, not prevent the good providers from helping their patients.
 
Protocol in this state is if you collar you backboard and if you backboard you collar. As far as GSW to the head, ABCs trump immobilization. My state has lightened up on the back boarding and leaves it to the discretion of the EMT.

What was patient's priority? Did you suspect injury to the back or neck? Did you use emergency, urgent, or non-urgent moves?
 
RebelAngel said:
Protocol in this state is if you collar you backboard and if you backboard you collar.
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So if you have a isolated hip fracture and the easiest/safest way to get the patient to the ambulance is using a backboard you would have to put a collar on the patient?
 
So...use a scoop? Remove it as soon as she's on the gurney? Or does the protocol still demand a collar as well in that case?
 
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