Collar, or no collar? Gsw to the head.

Jim37F said:
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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The only place I have seen a scoop around these parts is at my college for the EMT program haha
 
DesertEMT66 said:
The only place I have seen a scoop around these parts is at my college for the EMT program haha
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That sucks, each ambulance here in my dept. carries one. What do you use in it's place, do you only have backboards? Or at least have one of those folding/break away litter stretchers?

Back to your scenario, remove granny from the board once on the gurney and simply document the patient was carried to the gurney? Still seems better to selectively word the PCR than force a patient into full SMR for a hip injury. Unless of course the Receiving Facility docs insist on splinting a patient's neck and back for a non neck/back injury and will complain to Rebel's supervisors causing grief...

That's how I've started referring to C-collars when talking through scenarios with our new guys....why didn't we board and collar the 80 something year old patient involved in the TC? Well he was walking around on scene as well as you and me without any traumatic injuries, in fact his chief (and only) complaint was extreme hypertension. "Yeah but, because of his age and mechanism".....so should we have also applied our bilateral Sager splint on his legs, air splints on his arms and taped trauma dressings to his chest to stabilize possible flail chest segments? No, because we found zero signs/symptoms of those injuries, just like we found zero s/s of a neck or back injury, and just like we don't break out the Sager based on mechanism alone, neither do we with collars or boards.

To circle this mini rant back to the original topic, no collar for a GSW to the head, default of no for the GSW to the neck...but as I've said I can envision a scenario where it can be helpful...but default is no.
 
Jim37F said:
That sucks, each ambulance here in my dept. carries one. What do you use in it's place, do you only have backboards? Or at least have one of those folding/break away litter stretchers?

Back to your scenario, remove granny from the board once on the gurney and simply document the patient was carried to the gurney? Still seems better to selectively word the PCR than force a patient into full SMR for a hip injury. Unless of course the Receiving Facility docs insist on splinting a patient's neck and back for a non neck/back injury and will complain to Rebel's supervisors causing grief...

That's how I've started referring to C-collars when talking through scenarios with our new guys....why didn't we board and collar the 80 something year old patient involved in the TC? Well he was walking around on scene as well as you and me without any traumatic injuries, in fact his chief (and only) complaint was extreme hypertension. "Yeah but, because of his age and mechanism".....so should we have also applied our bilateral Sager splint on his legs, air splints on his arms and taped trauma dressings to his chest to stabilize possible flail chest segments? No, because we found zero signs/symptoms of those injuries, just like we found zero s/s of a neck or back injury, and just like we don't break out the Sager based on mechanism alone, neither do we with collars or boards.

To circle this mini rant back to the original topic, no collar for a GSW to the head, default of no for the GSW to the neck...but as I've said I can envision a scenario where it can be helpful...but default is no.
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We will use what we call a break away flat. It's great for moving people short distances. Once you get them on the gurney you can unlock the hinges at the side and it allows the patient to sit up in a semi fowler position. However due to it being slightly flimsy we do not usually take it anywhere we have to hike to the patient. Each of our ambulances are stocked with one of the flats and 2 backboards.
 
RebelAngel said:
Scoop is not immobilization device, just transport device
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It can be. When we do immobilize someone, we nearly always use a scoop. Then, when we get to the hospital, we can move them to the bed and break apart the scoop so they don't need to stay on the board.
 
RebelAngel said:
Scoop is not immobilization device, just transport device
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Besides the fact that you don't need to immobilize a patient's head, neck and back for a hip injury (unless there's signs/symptoms of a spinal injury), my local protocol says I can use a scoop stretcher as a method of Spinal Motion Restriction:
SMR Methods: (least to most invasive) cervical collar in fowler’s, semi-fowler’s or supine on the stretcher, vacuum mattresses/scoops/skeds, shortboards and keds, backboard and head blocks with straps.
http://file.lacounty.gov/dhs/cms1_206145.pdf
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RebelAngel said:
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?
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Can you show us what your protocol actually says?

Cause that's just downright absurd.
 
Also I heart the scoop. Just wish we could get some new ones with latches that work properly and don't destroy my fingers.
 
Tigger said:
Can you show us what your protocol actually says?

Cause that's just downright absurd.
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I talked to the head of the EMS bureau in our county about the person's scenario specifically. She said yes, we would have to collar if using backboard because of protocols but that the protocols will be changing about back boarding.
 
The scoop...wow. That's not how it is at all going by my state's protocols. Strictly moving device for non trauma pts.
 
RebelAngel said:
I talked to the head of the EMS bureau in our county about the person's scenario specifically. She said yes, we would have to collar if using backboard because of protocols but that the protocols will be changing about back boarding.
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Be a healthcare provider, not a robot. No tool has a single use if you are using a board for patient movement, why would you collar? And don't say "protocol."

Also the scoop is awfully useful for a variety of trauma patients. Do you really think your protocol is outlawing it for use with hip fractures? Of course not.

Critical thinking and problem solving, you can't do this job without them.
 
You raise a lot of good question and I have contacted the head of the EMS bureau to help me understand. I know my state is *** backwards and behind in the times. Changes to protocols are coming slowly, but they are coming.

The only answer I have for that is "protocols", sorry.

Three questions I have about all the posts are:

1-How can you be 100% sure with a hip fracture that there is no injury to the neck or spine?

2-From my practice in class and based on my knowledge the patient in the scoop has to move (wiggle) so they're not pinched. It also doesn't have very good support for the spine. Based on those two things how can you ensure that no further harm would be done to a trauma patient's spine/neck?

3-What have you found in your personal experience that the scoop is useful for?

Tigger said:
Be a healthcare provider, not a robot. No tool has a single use if you are using a board for patient movement, why would you collar? And don't say "protocol."

Also the scoop is awfully useful for a variety of trauma patients. Do you really think your protocol is outlawing it for use with hip fractures? Of course not.

Critical thinking and problem solving, you can't do this job without them.
Click to expand...
 
RebelAngel said:
You raise a lot of good question and I have contacted the head of the EMS bureau to help me understand. I know my state is *** backwards and behind in the times. Changes to protocols are coming slowly, but they are coming.

The only answer I have for that is "protocols", sorry.

Three questions I have about all the posts are:

1-How can you be 100% sure with a hip fracture that there is no injury to the neck or spine?

2-From my practice in class and based on my knowledge the patient in the scoop has to move (wiggle) so they're not pinched. It also doesn't have very good support for the spine. Based on those two things how can you ensure that no further harm would be done to a trauma patient's spine/neck?

3-What have you found in your personal experience that the scoop is useful for?
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The scoop is very useful. I like it on codes with the Lucas since it cradles device better.

I even used a KED the other day for a fall down basement steps: Super limited space and too tight of corners for a full board.
 
RebelAngel said:
You raise a lot of good question and I have contacted the head of the EMS bureau to help me understand. I know my state is *** backwards and behind in the times. Changes to protocols are coming slowly, but they are coming.

The only answer I have for that is "protocols", sorry.

Three questions I have about all the posts are:

1-How can you be 100% sure with a hip fracture that there is no injury to the neck or spine?

2-From my practice in class and based on my knowledge the patient in the scoop has to move (wiggle) so they're not pinched. It also doesn't have very good support for the spine. Based on those two things how can you ensure that no further harm would be done to a trauma patient's spine/neck?

3-What have you found in your personal experience that the scoop is useful for?
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1. You can never be 100% sure of anything. Even with imaging studies, small fractures can be missed. That being said, your physical assessment, if performed correctly and thoroughly, should help rule out spinal injury rather well.

2. This is exactly the point. Backboards don't actually prevent further harm. If you have a patient who has injured their vertebrae and/or spinal cord, that damage is done. Unless you plan on further assaulting your patient, they shouldn't get worse. All injuries are the result of a mechanism that generally exceeds the normal parameters of movement. If a patient is allowed to stand, walk, and/or sit on a stretcher in a calm, self-controlled manner, they shouldn't exceed those normal parameters. It has actually been proven in biomechanics studies that patients who self-extricate and move to the stretcher on their own actually have less spinal movement than those who are moved onto backboards by EMS.

3. Our scoops are actually designed as backboards that come apart (I believe they go by the name Combicarrier). They provide the same support, but they're more useful. I use them pretty much any time I need to move the patient from a tight place, such as a back bedroom or bathroom, or whenever I can't get the stretcher close enough to the patient. Easier to use than the backboard, and all the same benefits.
 
Look at the shape of the spine
1363459147_78010.jpg


Look at the shape of a spine board
Spine-Board-YDC-7B2-.jpg


How well do you think a flat board actually supports a human spine?


For further reading:
http://www.emsworld.com/article/10813735/evidence-against-routine-spinal-immobilization
http://roguemedic.com/2012/11/stop-...y-spinal-immobilizations-in-the-field-part-i/
 
Ivan_13 said:
multiple gsw's with one being in the head, in the right temple area.
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Just to be clear, the opposite side of her head from the GSW to the temple is still there right? Because if not I dont think she needs a c collar.

Jim37F said:
Not all GSWs to the head are fatal.
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That is true! I had a guy come in once saying he was pistol whipped and knocked unconscious. Had a little laceration to his forehead/temple area. Took a CT had a bullet in his head. Made the tiniest dent in skull, no fracture or penetration. Powder in the bullet must have been wet.

If it was indeed in the temple, the bone there is so thin so I imagine the outcome would not be great.
 
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Tigger said:
Be a healthcare provider, not a robot. No tool has a single use
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This, theres not a snowballs chance in hell that I would throw a collar on a person if I'm moving them with a backboard. I would get the "dude what the hell are you doing" look from everyone.
 
samiam said:
Just to be clear, the opposite side of her head from the GSW to the temple is still there right? Because if not I dont think she needs a c collar.



That is true! I had a guy come in once saying he was pistol whipped and knocked unconscious. Had a little laceration to his forehead/temple area. Took a CT had a bullet in his head. Made the tiniest dent in skull, no fracture or penetration. Powder in the bullet must have been wet.

If it was indeed in the temple, the bone there is so thin so I imagine the outcome would not be great.
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A guy I went to high school with shot himself through the head; in one temple, out the other. Today, he has minor vision impairment to his R eye and scars on both temples. All neuro sensory function is intact.

Not the norm by any stretch, but GSWs to the head are not always fatal.
 
gotshirtz001 said:
A guy I went to high school with shot himself through the head; in one temple, out the other. Today, he has minor vision impairment to his R eye and scars on both temples. All neuro sensory function is intact.
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Wow that is impressive. I would love to see his scans and records!
 
We don't spinal gsw. Actually we don't spinal much anymore. The only reason I would spinal a gsw is to move them onto the stretcher. I wasn't there but from the info you gave us this sounds like something I would not transport.
 
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