okay... i'm an emt in ny state, and i have never seen that. please post where you are quoting that from. C-spine considerations not only are part of the scene size up done PRIOR to AVPU, but if you didn't do it that way on the practical you would have failed. so i'd really like to know where you got that from.
the c-spine consideration is due to mechanism, which is determined PRIOR to reaching the patient. if you talk to him, it is possible to rule out c-spine, but it is applied FIRST before talking and ruling it out.
what if he hit is head and doesn't remember? what if the pt is unconscious??
i don't know of any NYS document that says what you said.
I will have to reference the state sheet...in class they have been telling us to to talk to the patient first, because let's say in an auto accident, you get in behind the pt for c-spine immobilization, and you just grab the guys neck from behind, he's prob gonna freak and move. if you walk up to them from the front, talk to them and in the process say something to the effect of "my partner is going to come up behind you and hold your neck, I want you to remain still and dont move your head" then you can get an idea of your LOC and do c-spine.
I just used an MVC as an example, but if its like for a hurt extremity or something, in the process of of doing LOC and initial assessment, we will ask the pt "did you fall?" in which case we will then consider c-spine also.
I'm not disagreeing with you at all, but thats what they teach us. I have the NYS protocol book and I am going to go look it up for my own information because I don't want to screw that up on the exam. Personally, I'm a big fan of erring on the side of caution and collar/boarding people. If we are called for something medical, and the person is on the ground and no one saw how they got there, then I'm collaring and boarding them no matter what the medical emergency is because their medical emergency may have just lead to a trauma. If theres a person there that said they helped them to the ground or the pt laid down them selves, then I'm not so concerned about it. If a person fell down a flight of stairs and hurt their leg, I'm collaring them and boarding them. I actually had that the other day, when I was on a basic ambulance, we had someone complaining of pain in their ankle after they slipped and fell down a flight of stairs. the person was never boarded or collared, and I asked the EMT i was with why they didn't do it. when they asked the person if they hit their head, they said they ddin't think so, but they could still have a back, head or neck injury and just not know it yet.