Do you know of anyone dying from being placed in spinal immobilization?

[mycrofft]

Positional asphyxia? Airway management problem? Just "sudden death"? Etc?

 

[usalsfyre]

I pose the inevitable counter question, can we identify anyone who has died from NOT being placed in spinal immobilization.

 

[BrushBunny91]

Yes one of my skills instructors who served as a fire/paramedic for 25 years, told us about a call where the passenger of a vehicle accident ceased breathing so he adjusted her airway and consequently died of a broken neck injury.

 

[usalsfyre]

Yes one of my skills instructors who served as a fire/paramedic for 25 years, told us about a call where the passenger of a vehicle accident ceased breathing so he adjusted her airway and consequently died of a broken neck injury.

Sooooo, she would have died of the occluded airway if he did nothing?

Sounds like a typical EMS instructor story designed to scare newbies...

 

[Handsome Robb]

I'm going to answer no to both. I could see some elderly patient dying from sepsis secondary to bed sores caused by spinal immobilization or a left sided CHFer but that would be the medics fault that they didn't catch it, not like they are going to die the second you lay them down...

The sepsis is a long shot

 

[usalsfyre]

The big problem is there's no proof either way because everyone is too scared of lawyers to design and run the study.

 

[Handsome Robb]

So with us being 'behind the times' so to speak in the U.S. when it comes to spinal immobilization, specifically with the LSB when most countries are using KEDs or scoops and collars, do you think it has to do with the lower education standards compared to the rest of the world for our prehospital providers or is there a different factor such as the litigious predisposition of Americans?

Edit: sorry if that sentence doesn't make any sense. It was a long, frustrating day in class.

 

[BrushBunny91]

Sooooo, she would have died of the occluded airway if he did nothing?

Sounds like a typical EMS instructor story designed to scare newbies...

He's not the type to scare with stories, I completely believe him. And yes she in every way and form ceased to breathe. They were attempting to excavate her and her head was forced by the dashboard at an awkward angle.

 

[Handsome Robb]

I think you mean extricate?

Sounds like an error on the extrication crew's part. Not knocking your instructor but I'm with usals on this one. Also, her respirations could very well have stopped due to a transection of her cord above c3-4 prior to her head being manipulated by the dash. If that was the case, if she had survived it would have been a terrible life for her and her family.

 

[BrushBunny91]

I think you mean extricate?

Sounds like an error on the extrication crew's part. Not knocking your instructor but I'm with usals on this one. Also, her respirations could very well have stopped due to a transection of her cord above c3-4 prior to her head being manipulated by the dash. If that was the case, if she had survived it would have been a terrible life for her and her family.

you are correct, she was not found buried in the ground.
True. Lose-lose situations are always an unhappy matter.

 

[Epi-do]

So with us being 'behind the times' so to speak in the U.S. when it comes to spinal immobilization, specifically with the LSB when most countries are using KEDs or scoops and collars, do you think it has to do with the lower education standards compared to the rest of the world for our prehospital providers or is there a different factor such as the litigious predisposition of Americans?

Edit: sorry if that sentence doesn't make any sense. It was a long, frustrating day in class.

Yes, and yes. I think part of it is the educational standards, part of it is the litigious world we live in, and part of it is the but-we've-always-done-it-this-way mentality quite a few providers seem to have. I am sure there are countless other reasons I could come up with, but those are the big 3, IMO.

 

[46Young]

If your pt cannot lie flat for any reason, just KED them, sit them up, and document appropriately. If you're too scared to do that, then call OLMD and have them tell you it's okay. Alternatively, have a conversation with the pt, then document that the pt refused to lie flat on a LSB, but gave consent for a KED/C-collar application.

 

[mycrofft]

I've seen a few who shut down when supinated onto a LSB.

As above, they were all probably not going to make it, but that rollover let their airway slop shut with blood, secretions, floppy airway, and cranial insult.
Other restraint situations require conscientious care to avoid positional asphyxia.