first spine boards now the c-collar?

[ParaPrincess904]

rhan101277, Where is here? I find that pretty interesting.

 

[Veneficus]

I'd argue both for the reasons I put forth earlier. I won't necessarily say that the concept of spinal immobilization is useless, just useless to the majority in the current patient population that it is applied to.

I don't think the concept is useless, but there seems to be a big problem with the implementation.

I think it is difficult to adapt physical exam as the determining factor because in order to do a proper exam you have to know not only the psychomotor skill but what to expect and when.

Without going back to the old dead horse argument, which we alredy know, do you see a practical way to transition from the current mechanism based protocols to an exam based protocol usable by all levels?

 

[zmedic]

You could just do something like the NEXUS study. Look at at 20,000 MVAs, see if there are criteria which if were all met, the patient would have a 0% chance of having a thoracic or lumbar fracture. So maybe something like:

1: Minimal damage to car
2: Complaint isolated neck pain, no other injuries
3: Denies back pain
4: No back tenderness bellow clavicals
5: No ETOH or drugs
6: No neuro deficits

if all true apply C-collar, help patient out of car and have sit on stretcher.

Just to be clear, this has in no way been validated. But if you had a big enough database and could show that if such criteria were true you could avoid backboarding those patients. And it's no more exam difficult than the NEXUS exam.

 

[Veneficus]

You could just do something like the NEXUS study. Look at at 20,000 MVAs, see if there are criteria which if were all met, the patient would have a 0% chance of having a thoracic or lumbar fracture. So maybe something like:

1: Minimal damage to car2: Complaint isolated neck pain, no other injuries
3: Denies back pain
4: No back tenderness bellow clavicals
5: No ETOH or drugs
6: No neuro deficits

if all true apply C-collar, help patient out of car and have sit on stretcher.

Just to be clear, this has in no way been validated. But if you had a big enough database and could show that if such criteria were true you could avoid backboarding those patients. And it's no more exam difficult than the NEXUS exam.

That alone would eliminate any chance of reducing over triage and applying a LSB.

The very design of today's motor vehicles are to absorb the force of impact, and just like a bicycle helmet or child safety seat, they are destroyed in the act.

 

[Aidey]

But it would help with all the rear-end, rolled into a sign post in neutral, had the rear corner clipped no damage accidents. You would probably be amazed the number of minimal damage accidents that happen where the occupants still get back boarded.

 

[Veneficus]

But it would help with all the rear-end, rolled into a sign post in neutral, had the rear corner clipped no damage accidents. You would probably be amazed the number of minimal damage accidents that happen where the occupants still get back boarded.

I don't think I would be shocked, I have seen kids who were hit in the abd. with giant rubber playground balls and didn't even fall down backboarded and collared.

Consider the amount of focus put on spinal immobilization in EMS classes. You go with what you know right?

 

[zmedic]

Yeah, I've seen quite a few patients who had pretty much no damage to the car and was complaining of neck pain. All of whom would have been put on a backboard under current protocols.

I guess first you should do a study to sort out how many people get backboarded with minimal car damage and therefore might be a target of such a protocol change.

 

[Veneficus]

Yeah, I've seen quite a few patients who had pretty much no damage to the car and was complaining of neck pain. All of whom would have been put on a backboard under current protocols..

How many would you say were "Dewey, Cheatum, and Howe" pain?

I guess first you should do a study to sort out how many people get backboarded with minimal car damage and therefore might be a target of such a protocol change.

I'd like to see a retrospective study on total amount of people backboarded compared to actual injuries that caused secondary cord damage.

Of course the major flaw is that we have only known for a very short period of time that inflammation is the primary cause of secondary cord damage. Which means some of that might have actually been caused by the restriction of the compartments from the board.