AnthonyM83
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How do we know this?
Ground level fall and the Backboard
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Properly pad a spine board and they actually can do OK for restricting motion. The problem is, how many of us actually properly pad the spine board prior to, and during, applying it to the patient? I would wager that probably very FEW of us (including me) actually do. Use them for what they're designed for and as soon as you can, get the patient OFF the board.
In this instance, a ground-level fall with a patient that recalls the entire event and states that she did NOT strike her head on the way down would NOT make me put her in any sort of spinal restrictions whatsoever unless during my evaluation I found evidence that such an action is needed.
In this instance, a ground-level fall with a patient that recalls the entire event and states that she did NOT strike her head on the way down would NOT make me put her in any sort of spinal restrictions whatsoever unless during my evaluation I found evidence that such an action is needed.
MexDefender
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From the book's perspective you wouldn't have needed to do so because of the MOI but from what I was taught in class by my instructor, when in doubt take extra precautions.
the_negro_puppy
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No no no no no
the quicker American EMS moves away from cookbook medical care the better.
Do you not see how absurd it is to assume that anyone who trips or falls over has a spinal injury?
If the patient was elderly, c/o neck or back pain, with any neuro deficits then it would be another kettle of fish.
If a football player got tackled an broke his wrist would you collar and board him?
the quicker American EMS moves away from cookbook medical care the better.
Do you not see how absurd it is to assume that anyone who trips or falls over has a spinal injury?
If the patient was elderly, c/o neck or back pain, with any neuro deficits then it would be another kettle of fish.
If a football player got tackled an broke his wrist would you collar and board him?
NYMedic828
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Absolutely.
Broken wrist is a distracting injury, obviously this means he has shattered atleast 3 vertebrae.
The problem is its pretty dubious if a LSB provides any "precaution" at all.
MexDefender
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I'm new but is it really for us to decide if a preventive care is necessary or not? giving all the possible care we can is what I was taught but from my clinicals I see its not always the case.
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It absolutely is your job to decide if a potential treatment will be helpful or harmful to your patient! Do some quick research on the efficacy of spinal immobilization and harmful effects associated.
EpiEMS
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It is for us to decide. We have to be educated. Yes, it's up to the medical director, but there is no reason why you shouldn't be a thinking provider of emergency medical care.
Is boarding necessary? Often, no. In fact, in isolated penetrating trauma, back boarding is contraindicated (http://www.ncbi.nlm.nih.gov/pubmed/20065766)!
According to the well-studied Maine spinal clearance protocols (http://www.ncbi.nlm.nih.gov/pubmed/16832265), there seems to be no reason to immobilize. Based on the data, we can say with a high level of confidence the the patient is unlikely to have a spinal injury.
Don't forget about NEXUS, either, folks! It seems pretty adaptable.
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Which is fine, but what exactly would have you "in doubt" here?
epipusher
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Due to not trusting our QI committee, I would full cspine all day long.
MexDefender
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if you are doubting whether or not you should immobilize you should just immobilize. at least that is what our instructor was saying.
What I meant on for us to decide is that I have seen some paramedics not do something even though they should have according to the protocols. The protocols for spinal immobilization and other treatments were put their for a reason and yeah questioning them is to be expected but shouldn't you take that put with your superiors if you do have a problem with it?
This as well.
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America is moving towards cookbook medicine even for its physicians. WHich is probably why it is rated so low on the WHO list of quality medical care.
"We didn't do :censored::censored::censored::censored: for the patient, but at least we didn't get sued" is American medicine.
NYMedic828
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A big problem with American EMS is the instructors. Many times we are looking at the blind leading the blinder.
If there is a question as to whether you should immobilize, than odds are you aren't at the level of experience, both classroom and clinical, that you need to be to be a truly competent provider. More often than not, especially in this case presented in this thread, the need for immobilization should be obvious.
Did you ask those medics why they did something the way they did it? Yes people often do things out of laziness but other times they do it because it was warranted. Our protocols have a line in them that says "these protocols are not to be used in place of good clinical judgement."
Protocols are a guideline to what I CAN do, not what I have to do. I can't exceed their limitations without further approval but that doesn't mean I always need to work to the edge of their limits either.
If it ain't broke, don't try to fix it. Sometimes the best thing we can do for a patient is absolutely nothing. Just because an ambulance was called does not mean we need to find an emergency. If the patient just wants a ride to be checked out at the hospital, so be it atleast let them be comfortable and not unnecessarily straight jacketed to a plastic surf board.
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Protocols are meant to be applied in a clinically appropriate way. There are few "musts" in most protocols, it's all about using them with discretion. If after assessing a patient I find myself wondering if I should spinal, based on some murky results of the assessment, I probably will. But I'm not going to use an intervention just because the book says to consider it.
MexDefender
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I understand now, so there seems to be a big gap between newbies and experienced EMTs. My question now is do experienced EMTs help new EMTs from separating the book from real life events?
NYMedic828
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The gap is not, or atleast should not, be so much based on experience as it should be on baseline education. The minimum standards to be an EMT or medic are substantially lower than they should be. It's a topic that comes up every day or so.
epipusher
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Or it should be: WWCQID?
EpiEMS
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I've never had a more experienced provider (EMT, AEMT, Medic, PA, or MD) not provide me help when I needed it. People are usually pretty good about answering questions.
