Immobilization: Head Strap, Chin strap, or Head & Chin straps

Correct Why would you be puttign tape in contact with the skin?


Bottom tape is on collar top but has a 4x4 between the head and tape or tape gets doubled. I'd freak if i saw tape on skin like that. There I no need.

Rid i dont follow with the vomiting?

Rid was being sarcastic. Freddy did say he was brand spanking new, and asked a legitimate question.
 
Rid wasn't being sarcastic... people with head injuries sometimes vomit forcefully.
 
46Young: thank you for explaining towel rolls. I now have a better understanding of this technique.

8jimi8 & Rid: So you're saying some EMT's hold off on the chin strap if there's vomiting?
 
don't you think vomit would get all over the strap, or keep the patient from effectively opening their mouth to expel said vomit?
 
No the strap, at least here, goes on the collor not their mouth. The Collar therefor would be the only thing preventing? an open mouth. Not that i have ever seen a problem with thes. We just roll to the side, i cant see an impact of a chin strap on this.
 
If you sucesssfully place a chin strap on the patients chin to prevent "slippage" or movement. Then NO they will not be able to open their mouth sucessfully to vomit. Sorry, I have seen this & increase risks or a sure chance of aspiration.

The "chin strap" method was abolished several years ago when the majority of the cervical collars were the whiplash collars made of soft foam and EMS was taught to use Kerlix /king when immobilizing on a short spine board. Remember also the short spine board, the restraining for head was placed in a modified circular pattern.

When the KED device entered the area, big debate was if the chin strap was really needed or even really made a difference? Then with the surplus of cervical collars becoming rigid or hard the "chin" strap is more commonly placed over the cervical collar and not really on the chin itself and personally believe it should not be called a chin strap (since it is not on the chin).

There are a few that still that make a figure 8 type and thus pulling on the chin & forehead. And again, those have a high increase of aspiration, and please do not tell me that it is simple just to turn them over on the side ( I will tell you that you are inexperienced) . Patients vomit rapidly, when the patient inhales there is a high chance of aspiration if any vomitus is in their mouth. Even good suctioning with movement cannot ensure total prevention.

Personally, I do not like any device restraining the mouth area. I have yet seen any device manufactured that really provides true immobilization as it is supposed to be done and most are crap, and only give an illusion of immobilizaition, and yes I have played the majority of them .

R/r 911
 
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Just so i have it clear.

I refer to a stiff neck collar,We typically use a hard foam block with the supplied foam straps. The lower of the two straps does not come in contact with the skin. It is either on the bridge of the chin of the collar, or just below it, but on the plastic of the collar.

Do some places put the chin strap above the collar on the skin.
and when i said just turn it was not to imply simplicity. and i misuse the term immobilization, it is used for simplicity and historic reasons rather than an inference to an actual act.
 
Do some places put the chin strap above the collar on the skin.

I'm sure some people do it, but they should not. The chin strap should not put any downward pressure on the chin as this will tend to close the airway (think reverse jaw thrust). Lifeguards do backboarding without applying C Collars and they are taught to do only the forehead strap and leave the chin strap off.
 
Don't come up my way! Protocols say 2 inch tape right on the forehead just above (if not on<_<) the eyebrows. (Plus the tape under the chin.) The only time we are even allowed to think about doubling the tape over is when the pt is elderly and/or has very fragile skin that the regular cloth tape would lift right off. (We may be starting to carry paper tape for this. Put down a layer of paper tape first, then 2 inch tape over that.) Frankly, I don't see what the big deal is with people doing everything possible to keep tape off skin. What would be more importaint to you, your eyebrows, or the ability to walk? (Not that taping the head eliminates the risks. But if I had a busted neck, I'd want to be as immobilized as you can get. In the field, that means full spinal precautions. It seems to me that when the tape is not in contact with the skin, the pt is able to move their head alot more.)

Your protocols are that specific? Ours says, "perform c-spine immobilization" the rest is left to us to do as taught and as appropriate to the patient's condition.

Generally I do have tape in contact with the patient's skin (Cloth 2" bandage tape) but I can definitely see the problems with it. Namely, how many of our SMR's end up as cosmetic? Without the ability to clear c-spine in the field, quite a lot. So if your patient walks out of the ED after two, three hours with nothing wrong with them, was the discomfort you added with the tape in their hair still worth it? Maybe, maybe not.

Now consider the amount of research that supports SMR? Very little, and none of it of the best quality. We continue to do it as common sense medicine and because ethically how do you test for this? How many case studies are on the book showing poor SMR leading to neurological deficit or any other increased morbidity?

Restrict motion? Definitely. Ensure a patent airway that can be cleared easily? Definitely. Worry about which taping method is the be all and end all of SMR? Not so sure.
 
How many of you work at a service that doesn't have to c-spine every MVA patient ?
 
How many of you work at a service that doesn't have to c-spine every MVA patient ?

Lots of threads around this forum on the subject if you look around a bit :)

No where I've ever seen has automatically required SMR of every patient from an MVA. I know there are services from the Dark Ages still out there, but something that asinine would be a deal breaker for me.
 
How many of you work at a service that doesn't have to c-spine every MVA patient ?

The service I work for uses the canadian c spine rules. When I worked in maine we used a modified nexus.

In our next protocol update we may no longer use boards for transport (fingers crossed). The state of nh and services throughtout the usa have already adopted this.
 
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