Rid was being sarcastic. Freddy did say he was brand spanking new, and asked a legitimate question.
Immobilization: Head Strap, Chin strap, or Head & Chin straps
- Thread starter Freddy_NYC
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Rid was being sarcastic. Freddy did say he was brand spanking new, and asked a legitimate question.
8jimi8
CFRN
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Rid wasn't being sarcastic... people with head injuries sometimes vomit forcefully.
Freddy_NYC
Forum Probie
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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?
8jimi8 & Rid: So you're saying some EMT's hold off on the chin strap if there's vomiting?
8jimi8
CFRN
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don't you think vomit would get all over the strap, or keep the patient from effectively opening their mouth to expel said vomit?
Scout
Para-Noid
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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.
Ridryder911
EMS Guru
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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
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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Scout
Para-Noid
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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.
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.
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.
WolfmanHarris
Forum Asst. Chief
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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.
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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.
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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.