in trouble

I don't think you need to worry about a suspension or revocation of your tags. As long as you did proper and thorough documentation of why the patient wasn't immobilized I wouldn't be terribly concerned.

As a general rule, however, its typically better to immobilize the patient if they have any complaint of H/N/B pain with that type of mechanism of injury (assuming the immobilization doesn't exacerbate the issue). The reason its spinal immobilization precautions is because we really can't diagnose that in the field; its a matter of keeping them in good shape until they can be cleared at the ER.

Any time i have a patient that refuses immobilization, they sign a refusal which gets attached to my PCR. Better safe than sorry
 
Before i post this, i will say I am pretty conservative with Spinal Immobilization. I tend to backboard a lot more people then those i work with...

It's not really a matter of "keeping them in good shape", its a matter of protecting yourself from liability... There have been various studies that show that 1) immobilization doesnt decrease injury, but in fact can induce injuries and 2) we dont do this effectively anyway.... Unfortunately, it remains (and probably will remain) the standard of care in the U.S.

check out...
http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.1998.tb02615.x/pdf
(And before i get burned in Effogy, I know there are several flaws with this study. But... It brings up a good topic for the conversation)


spike91 said:
I don't think you need to worry about a suspension or revocation of your tags. As long as you did proper and thorough documentation of why the patient wasn't immobilized I wouldn't be terribly concerned.

As a general rule, however, its typically better to immobilize the patient if they have any complaint of H/N/B pain with that type of mechanism of injury (assuming the immobilization doesn't exacerbate the issue). The reason its spinal immobilization precautions is because we really can't diagnose that in the field; its a matter of keeping them in good shape until they can be cleared at the ER.

Any time i have a patient that refuses immobilization, they sign a refusal which gets attached to my PCR. Better safe than sorry
Click to expand...
 
Trevor said:
Before i post this, i will say I am pretty conservative with Spinal Immobilization. I tend to backboard a lot more people then those i work with...

It's not really a matter of "keeping them in good shape", its a matter of protecting yourself from liability... There have been various studies that show that 1) immobilization doesnt decrease injury, but in fact can induce injuries and 2) we dont do this effectively anyway.... Unfortunately, it remains (and probably will remain) the standard of care in the U.S.

check out...
http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.1998.tb02615.x/pdf
(And before i get burned in Effogy, I know there are several flaws with this study. But... It brings up a good topic for the conversation)
Click to expand...

Doesn't that mean you backboard liberally?

And yes, we are constantly reminded of how much we overuse longboards, oxygen, ALS, etcetera
 
Trevor said:
It's not really a matter of "keeping them in good shape", its a matter of protecting yourself from liability...
Click to expand...
If there are evidence based methods to determine when immobilization is indicated besides the presence or absence of trauma, is immobilizing patients where immobilization is not indicated really protecting you from liability?


Unfortunately, it remains (and probably will remain) the standard of care in the U.S.
Click to expand...
Is it the standard of care? Meh, maybe. Is the standard of care slowly changing to where the indication for immobilization is more restricted than "trauma? Y/N?" Definitely. Will there be a day when backboards go the way of mast pants? Most likely.
 
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AMF said:
Doesn't that mean you backboard liberally?

And yes, we are constantly reminded of how much we overuse longboards, oxygen, ALS, etcetera
Click to expand...

yup, your correct, sorry i was distracted by my partner's snoring when i typed that... :)
 
JPINFV said:
If there are evidence based methods to determine when immobilization is indicated besides the presence or absence of trauma, is immobilizing patients where immobilization is not indicated really protecting you from liability?

No its not... Im talking about backboarding people, when it IS indicated (like as the OP made it sound like it was), when you have a pretty good feeling that backboarding, as a whole, doesnt do what it is "thought" to do. Ex: You ever run those car wrecks where there is almost NO mechanism, but someone says they have midline C spine tenderness? Do i board those people? You bet your *** i do? Not because i think they have a C spine injury (despite there being a VERY, VERY, VERY, VERY small chance they may) but because its 1) standard of care and 2) in the off chance they do have a spinal injury (and i dont "borad em' " I could be hung out to dry... (by both my company AND a lawyer...

Is it the standard of care? Meh, maybe. Is the standard of care slowly changing to where the indication for immobilization is more restricted than "trauma? Y/N?" Definitely. Will there be a day when backboards go the way of mast pants? Most likely.
Click to expand...

I dont see backboarding going away anytime in my career...
 
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When I was brand new I never thought atropine would go mostly out of ACLS, three stacked shocks would go away, titrated O2 would be a recommendation, we wouldn't intubate arrest...

That's just in a decades time.
 
Trevor said:
[/B]
I dont see backboarding going away anytime in my career...
Click to expand...
I don't see back-boarding going away completely either. I see it evolving to a more assessment-based determination of whether or immobilize or not. Of course that will mean that there'll have to be more education in the area of physical examination of the spine...

I also see a change in HOW we do spinal immobilization. In particular, I see hard boards going away and some variant of that used for the "transfer" between the scene and an appropriately set-up ambulance cot along with a LOT more in-depth neuro checks performed at each transfer. This will, however, have to coincide with a change in lawsuit mentality, in particular, fear of the lawsuit as what will have to occur on that end is that lawsuits will have to be tossed out on their ear as long as proper procedure and documentation is done.

IMHO, it's not simply number of hours of education one is exposed to... it's the quality of education within those hours that matters and whether or not the student has absorbed that material.
 
JPINFV said:
If there are evidence based methods to determine when immobilization is indicated besides the presence or absence of trauma, is immobilizing patients where immobilization is not indicated really protecting you from liability?


Is it the standard of care? Meh, maybe. Is the standard of care slowly changing to where the indication for immobilization is more restricted than "trauma? Y/N?" Definitely. Will there be a day when backboards go the way of mast pants? Most likely.
Click to expand...

I would just like to point out Rhode Island still uses EOAs and MASTs :).
 
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