Is anyone in the State of Michigan field clearing c- spine

[pilotmedic]

Pretty much says it all. I want to get the ball going here and it always helps to know if other agencies here in the state are doing this.

Thx

 

[Christopher]

Pretty much says it all. I want to get the ball going here and it always helps to know if other agencies here in the state are doing this.

Thx

I believe Kent County EMS protocols allow for "spinal clearance". Of the MI systems I'm aware of, they're pretty good (I think Life runs out of there).

 

[Anjel]

Pull up Livingston county and HVA protocols. They are up there with the most progressive systems in Michigan.

 

[Anjel]

For me in Oakland county. If there is a significant MOI than a spinal assessment must be preformed.

If there is any head, neck, or back pain than they get a board. Also if they meet any of the following criteria:

Altered Mental Status
Use of intoxicants
Extremity fracture
Motor/ sensory deficit

If none of those then no board even if it is a significant MOI.

 

[pilotmedic]

Thanks everyone for your help

 

[resqguy86]

Ive worked in a few systems in michigan most currently in Macomb County and all the systems I have worked in allow for c-spine clearance. They go along with the nexus criteria which consists of if during the spinal assessment the pt has:

Neck or back pain
Use of intoxicants
potential distracting injury i.e. long bone fx
altered mental status
use of drugs or alcohol

they get a full spinal precautions also even the there is a negative spinal assesment and a mechanism enough to potentially cause spinal injury to anybody over the age of 65 the get a c-collar only.

 

[Anjel]

Ive worked in a few systems in michigan most currently in Macomb County and all the systems I have worked in allow for c-spine clearance. They go along with the nexus criteria which consists of if during the spinal assessment the pt has:

Neck or back pain
Use of intoxicants
potential distracting injury i.e. long bone fx
altered mental status
use of drugs or alcohol

they get a full spinal precautions also even the there is a negative spinal assesment and a mechanism enough to potentially cause spinal injury to anybody over the age of 65 the get a c-collar only.

I've never heard the c-collar only thing. I work in Oakland County. Macomb allows this?

 

[resqguy86]

yep look in your spinal assesment protocol and its in their.

 

[Anjel]

yep look in your spinal assesment protocol and its in their.

Ha well will you look at that. I've never done that or seen it done. I guess I missed the last line of that page.

 

[blindsideflank]

I don't understand what being allowed to clear cspine means. You arrive and do an assessment and decide on a treatment (oxygen, collar, epi). Clearing cspine to mean sounds like you have already deemed that it is a required treatment at which point you can clear it without imaging.

In other words you don't clear cspine, you decide if its a requires treatment (and those criteria are just things to consider in an assessment, just like you consider a hx of htn and diabetes when you approach a chest pain call. They don't turn the chest pain to an automatic cardiac call and you activate a cath lab, you simply consider them in the big picture.

 

[Anjel]

Clearing Cspine is means to justify not back boarding the patient.

So in our case if there is no significant MOI then it is cleared and no back board.

If there is a MOI and any of the conditions I previously listed are present, then a back board is required.

Some systems are getting rid of backboards all together, which is awesome, but we will keep that topic for a different thread.

We are not claiming the pt has no spinal injury. We are just justifying not using the LBB.

 

[blindsideflank]

It just seems irresponsible to have to rile out a treatment to not perform it. Every bug bite gets epi unless they meet this criteria? No. Nobody gets epi unless they show clinical signs and a history consistent with anaphylaxis. Get what I mean? It's backwards to the way we do everything else.

 

[resqguy86]

Blindside flank I really think you should start doing your research and the research as to why we do things. If and when you do that you will then realize how much a back board is hurting people and making them worse off in the long run. I.e. Why a lot of areas are getting rid or away from the use of long backboards I.e. Why we are able to clear cspine on a patient if they truly don't need to be on it. So I encourage you to actually do your research before you comment

 

[Carlos Danger]

It just seems irresponsible to have to rile out a treatment to not perform it. Every bug bite gets epi unless they meet this criteria? No. Nobody gets epi unless they show clinical signs and a history consistent with anaphylaxis. Get what I mean? It's backwards to the way we do everything else.

Exactly.

I don't like the term "C-spine clearance". "Clearance" implies that an injury is suspected or likely due to the clinical presentation, but has been somehow ruled out. But if we suspect an injury to the c-spine, then by definition we can't clear it in the field. The concepts are in opposition to each other.

To me, from both a clinical and medico-legal perspective, it makes more sense to simply not address c-spine stability in the first place. Unless, of course, there is an indication to do so (pain or deformity), in which case you'd need to immobilize or document a really good reason why you didn't.

Who documents on every call that they "cleared" the humerus? Not many, probably. Why not? Because if you don't suspect an injury, you don't treat it, and you don't need to make a big production out of justifying why you didn't treat an injury that you had no reason to believe existed. But applying the logic that we use to approach potential cervical injuries, we should be splinting or "clearing" every long bone in the body on almost every transport.

 

[Anjel]

Just because there is a significant MOI does not mean that the person needs to be on a backboard.