Neckbrace out of ATLS

[Dutch-EMT]

There are rumors that the neck-brace (stiff-neck ® and other brands) will disappear out of the EMS protocols.
Are there in the USA ambulance-services who already removed the neck-braces out of the protocols?

 

[Cup of Joe]

I think I speak for a majority of US states when I say long spine board AND cervical collar are considered spinal immobilization.

 

[usalsfyre]

There are rumors that the neck-brace (stiff-neck ® and other brands) will disappear out of the EMS protocols.
Are there in the USA ambulance-services who already removed the neck-braces out of the protocols?

Very, very unlikely in the current legal environment.

 

[JPINFV]

Very, very unlikely in the current legal environment.

I'm not so sure, given the increasing evidence of associated harm tied with the lack of evidence of efficacy. If anything, I think we'll see more services using liberal "selective spinal immobilization" (...because deciding people where glucagon administration isn't medically indicated is "selective glucagon administration?"), which will greatly reduce the number of people immobilized. Additionally, I think we'll eventually see spine boards dropped in favor of either something softer or vacuum splints.

 

[usalsfyre]

I'm not so sure, given the increasing evidence of associated harm tied with the lack of evidence of efficacy. If anything, I think we'll see more services using liberal "selective spinal immobilization" (...because deciding people where glucagon administration isn't medically indicated is "selective glucagon administration?"), which will greatly reduce the number of people immobilized. Additionally, I think we'll eventually see spine boards dropped in favor of either something softer or vacuum splints.

We already use it, I just don't see collars and longboards leaving town for patients with confirmed neck pain anytime soon.

 

[MSDeltaFlt]

The thing about evidence based medicine is that guidelines are written in pencil. LSB's were invented merely for transport from scene to hospital. The term "spinal immobilization" will, I guess, forever "irk" me to no end since there is no such beast as full spinal immobilization from C1 - S5.

So when you look at the big picture, one can see where there will be future modifications to selective spinal precautions ranging from full clearance to full restrictions.

For instance, if a pt needs to be packaged and can't breathe supine on a LSB, I'll put them on a KED and sit them up.

We all basically do That now, don't we? If your protocols wont allow you, then call OLMC and chart chart chart. Simple.

 

[Dutch-EMT]

The guidelines are changing here in about a year.
Not only the stiff-neck, but also the spineboards are in discussion right now.
It could take years before those changes are worked out in the countrywide protocols. I'm searching for evidence based research results about this subject.
Hard to find exactly where i'm looking for.
Is there any research in USA going on right now?

 

[Trevor]

in my system we have a pretty good Spinal Motion Restriction protocol. It combines the Canadian C Spine Rule Study and the NEXUS study.

Unfortunately, I dont see this changing very soon, at least not in the U.S. We're way too letigious. I mean even "progressive" medic schools dont teach C Spine clearance yet... And still many, many systems dont practice it yet. Its still not really standard of care yet...

Several studies have questioned the efficacy of SMR and have found the same result... Probably doesnt help. Several studies have also shown that Spinal Injuries occur at the time of the incident USUALLY not afterwards...

Take a look at this attachment... And this study was done about 10 years ago!
P.S. Im aware that its only one study, and it has a decent amount of room for criticism...

 

[LondonMedic]

The extrication board is not spinal immobilisation, it does not protect against torsion, extension or flexion and it can actually exacerbate thoracic and lumbar injuries if it's not used properly as well as create new pain and injuries which harm the patient and make assessment difficult. A scoop is significantly better and a vac mat is the gold standard. I always recommend that if a board is used to extricate a patient that they are scooped off it and either scooped onto a trolley, scooped onto a vac mat or left on the scoop. I appreciate that people are limited by manpower and equipment but I think that leaving someone on a board for longer than absolutely necessary is poor practice.