new WMS research : c spine protocols

K

kaisardog

Forum Crew Member
Messages
42
Reaction score
1
Points
8
The Wilderness Medicine Society has just published some very interesting consensus research on preventing C spine injuries in prehospital care. what interested me most was the discussion on logrolling vs. a trap slide, and the importance of padding the occiput to minimize motion....

although a full WMS subscription costs money, this article is free:

http://www.wemjournal.org/article/S1080-6032(13)00071-9/fulltext
 
I don't know...they seem too logical and level headed for EMS :)
WMS said:
For the purpose of developing proper guidelines for spinal immobilization in a dangerous environment, it is important to recognize and attempt to differentiate 5 types of spinal injury scenarios:

1) an uninjured spine,
2) a stable spine injury without existing or potential neurologic compromise,
3) an unstable, or potentially unstable, spine injury without apparent neurologic compromise,
4) an unstable spine injury with neurologic compromise, and
5) a severely injured patient with unknown spinal injury status.

If immobilization is to be used, it would be indicated for numbers 3, 4, and 5.
Click to expand...

5 years ago when I took my first wilderness EMS class, many of these issues were already being discussed and points like skipping log-roll in favor of lift/slide. Granted, the instructors were incredible and in retrospect they've contributed quite a bit towards how I practice "civilized" EMS.
 
Christopher said:
I don't know...they seem too logical and level headed for EMS :)


5 years ago when I took my first wilderness EMS class, many of these issues were already being discussed and points like skipping log-roll in favor of lift/slide. Granted, the instructors were incredible and in retrospect they've contributed quite a bit towards how I practice "civilized" EMS.
Click to expand...

That's what I was taught.
 
I know that there's a service in the U.S. Who's protocols actually discourage the use of long spine boards.

We're moving in the right direction!
 
EMT B said:
apparently not...why doesn't it work?
Click to expand...

It allows for a lot of spinal motion. If you believe in the fairy tale that any motion in the spinal column causes further injury, this is obviously A Bad Thing(TM).
 
how would you move a patient onto a longboard then? i was taught that lateral movement of the spine was ok..would you just slide them up onto the board? could you use a scoop to get them up and onto a board?
 
EMT B said:
how would you move a patient onto a longboard then? i was taught that lateral movement of the spine was ok..would you just slide them up onto the board? could you use a scoop to get them up and onto a board?
Click to expand...

Nobody knows what movements in the spine are Ok (in all likelihood any movement within the normal range of motion is Ok). It really does show the failure in EMS education in the US when you're given only one means to move somebody.

I can think of three others:

1. Scoop stretcher
2. Lift and slide
3. Straddle-lift and slide
 
ive been taught scoop strecher, ked, lift, straddle-lift, and all the emergency moves. i was taught the only way to backboard somebody was to use the ked, or the log roll technique because lifting patients without anything under them is bad. im not trying to say that im right...im just trying to say what i was taught
 
Last edited by a moderator:
EMT B said:
ive been taught scoop strecher, ked, lift, straddle-lift, and all the emergency moves. i was taught the only way to backboard somebody was to use the ked, or the log roll technique because lifting patients without anything under them is bad. im not trying to say that im right...im just trying to say what i was taught
Click to expand...

Good news, the KED actually does not immobilize the C-spine either because it lacks shoulder straps.

"Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don't know which half is which." -Dr. Charles Sidney Burwell in an address to Harvard medical school students.
 
Scoop for Spinal Precautions

I find this topic very interesting, as it has been something I have been doing a lot of research on. Has anyone heard of a scoop stretcher being used in spinal immobilization? At my volunteer department, we have recently received approval by New Jersey OEMS (under the circumstane that proper training is provided to users) to use a scoop in spinal immobilization. My chief has performed extensive research and followed the research of others showing how a scoop can be just as good, if not better, than a longboard. It potentially eliminates the effects of log rolling a patient.

The agruement that was brought to OEMS was that our state protocols state to follow manufactures guidlines on equipment. Well in short terms, Ferno states that the Ferno Scoop EXL is adequate for spinal immobilization and even has specialty head immobilizers. See below. This shows the head immobilizers on their site.

http://www.fernoems.com/products/immobilization/scoop-stretchers

Just to help support my statement, I want to add some links.

Ferno Scoop EXL
Comparison of Scoop Ferno Stretcher with the Long Board for Spinal Immobilization
 
Last edited by a moderator:
ZombieEMT said:
I find this topic very interesting, as it has been something I have been doing a lot of research on. Has anyone heard of a scoop stretcher being used in spinal immobilization? At my volunteer department, we have recently received approval by New Jersey OEMS (under the circumstane that proper training is provided to users) to use a scoop in spinal immobilization. My chief has performed extensive research and followed the research of others showing how a scoop can be just as good, if not better, than a longboard. It potentially eliminates the effects of log rolling a patient.
Click to expand...

There is no evidence in favor of a longboard, so it doesn't take much to beat it!

A padded scoop stretcher is more likely to actually help limit energy deposition on the spine due to the gap in the back than a backboard. (Note: I didn't say movement, I said energy deposition)

ZombieEMT said:
The agruement that was brought to OEMS was that our state protocols state to follow manufactures guidlines on equipment. Well in short terms, Ferno states that the Ferno Scoop EXL is adequate for spinal immobilization and even has specialty head immobilizers. See below. This shows the head immobilizers on their site.

http://www.fernoems.com/products/immobilization/scoop-stretchers

Just to help support my statement, I want to add some links.

Ferno Scoop EXL
Comparison of Scoop Ferno Stretcher with the Long Board for Spinal Immobilization
Click to expand...

Also:

Del Rossi G, Rechtine GR, Conrad BP, Horodyski M. Are scoop stretchers suitable for use on spine-injured patients? American Journal of Emergency Medicine; 2010 Sep 1;28(7):751–6. Available from: http://dx.doi.org/10.1016/j.ajem.2009.03.014

Hachen HJ. Emergency transportation in the event of acute spinal cord lesion. Spinal Cord 1974 May;12(1):33–7. Available from: http://www.nature.com/doifinder/10.1038/sc.1974.6
 
Robb said:
I know that there's a service in the U.S. Who's protocols actually discourage the use of long spine boards.

We're moving in the right direction!
Click to expand...

We are a non wilderness service and it's likely our next protocol revision will do away with lsb immobilization all together. Thank god.
 
TransportJockey said:
We are a non wilderness service and it's likely our next protocol revision will do away with lsb immobilization all together. Thank god.
Click to expand...

Will you still have C-collars?
 
I love this, but I read this:

"Although the expert panel was unable to identify a single well-documented case in the literature of prehospital neurologic deterioration as a direct consequence of improper or inadequate immobilization, many cases have documented severe morbidity, and even mortality, secondary to immobilization itself".

By logic and the absence of, say, Nazi camp experiments, this would not be able to be proven in any event except where a radiological exam was done on scene, then the immobilization was really botched.

I'm going to keep on reading, especially looking for citation about struggling patients.

BTW: in the responses above I keep seeing the EMT insistence that there is "A Right Way" to address a potentially complex situation like "spinal injury". I'm also seeing people arguing against immobilization but citing how a certain type of movement or immobilization is bad, when their premise is that it is all bad.

(Of course, my premise is know how to do it right, have the tools, only use it when it is proper).

EDIT: I am already seeing nearly absolute lack of specific consideration of the patient needing extrication , not just given a hand to climb out of the situation. THIS is an example of the EMT "all or nothing" thinking when these results are applied to different situations (cutting patient out of a car, patient stuck in a culvert down a slope, etc). THIS way lies "cook booking".
 
Last edited by a moderator:
Christopher said:
Good news, the KED actually does not immobilize the C-spine either because it lacks shoulder straps.

"Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don't know which half is which." -Dr. Charles Sidney Burwell in an address to Harvard medical school students.
Click to expand...

I was KED'ed and it held MY head pretty darn immobile. And that was without a C-collar. It was a brand-name KED and the user knew what he was doing, too.
 
mycrofft said:
I was KED'ed and it held MY head pretty darn immobile. And that was without a C-collar. It was a brand-name KED and the user knew what he was doing, too.
Click to expand...


"If you are basing your claims on anecdotal experience, then any treatment will seem to work for anything and everything."
—Steven Novella, MD

Next.
 
Last edited by a moderator:
You must log in or register to reply here.
Back
Top