No C-Spine... Right call?

[BigBadWolf]

Collar and board from me and if my medic made the call to remove it I would certainly be asking later why just to see if I had missed something.

 

[TransportJockey]

Collar and board from me and if my medic made the call to remove it I would certainly be asking later why just to see if I had missed something.

Backboards are bad news in general. No proof of helpfulness in anything other than an extrication device. Proof of harm when used as a transport device.

 

[Amber Lance]

Had a patient in a clinical rotation who was 93 with altered mental status who had fallen from a standing height and hit her head. We didn't know her medical history so we weren't sure if she had dementia or something else was going on (ICP, etc). She had no CMS deficits. She had a rigid c-collar (unknown if placed by EMS or ER) and it was clearly the wrong size. It kept riding up to where the part that was supposed to be under her chin was up around her nose. Being a student I wasn't allowed to adjust without permission so I told a nurse and she fixed it but it rode up again after about 5 minutes. Rinse and repeat for the next 6 hours until the patient finally figured out how to take it off. The nurse went "eh" and threw it out. The patient had been getting increasingly agitated and upset. When she took the collar off, she calmed down and fell asleep almost immediately. CT scan came back no bleed or skull fracture and her son called and said she had dementia. The whole thing just kind of left me scratching my head.

 

[chaz90]

@Amber Lance
Say the CT results came back positive for some sort of traumatic bleed or there was indeed a skull fracture. Would the hemostatic C-Collar we so desperately cling to help treat this patient or manage them more effectively in any way?

It's good you're asking these questions. Much of what we're taught today at face value could be disproven in the future, and it's good to research these topics on your own to learn the how and why whenever possible. In almost any case, if an agitated and altered patient is more combative and causing more movement due to an attempt at "spinal immobilization" it is a good idea to remove the source of increasing agitation. I like to think we've moved past the days of tackling and wrestling an uncooperative "spinal injury" patient so we can apply our life saving C-Collar, head blocks, and backboard with spider straps.

 

[Zredmond]

@Amber Lance
Say the CT results came back positive for some sort of traumatic bleed or there was indeed a skull fracture. Would the hemostatic C-Collar we so desperately cling to help treat this patient or manage them more effectively in any way?

It's good you're asking these questions. Much of what we're taught today at face value could be disproven in the future, and it's good to research these topics on your own to learn the how and why whenever possible. In almost any case, if an agitated and altered patient is more combative and causing more movement due to an attempt at "spinal immobilization" it is a good idea to remove the source of increasing agitation. I like to think we've moved past the days of tackling and wrestling an uncooperative "spinal injury" patient so we can apply our life saving C-Collar, head blocks, and backboard with spider straps.

You know that's a very interesting point, and I definitely see where you are coming from. As someone who has been boarded post traumatic injury I understand the discomfort.

 

[BigBadWolf]

Backboards are bad news in general. No proof of helpfulness in anything other than an extrication device. Proof of harm when used as a transport device.

Really? I just finished class a month ago and they taught us to backboard damn near everything. ALOC, pain in the neck, back or hips, cant speak english, MOI, you all get backboarded. I will say having done an MCI and been backboarded for almost half an hour I would love to see studies showing us to throw them out even if just for patient comfort, those things suck.

 

[ERDoc]

Really? I just finished class a month ago and they taught us to backboard damn near everything. ALOC, pain in the neck, back or hips, cant speak english, MOI, you all get backboarded. I will say having done an MCI and been backboarded for almost half an hour I would love to see studies showing us to throw them out even if just for patient comfort, those things suck.

Yup, really. That class sounds like a huge mistake. Want to see the studies? Pubmed is your friend.

 

[BigBadWolf]

Yup, really. That class sounds like a huge mistake. Want to see the studies? Pubmed is your friend.

Well there is probably a reason that the instructor and both assistants were let go right after the class finished and the next class canceled lol. My medic has us using a study that has 5 indicators for c-spine that seems much more reasonable but my mind just blanked on the name of the study.

 

[chaz90]

Well there is probably a reason that the instructor and both assistants were let go right after the class finished and the next class canceled lol. My medic has us using a study that has 5 indicators for c-spine that seems much more reasonable but my mind just blanked on the name of the study.

NEXUS criteria? Canadian C Spine rules? Both were created in order to clinically clear possible cervical spinal injuries without using imaging, but many EMS protocols have adopted or modified them.

 

[BigBadWolf]

NEXUS criteria? Canadian C Spine rules? Both were created in order to clinically clear possible cervical spinal injuries without using imaging, but many EMS protocols have adopted or modified them.

Nexus thats the one. Seems very reasonable to me and with my limited knowledge the study seemed to strongly support its use.

 

[ERDoc]

But remember, NEXUS and CCS only apply to cervical spine, not long board.

 

[TransportJockey]

But remember, NEXUS and CCS only apply to cervical spine, not long board.

Which is another reason LSBs need to die a slow and fiery death

 

[ERDoc]

But but but, Transport, we've always done it that way. I try to get the pt off the board and give the board and straps back to the crew before they leave. Do they still teach standing takedowns in EMT classes?

 

[chaz90]

But but but, Transport, we've always done it that way. I try to get the pt off the board and give the board and straps back to the crew before they leave. Do they still teach standing takedowns in EMT classes?

God help us all, but yes they do :/ I was an unwilling witness/participant in a call with two simultaneous standing takedowns just a couple months ago. Stupidity reigned.

 

[ERDoc]

God help us all, but yes they do :/ I was an unwilling witness/participant in a call with two simultaneous standing takedowns just a couple months ago. Stupidity reigned.

It doesn't have any affect on me in the ER, but I feel for you out there in the field.

 

[BigBadWolf]

But but but, Transport, we've always done it that way. I try to get the pt off the board and give the board and straps back to the crew before they leave. Do they still teach standing takedowns in EMT classes?

Finished my class a month ago and while they showed them to us they said there is no reason to use them. If the patient is already mobile just ask them to lay down on the board that is on the stretcher.

 

[DesertMedic66]

Finished my class a month ago and while they showed them to us they said there is no reason to use them. If the patient is already mobile just ask them to lay down on the stretcher.

Fixed it for you.

 

[Amber Lance]

Unfortunately LSB is still in the NREMT skill list so we had to be taught (and tested on) standing takedowns and full immobilization in AEMT class even though it is almost completely absent from local protocols in NM. Does anyone know if it might be taken out of NREMT anytime soon? That would go a long way towards stopping the madness.

 

[highglyder]

Just for my own knowledge, the controversy isn't over collars, it's over LSBs correct?

Rigid c-collars are also controversial. Some studies have them increasing ICP by as much as 25 mmHg. Not something you'd want in a head injury.

 

[Martyn]

Dat MOI doe...
So you know better than everyone else ever on scene with you? When there is a paramedic with a higher level of education than you, you do what you wanna do because you're right and JESUS LOOK AT THAT MECHANISM!
If you tried that with me you'd be kindly asked to leave my scene, and I'd have your supervisor on the phone. You're ridiculous. Not your patient, not your call once there is a higher level of care on scene.
Do you go around stopping "lazy and stupid" cops too?

Really?