Question on long board

[MS Medic]

I'm no expert, but it baffles me how the world still thinks long boarding and collaring all these people is such a fantastic idea.

The first thing the hospital does 99% of the time is leave the collar on and give us our board back within 2 minutes of being seen.

Studies have shown that in patients who have legitimate spinal injuries, which are few and far between, we usually do more damage with imperfect application of collars than good. We often apply the collar too large or small causing either further separation/extension the spinal column or allows for too much movement.

Long Boards alone also cause major discomfort to patients. Im sure everyone has been strapped down to one at some point or another.

Have you ever seen a long board that didn't belong to EMS hanging up in the ER to be used a splint if they discovered a spinal injury? Hell no.

Your spine is curved, why in the world would anyone think that strapping someone down on a horribly uncomfortable flat board is an outstanding idea.


And honestly, KEDs are equally moronic. They just waste more time to apply, make the patient more uncomfortable then they already are and don't do much of anything to justify their use. Not to mention inside of a real vehicle its damn near impossible to apply them without causing any movement to the patient.

Again this is just my opinion, please prove me wrong so I don't have to be annoyed every time I have to use these things. If I get into an MVA and someone wants to board me my first question is where do I sign.

(and as someone already said, 95% of the time the patient already got out of the car to see how upset Geico is going to be)

While I can't say your wrong about the LSB, it is what it is and you have to use it unless you can justify withholding it. As far as your opinion on the K.E.D., I use it regularly and the only problems I run into with its application are others who do not use it enough to be familiar with it. Once you use it regularly enough to be as familiar with it as most of your other equipment, it can be applied with minimal spinal manipulation, especially less than rapid extrication to a LSB. But with that said, I'm a big fan of judicious but appropriate use of selective spinal precautions.

 

[beantown native]

My younger brother was in an mva, roll over, Black ice spin out on a curve, hit a stone wall, and it flipped..... when EMS showed up, all occupants were up and walking around.... Complainaing of no pain what so ever. They transported him to a trauma ctr just on mechanism of injury.... glad they did too. He actually had a fx of his c-2 and c-3 vertabrae, and the dr said one wrong move and he was dead... oh, btw... he WAS placed on a longboard. Now without knowing his injuries, would YOU have put him in a lsb ?

 

[NYMedic828]

My younger brother was in an mva, roll over, Black ice spin out on a curve, hit a stone wall, and it flipped..... when EMS showed up, all occupants were up and walking around.... Complainaing of no pain what so ever. They transported him to a trauma ctr just on mechanism of injury.... glad they did too. He actually had a fx of his c-2 and c-3 vertabrae, and the dr said one wrong move and he was dead... oh, btw... he WAS placed on a longboard. Now without knowing his injuries, would YOU have put him in a lsb ?

No, because that story sounds completely farfetched and you said he was walking around when EMS showed up,

 

[MS Medic]

No, because that story sounds completely farfetched and you said he was walking around when EMS showed up,

That isn't that far fetched. I've actually done IFT from the local band-aid station where someone came in POV after a MVC and had a couple of C-Spine Fx.

As to beantown's comment, here in MS the only mechanism that matter's in trauma guidelines are ejection and same vehicle death. If your brother was A/Ox4 and wasn't complaining of pain to ROM or palpation and I didn't find any deformities then I wouldn't have packaged him.

 

[beantown native]

Let me look and post you a few pics of my brother wearing his halo then.

 

[zmedic]

My younger brother was in an mva, roll over, Black ice spin out on a curve, hit a stone wall, and it flipped..... when EMS showed up, all occupants were up and walking around.... Complainaing of no pain what so ever. They transported him to a trauma ctr just on mechanism of injury.... glad they did too. He actually had a fx of his c-2 and c-3 vertabrae, and the dr said one wrong move and he was dead... oh, btw... he WAS placed on a longboard. Now without knowing his injuries, would YOU have put him in a lsb ?

I'd say if he was walking around the fracture probably wasn't that unstable.

As no not using the backboard in general, I'd love to be able to put a collar on people with BS neck pain, have them step out of the car and lay down on the stretcher. But I haven't seen studies that say it's safe. I'd like to see some studies that show there isn't much c-spine movement with that maneuver. Then I'd like to see some studies in a animal model that isolate c-spine injuries are not made worse with back movement. Lastly I'd like to see a study that patients with neck pain randomized into getting a spine board or stepping out of the car have the same rate of neurological injuries.

The problem is that backboard is the standard of care, and it's hard to get rid of something that is the standard without good proof.

I think a better first step is to get selective spinal immobilization (NEXUS, canadian C-spine) made the national standard. Then a lot of these people we could clear in the car and just get them out.

 

[Tigger]

My younger brother was in an mva, roll over, Black ice spin out on a curve, hit a stone wall, and it flipped..... when EMS showed up, all occupants were up and walking around.... Complainaing of no pain what so ever. They transported him to a trauma ctr just on mechanism of injury.... glad they did too. He actually had a fx of his c-2 and c-3 vertabrae, and the dr said one wrong move and he was dead... oh, btw... he WAS placed on a longboard. Now without knowing his injuries, would YOU have put him in a lsb ?

That is a 1 in a million occurrence. The chance of someone having an unstable spinal fracture while displaying no signs or symptoms of injury is rare. I doubt I would not have spinalled him if he was walking around. Guess I lose there.

 

[beantown native]

Thats just it.. I probably wouldnt have either, but protocol says to do it, and therefore we do. If he wasnt.. he could be dead, and the questions remains, how would you feel knowing you may have had something to do with it.. lol, yeah its a one in a million chance, and I tell ya It is my shi**y luck.... Id be screwed.

 

[NYMedic828]

Thats just it.. I probably wouldnt have either, but protocol says to do it, and therefore we do. If he wasnt.. he could be dead, and the questions remains, how would you feel knowing you may have had something to do with it.. lol, yeah its a one in a million chance, and I tell ya It is my shi**y luck.... Id be screwed.

Listen, I don't doubt that your brother had a cervical fracture.

I do doubt that it was so bad, that if he had accidentally turned his head the slightest wrong way while walking around probably flipping out about his car and what just happened turning every which direction making phone calls, that he would be dead.

 

[Tigger]

Thats just it.. I probably wouldnt have either, but protocol says to do it, and therefore we do. If he wasnt.. he could be dead, and the questions remains, how would you feel knowing you may have had something to do with it.. lol, yeah its a one in a million chance, and I tell ya It is my shi**y luck.... Id be screwed.

My protocols tell me to consider to consider spinal motion restriction when clinically indicated, as do most. It also says to consider mechanism of injury when making that decision. Nowhere however, does it say to spinal anyone based purely on mechanism of injury. And given that MOI is a proven crappy predictor of spinal injuries, I rely on my assessment to determine whether or not someone gets spinalled. Too many times EMTs justify their choice of using spinal motion restriction with the "because it's in the protocols" line. If they actually read the protocols, they would see that this argument holds no water and makes them look like a bunch of robots.

I'm glad your brother is ok, but it is quite the hyperbole to say that your brother would be dead without a backboard.

Listen, I don't doubt that your brother had a cervical fracture.

I do doubt that it was so bad, that if he had accidentally turned his head the slightest wrong way while walking around probably flipping out about his car and what just happened turning every which direction making phone calls, that he would be dead.

Exactly. It takes a significant force to fracture a vertebra. Once that force goes away, the vertebra stops breaking. I suppose that it's possible turnings one head could snap what's left of a vertebra and transect the cord but I am going to go ahead and place that in the very, very unlikely to happen category.

And while these stories are being told; I have a friend who came "millimeters" from being paralyzed with fractures in his C4 and C5. He dove into the shallow end, hit his head, got out, dried off (including hair), made himself lunch, and then told his mom that his neck hurt. Point being, you can do a lot with a stable fracture and still be told you almost died.

 

[Shishkabob]

No, because that story sounds completely farfetched and you said he was walking around when EMS showed up,

Let me try then.


I worked NYE 2010/11. I got called to an MVC, and as the first arriving unit, found 3 cars and 9 patients. One car had massive front end damage, engine pushed all the way in to the cab, driver half in driver seat, half in rear seat, DOS.

First vehicle that driver struck was a full extended cab pickup. Its bed was pushed all the way in to the rear seat, where had anybody been occupying the rear seat, they'd be dead. The driver of said pickup was walking around on our arrival, Since he was technically a green, I gave him to my EMT while I went to a car, which had 7 occupants and was struck on the side.

After a bit, I go back to the green walking patient to see what's what. Has a head lac, and now does not know where he is ( a revelation the EMT didn't tell me... but that's neither here nor there). He immediately sat down on a stretcher next to him... then complained of numbness and tingling. I upgraded him to a red and sent him out on the first unit. The medic transporting said he went unconscious within a minute of transporting.


Found out from my med director that he was put on a HALO and spent the next 4 weeks in the ICU, as his C2 and C3 were non-existant. Completely decimated on impact.



That sound far-fetched because he was walking around? It's not. It happened.

 

[NYMedic828]

Right... Difference being your patient had complaints and symptoms concurrent To the spinal immobilization inclusion criteria...

(Mechanism + head injury + AMS + Parathesia) screams neurological damage...

Your scenario Is completely separate. The one I said was far fetched, the doctor told his brother one slight move he would be dead. Meanwhile he had no complaints at all, ever. That is hard to believe. Possible? Sure. Likely? No. His fracture probably wasn't all that unstable.

 

[Shishkabob]

AMS doesn't mean spinal injury, just means you can't take their word for it to do spinal clearance. And if someone answered all my questions right, but just didn't know where they were or what happened right after an accident, I'm not overly concerned (AOx3 doesn't freak you out otherwise, does it?)

Parathesia was after sitting down, not before.

Mechanism... people have broken their necks falling from a bed, and lived following a massive accident. Not something I like to follow, really.



Point being, you can be walking around, turning your head, doing all sorts of movements, with a compromised cervical spine, and not notice any deficits until just the right time, when one wrong move takes place. His just happened to be compressing his spine by sitting down.


It's not a common occurrence by any means, but saying it can't/doesn't happen is silly.

 

[Bullets]

Ambulatory patients isn't grounds for eliminating SMR, but it could help to guide treatment.

Linuss' patient presents with a significant mechanism + head injury + altered mentation outweighs the ambulation

AMS is not a definitive indicator of neurological defect, but given the nature and other symptoms key me to SMR

and I hate SMR


I use a KED on a regular basis as prescribed in my protocols. Mostly because I enjoy going through the process with probies and the added joy of treating insurancitis

 

[zmedic]

Point being, you can be walking around, turning your head, doing all sorts of movements, with a compromised cervical spine, and not notice any deficits until just the right time, when one wrong move takes place. His just happened to be compressing his spine by sitting down.


It's not a common occurrence by any means, but saying it can't/doesn't happen is silly.

Can you find a case report of this happening? Patient turns their head and is paralyzed? In your story the patient had an unstable fracture, but were they paralyzed from walking around?

Especially as we are getting to the point where we need to really look at how much we are spending on healthcare costs, we need to think about it is worth all this effort immobilizing people we know have a 1 in a million chance of having a fracture. How many people have we put in a collar because this fear that they are going to move their head an inch and be paralyzed even though they have no complaint.

Like I said. We need to get states to let EMTs use NEXUS in the field. It works.

 

[Monkadelic]

Never used or seen the KED actually used out in the field. I have only heard of it being used once and that was for pelvic instability.

But I get to use the KED in training every week at college.

around here they use a PASG or MAST trousers for pelvic stability; from what ive seen in my clinicals... KED is awesome tho- totally throws out the need for short spine boards anymore. but i guess if a KED is all you have to work with you gotta use it- but i dont see how that would help with a pelvic fracture since it basically just comes down to the illium area; i dont think it would have any effect on the ischium area or a hip dislocation at all. but then again im still in school so i dont know all the tricks of the trade yet.

 

[DesertMedic66]

around here they use a PASG or MAST trousers for pelvic stability; from what ive seen in my clinicals... KED is awesome tho- totally throws out the need for short spine boards anymore. but i guess if a KED is all you have to work with you gotta use it- but i dont see how that would help with a pelvic fracture since it basically just comes down to the illium area; i dont think it would have any effect on the ischium area or a hip dislocation at all. but then again im still in school so i dont know all the tricks of the trade yet.

You flip the KED upside down so where the head goes is actually where the feet are. The allows you to place the main part of the KED on the hips.

We got rid of the MASTs a long time ago.

 

[Monkadelic]

You flip the KED upside down so where the head goes is actually where the feet are. The allows you to place the main part of the KED on the hips.

We got rid of the MASTs a long time ago.

wow- nice! never would have thought of that... i love being on the field you learn a bunch of tricks; so on the KED the head actually is at the groin area and you wrap around the legs from the outside?

edit;
but with that being said; if the KED is flipped upside down how is C-spine supported other than the collar before getting on a long spine board? they holding it all the way until stabilized?

 

[DesertMedic66]

wow- nice! never would have thought of that... i love being on the field you learn a bunch of tricks; so on the KED the head actually is at the groin area and you wrap around the legs from the outside?

The torso straps and area on the KED is upside down and wraps/secures the pelvis/hips. The head area on the KED is at the patients calfs/ankles.

If there is any need for C-spine then the KED would not be used that way. The patient would either have the KED on normal plus the backboard or just the backboard

 

[Monkadelic]

The torso straps and area on the KED is upside down and wraps/secures the pelvis/hips. The head area on the KED is at the patients calfs/ankles.

If there is any need for C-spine then the KED would not be used that way. The patient would either have the KED on normal plus the backboard or just the backboard

awesome man thanks alot man! ill have to hit them up in class tuesday sicne we been doing practicals on KEd and extrication trauma recently i want to throw this out to the class for real!; damn good info man thanks again!

edit; so if there was a need for c-spine to begin with you would do KED normal then if the PASG wasnt available you would stabilize the pelvis via long spine board? this method is only for those with pelvic injury with no MOI for c-spine?