Selective c-spine - would you c-spine this patient
- Thread starter Epi-do
- Start date
JPINFV
Gadfly
- 12,681
- 197
- 63
Let me preface this. Farva, this isn't directed at you specifically, but at the prevailing wisdom of 'letting the doctor take the hit.'
Why can we (we being EMS) expect other people to have confidence and trust in our assessments and judgement if we ourselves do not? If you essentially know that a c-spine injury doesn't exist (and if the patient is negitive on NEXUS, essentially he doesn't have a c-spine injury), then why go through the dog and pony show of c-spine? So we can pawn it off on the physician (who's hands aren't any magically better at invoking pain in a tender area. Nor does he have x-ray vision. Of course pain might be present after laying on a hard board during transport)? We keep wanting more trust, more tools, and more interventions, yet when actually given the oppertunity to use that trust and use those tools, collectively we're too scared to do so without someone holding our hands through the process.
Why can we (we being EMS) expect other people to have confidence and trust in our assessments and judgement if we ourselves do not? If you essentially know that a c-spine injury doesn't exist (and if the patient is negitive on NEXUS, essentially he doesn't have a c-spine injury), then why go through the dog and pony show of c-spine? So we can pawn it off on the physician (who's hands aren't any magically better at invoking pain in a tender area. Nor does he have x-ray vision. Of course pain might be present after laying on a hard board during transport)? We keep wanting more trust, more tools, and more interventions, yet when actually given the oppertunity to use that trust and use those tools, collectively we're too scared to do so without someone holding our hands through the process.
emtfarva
Forum Captain
- 413
- 2
- 0
In some cases I agree with you on EMS in the field clearing C-spine. In this case I do not. Even though the Pt is CAOx4, he is slow to respond and details change. I feel either he is faking, he has something really wrong, or something is going on besides the MVC. But you bring up a good point about a Doctor not have a special touch, or having x-ray vision. But a doctor also has about 10 years more education then we do as a EMS profesionals. They are trained to clinically clear c-spine we as EMS (speaking about MA) are not. I would have placed this Pt in C-spine precautions, and I bet I could ask about 10 medics in my company and they would do the same. I wasn't there, but I my gut is telling me something is up. Something doesn't fit right with me.
OP
OP
Epi-do
I see dead people
- 1,947
- 9
- 38
But, what mechanism? There was no damage to the vehicle, so it wasn't a hard hit.
JPINFV
Gadfly
- 12,681
- 197
- 63
The funny thing about MA's statewide protocol is that either it's essentially written to imply selective spinal immobilization or who ever actually wrote it doesn't have a good command of the English language. Section 4.7 looks like it was written based off of the Canadian C-Spine rule, but any protocol that lists indications as "high risk factors" that should be "considered" is asking to be loosely interpreted.
emtfarva
Forum Captain
- 413
- 2
- 0
Yeah, but you said that the Pt went forward and hit the wheel... wait a sec, see this is why it doesn't feel right... He was hit from behind? wouldn't his head go backward toward the headrest... I have been in a rear end MVC my head went backwards not forward. I don't epi, i wasn't there... But I can't justify why I would do it, but I would.
emtfarva
Forum Captain
- 413
- 2
- 0
But it doesn't give us the ability to clinically clear C-spine.
JPINFV
Gadfly
- 12,681
- 197
- 63
Well, that depends on how you look at it. There's really two ways to look at it. Either
1. in trauma (and this should be any trauma) c-spine is to be taken until cleared. Stub your toe? C-spine. Cut? C-spine. So on and so forth. Anything else is clearing it.
2. You treat c-spine as any other intervention. There are indications and contraindications to it's use. If it doesn't meet the indications for use, then you shouldn't be using it. I honestly think that we look at c-spine bass ackwards. Do you initially approach every patient with the intent of putting the patient on 15 l/m supplemental O2 via NRB and then "clear oxygen" based on the assessment? Alternatively, do you choose whether to initiate O2 treatment based on your assessment?
1. in trauma (and this should be any trauma) c-spine is to be taken until cleared. Stub your toe? C-spine. Cut? C-spine. So on and so forth. Anything else is clearing it.
2. You treat c-spine as any other intervention. There are indications and contraindications to it's use. If it doesn't meet the indications for use, then you shouldn't be using it. I honestly think that we look at c-spine bass ackwards. Do you initially approach every patient with the intent of putting the patient on 15 l/m supplemental O2 via NRB and then "clear oxygen" based on the assessment? Alternatively, do you choose whether to initiate O2 treatment based on your assessment?
wyoskibum
Forum Captain
- 363
- 2
- 0
Selective spinal immobilization criteria is not clinically clearing c-spine. It is a criteria to determine if spinal immobilization is indicated. Just like we use criteria to determine if other body parts need splinting. We apply a traction splint because the patient meets a certain criteria. We use a sling & swathe because the patient meets the criteria.
Any patient that need to have their c-spine clinically cleared then should be on long board with c-collar and transported to hospital.
emtfarva
Forum Captain
- 413
- 2
- 0
right, but the MOI in this case was an MVC... not saying that you are not right JP.
JPINFV
Gadfly
- 12,681
- 197
- 63
Since you're using MOI as the indication, was it a "MVC at 30+ mph, or rollover or ejection?"
emtfarva
Forum Captain
- 413
- 2
- 0
nope, but it also had enough force to jerk the kids head, if his story is true.
JPINFV
Gadfly
- 12,681
- 197
- 63
So everyone who goes on a rollercoaster should get c-spined after getting off even if their neck doesn't hurt? Also, the "30 MPH..." quote was straight from the MA statewide EMS protocol.
emtfarva
Forum Captain
- 413
- 2
- 0
Guidelines... and yes if they wanted to go to the hospital i would use c-spine precautions..
JPINFV
Gadfly
- 12,681
- 197
- 63
So if you had a dehydrated patient at an amusement park, you'd c-spine them based on the fact that they were on a roller coaster?
emtfarva
Forum Captain
- 413
- 2
- 0
no, i was joking... but still on a roller coaster ride you are expecting it, in a MVC you are not
JPINFV
Gadfly
- 12,681
- 197
- 63
How does expecting it change anything? Plenty of roller coasters are designed so that you don't necessarilly know which direction you're going to go in next. Especially wooden roller coasters.
emtfarva
Forum Captain
- 413
- 2
- 0
yep, but still, I was taught in school to keep c-spine in mind, he had MOI, whether it was true or not, I don't care whether he had pain or not, I would still have boarded and collared him... He stated that his head went forward and he struck the wheel... thats enough for me... he gets a board.
OP
OP
Epi-do
I see dead people
- 1,947
- 9
- 38
And that was why I posted my protocol. No where in it does it say head pain = c-spine precautions/boarded. I did keep c-spine in mind, but then decided it wasn't warranted.
Do you board every passenger from a fender bender that you run on? Essentially, this was, at best, a fender bender.
Do you board every passenger from a fender bender that you run on? Essentially, this was, at best, a fender bender.
emtfarva
Forum Captain
- 413
- 2
- 0
no, because most of the people in fender benders refuse, or complain of neck/back pain and then I have to board. I hate people that think they can get money out of a minor MVC... and even if they say that they have back or neck pain i will go the whole nine yards... Collar, Ked, and back board... I don't be the EMT that they pull into court to say that you didn't follow your protocol