Spinal immobilization doing harm?

[c-spine]

The researchers found that in New Mexico, 334 spinal injury patients were fully immobilized, while in Malaysia, 120 spinal injury patients were not immobilized. Of the immobilized patients, 21 percent had neurological disability, but only 11 percent did in the non-immobilized group. Thus, outcomes were worse when the patient was immobilized.

http://www.jems.com/columnists/bledsoe/articles/111046/


This is a very interesting study on spinal immobilization. Raises a few good questions, at any rate.

 

[gradygirl]

I think a great deal of the debate lies between spinal immobilization and proper spinal immobilization.

 

[Jon]

I'm not sure, Liese... Proper spinal immobilization involves spider straps or similar use of many straps, and that is rare.

I think the study shows some promise, but can we do a study here in the US? would any system medical director approve such a study? What is the liability for "going against common practice"???

As with EVERYTHING else... we need more DATA and PROOF. Welcome to EMS....

 

[gradygirl]

I think the study shows some promise, but can we do a study here in the US? would any system medical director approve such a study? What is the liability for "going against common practice"???

I totally agree. And all I can say is law suits out the door. Kinda like with most other "revolutionary" EMS protocols.

 

[c-spine]

We test drugs on people that have the potential to kill them. Why not test the spinal immobilization theory too? Granted you can't just walk up to them and say 'we're going to get you in a car accident and then not put you on a board all the way to the hospital'... but maybe the study could prove that spinal immobilization doesn't really make a huge difference? That would cut back on the back pain due to long transport times; or in the elderly.

 

[Jon]

The question is: Is there enough research out there that a Medical Director and Risk Managment would be willing to run a pre-hospital study - one day we use full spinal immobilization with "Standard" techniques, and the other day we just put them on the strecher and take them to the hospital.

How about a study comparing ED "walk-ins / Drive ups" to ambulance patients? How about patients that declare "spinal immobization criteria" upon ED arrivial? That is probably the next step, before a field study.

 

[Stevo]

So why do we do it?

because we are the most litigant society on the planet

iirc, Canada has a MOI protocall, and so does Maine (apparently they have a bold Medical Director, anyone here from Maine?)

and pressure necrosis studies are nothing new, we hurt more people immobilizing them due to our own fear of retribution, than help them

~S~

 

[fm_emt]

I've heard of some places where they will let Paramedics (and in some cases, and EMT-B) clear patients that have been c-spined. Usually in cases of long transports or waits in the hospital.. (I think).

Still too much C.Y.A. necessary in the US, though.

 

[Flight-LP]

Actually a better term would be "selective immobilization" instead of c-spine clearance. Your not clearing anything..........

I agree with Jon, additional studies involving drive ups / EMS arrivals would be the best way to research to avoid the "sue happy" public, but the statistics may be slightly tainted due to additional movement by the patient who has walked around at home before he decided to drive to the ER..........