To Backboard or Not to Backboard...

[MedicPrincess]

Example - MVA - rollover with ejection at 0100. During the daytime, speeds on this stretch of road a pretty slow, maybe 30-45 MPH. But at 0100, its easy to reach 90-100 MPH as it is pretty straight, a 3 mile bridge over the bay and no traffic.

So witnesses on scene say the patient got himself out of the overturned vehicle, walked around for a minute, sat down on the curb, then laid down.

The responding unit had the patient get up off the ground, walk to their stretcher and lay down on the backboard.


Another - Gramma "fell." After getting on scene, the FD finds that Gramma actually drove her motorized wheelchair off a 5 foot porch, landing on her head and laid there for at least 30 minutes (that was the last time someone spoke to her before her caregiver found her).

FD takes full C-Spine procautions, backboards gramma and the Med Unit takes her away.


So, Are you guys allowed to clear C-Spine in the field based on assessment? Around here, as in my county and the 2 adjacent, we are not allowed to. Any fall/MVA/Head-Neck-Back Trauma/injury that C-Spine injury could happen and the EMS crews must fully immobilize.

How they get them to the backboard is another story. It can be like the first one where they tell the pt to lay down on this backboard then procede to apply the collar and strap'em down to "textbook" C-Spine procations.

If you are allowed to clear C-Spine, how do you do it? There appears to be some studies/evidence that not every patient that we backboard really needs it and in some cases it can even cause additional trauma that wasn't there in the first place.

So, To backboard or Not to Backboard - thats my question. Where, Where, Why, How....

 

[squid]

We're allowed to clear C-spine, and I've noticed that medics here are all over the map on what they decide to do. We had a 4-year old fall from about 3 feet, land on her feet or knees (can't recall -- I think she landed on hands and knees, definitely didn't hit her head), pain in her hip, and got backboarded. I thought that a bit excessive. And I've seen people clear c-spine on folks in rollovers with whom I would have been a bit more cautious.

Both of those patients you mentioned sound like candidates for boarding. I think I would defintely board the one in the MVA just due to the MOI and the likelihood of "distacting pain" -- which is one of the things that makes you fail you spinal clearance test. Grandma, I'd like to know more about how robust she is, what hurts, etc, but I'm thinking someone who lands on her head with the combined weight of herself and a motorized wheelchair has had uite an impact to a spine that is presumably not in perfect shape to begin with. I'd probably board her too. Maybe if she needs boarding throw a blanket or two on the board to keep her more comfortable. I do believe that older folks are more likely to suffer from long times on a hard board.

 

[emtbuff]

we aren't allowed to clear c-spine. As for the two pt listed above I would say both should be c-collared and backboarded. As for the MVA I wouldn't have hime get up and walk to the board due to the MOI as that could cause more injury. Since he is laying down log roll him. If he was sitting on the curb I would use the KED. You can never be to carefull. Right.

 

[Stevo]

ems generally protects itself backboarding than that of actually helping a patient Princess, and we're by no means alone in liability driven medicine either....

in fact, studies on pressure necrosis 24/48/96 hrs after being boarded have revealed the instrument in question to be the only chief complaint

Maine, iirc has an moi ruleout guideline, so does Canada, i guess the radiologists have better things to do...

and if your Q is the patient moving before you can board him/her i would say it wise to board as found with minimal movement, they can dance the macarena before we get there, but should stay still for our bondagde routine afterwards

generally, if you'd like to stay outta trouble, just expect to tie every trauma patient up. but i would advise that you take the time to ride back from the er on a board if you can, as it's always good to feel first hand what we impart

10 points for every frost heave!

~S~

 

[Jon]

PA's BLS protocols do not allow for clearing C-spine in the feild. I had this, umm, discussion just last night at the squad for a similar incident. PA has a specific protocol for determining if C-spine needs to be immobilized.

26 y/o female in reletivly low-speed impact at rear driver's tire from behind while making a left turn into a parking lot.

First point to the call - Initial dispatch location was 1 mile from the actual call - only figured out the call location by looking at the call text on the Terminal - said she was stairing at _____ car dealership. We went down to the autopark, where the dealership was, and wow... found the MVA.

Pt. gets out of car to meet us, walks over, says "I can't move my neck" We collared the patient while they were standing, and did a standing take down with the patient onto the backboard.

The reason I did a standing takedown was first, that it was the most appropriate way to immobilize the standing patient (as opposed to having the patient walk to the strecher and sit on the backboard - THIS IS A BIG PET PEEVE. I also did it to set a good example for the "brand new" EMT I had riding as a secondary. - Oh, and this was I think the 3rd or 4th time I'd ever done it... Too often someone else insists on doing it the "lazy way."

Both of Princess's examples deserve being fully boarded and collared, and both should probably be going to a trauma center.


As for the appopriate way to immobilize someone, I already mentioned the "lazy way" of walking the patient to the strecher. VERY BAD IDEA. The KED was designed to preform a function. When did you last use a KED on a call. I've never used one. To use a KED, you need at least 2 people who have practiced on the KED, and KNOW how to do it quickly. Unfortunatly, too many folks will stare at you as if you had 3 heads if you try to pull out a KED for a call.

Jon

 

[ffemt8978]

I posted our requirements in a thread a long time ago, entitled Protocol Changes, What would you change if you could?

This is our C-spine clearance procedure from our protocols:

Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:

1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury

 

[Stevo]

i'm agreeable to that ffemt8978

the other day we BB'd 4 patients in a low speed fender bender

2 cops cars

3 fire trucks

3 ambulances (3 different towns)

2 of the 4 simply wanted to be 'checked out', and met your criterior, for 'insurance reasons'

and people wonder why their health care premiuims have gone up....

~S~

 

[hfdff422]

If it is a trauma situation and they are not going to SOR, then take all standard precautions. And I agree with Jon on using the standing take down whenever feasible. The only time I would not is If the patient walks up to the ambulance before I have time to assess. Once I have made contact with a patient that will be transported, I will use textbook precautions.

 

[bravofoxtrot]

If he was sitting down on the curb, I would probably not put a KED on him. Too much moving around to get it on (I mean, it's not like they're in a car seat with some support in the back) and it takes too long. I'd just move the backboard as close to the patient as I could get, and get him to lay back.

In either case, I would've backboarded both.

 

[Jon]

What is an "SOR" - is that a sign-off / refusal???

As for the standing take-down. Reason #1 i did it is I had an impressionable, young EMT with me, and I wanted to show the "right way." Yes... it took longer, probably didn't make a difference, and we all got wet kneeling to put straps on - but I set an example, and also, I'm covered in case there was something wrong.... she didn't move her neck after we arrived on scene - I had manual traction in place 30 seconds after getting out of the rig.

Jon

 

[hfdff422]

Originally posted by MedicStudentJon@Nov 18 2005, 10:43 AM
What is an "SOR" - is that a sign-off / refusal???

Basically- It is different everywhere. But in central Indiana it stands for what Jon said. We just call it signature of refusal.

 

[ffemt8978]

Originally posted by Stevo@Nov 18 2005, 04:38 AM
i'm agreeable to that ffemt8978

~S~

I don't have a problem with it anymore, but I still wish we could use MOI as a basis if we feel it is necessary. I can declare a trauma alert based upon my gut instinct, but I can't place a patient in full spinal precautions using that same criteria.

 

[TTLWHKR]

when in doubt, lay em out.