Transition to new SMR protocol

LACoGurneyjockey

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Our county just put out the draft for a new Spinal Motion Restriction protocol to take effect in June, in the past having collared and boarded any and everyone with any physical findings or ALOC in a setting of trauma. Grandma rolled out of bed and has some hip/femur pain? Well that's a distracting injury in a setting of trauma, let's put grandma on a backboard for the transport down a dirt road and up to 60min drive to the hospital. Billy bob has been drinking and got punched by Joe bob? Etoh and head trauma definitely needs a backboard.
When the new protocol takes effect we will place them on the gurney, supine/position of comfort, with a c-collar. If they can walk, assist them to the gurney, or otherwise use a breakaway flat. The only indication for a board will be extrication, to be removed once they're on the gurney. I'll be finishing up medic school and starting my internship right around the time this new protocol takes effect, and now every time I hear my instructor telling us "we need to c-spine this and backboard that" I cringe a little inside.
The reason I'm posting this isn't just to gloat that we are finally catching up to the rest of EMS, ever so slightly and a little late to the party. But I wanted to get input from others who have made the switch on how difficult it was to break the habit of backboarding everyone for anything.

How hard was it for the medics who had spent all their time in EMS backboarding every significant trauma to stop, and just put a patient on the gurney with a collar? Backboards have always been perceived as one of the more important interventions in any trauma patient. And now to see them effectively vanish, I just wonder how our experienced medics will make the switch.
 

NomadicMedic

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It's harder to break BLS of the habit. If I see a collar or board that are unneeded, I just take them off.
 

DesertMedic66

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I ran into this issue a lot during my medic training. My FTO likes to backboard everyone. His reasoning is that "you don't want to find out that patient had a brain bleed and you didn't C-spine them". it was very hard to keep my mouth shut to get through training faster.
 

Flying

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Everyone around me just rolls their eyes when I try to stop Grandma from getting the board.
Or puts out the classic "It's part of protocol!".

CNJ's medics are hit and miss with SMR, some will take off the collar, some will ask why we didn't put it on. It all depends on the time of day and which hospital we are closer to.
 
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DWR

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I think you'll still be ahead of the curve. I was always used to back boarding people that don't always need it. If you hang out in the trauma bay or whatever room you take your Pt too one of the first things they do to stable patients is take them off the board. Use judgement. Study the CDC criteria for trauma centers and then honestly think through the call. Also body size vacuum splints are a great alternative!
 

TRSpeed

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Not many places are actually completely removing backboards like kern is. So I am excited. Most use what we were using which was essentially NEXUS criteria aka
N-NEURO DEFICIT
S-SPINAL PAIN
A-ALOC
I-INTOXICATON
D-DISTRACTING INJURY

There has been lots of talk of the removing backboards but I can probably bet the vast majority of places still use them.
We are to remove the backboards if used for extrication unless we can't because it will interfere with important procedures or tx.
 
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LACoGurneyjockey

LACoGurneyjockey

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I was trying to hide how excited I am for the new protocol. And no more calling for orders for pain meds, choice of seizure meds, and in defense of little old ladies everywhere no more verapamil. Maybe this will make up for all those years of stacked shocks...
 

TRSpeed

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I'm almost 99% sure we are the first and only county in socal to remove backboards .
 
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LACoGurneyjockey

LACoGurneyjockey

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Tulare beat us to it if I'm not mistaken. I believe it's soft collars and position of comfort now up there. But let's just say that's not so cal
 

Brandon O

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I ran into this issue a lot during my medic training. My FTO likes to backboard everyone. His reasoning is that "you don't want to find out that patient had a brain bleed and you didn't C-spine them". it was very hard to keep my mouth shut to get through training faster.

Ah, the ol' hemostatic collar.
 
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LACoGurneyjockey

LACoGurneyjockey

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Hold on! You mean to tell me that putting a possible neck injury on a backboard doesn't help treat their injuries?!? That's absurd. We've been doing it forever, and look at how many of them ended up with spinal injuries. That's how you know it's working! Y'all are just stoopid...
 

TheLocalMedic

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The whole premise of fully backboarding and immobilizing patients was based on a poor understanding of body mechanics and anecdotal evidence. I've always had a problem with it, and even before my county in Nor Cal adopted the new SMR protocol I was constantly taking flack for not putting people on boards.... It was a real blessing to have my decades-long philosophy of only boarding those with readily apparent neck (and neck only, not back) injuries or neuro deficits finally vindicated.

Death to the backboard!!!!
 

281mustang

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Have you all ever run into issues with ER docs? I personally haven't had problems but I've known of others that have caught flack from old school Physicians that haven't adapted to the change.

A couple months I transported a pt from a level 1 trauma center to another level 1 trauma center for HLOC. The sending facility took pt off the board but the doc at the receiving facility was adamant that she be backboarded again prior to transport because she had a confirmed cervical fx. It's not just EMS that is stuck in the mindset...
 

DesertMedic66

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I talked to our new medical director for Kern and he had some exciting things to say about Ketamine and TXA, too.
We are supposed to be starting TXA trials next month (fingers crossed). There has also been talks about Levophed drips in my area.
 

GirevikMedic

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My area has been doing something similar for about a year and half or so. Breaking the habit was easy since I hated boarding patients who didn't need it. The discretion of collar only and self-extrication, when indicated, was an added bonus. I'm not such a huge fan of back boards being outlawed as I think they can still serve a purpose beyond extrication. Mainly in regards to time spent/wasted with extra procedures (the patient's being flown and we're still forbidden to use a long board for packaging purposes, instead we have to use the KED and collar and wait for air to land, bring their long board, etc, etc.). Overall, I'm still a bigger fan of our current policy.
 

Accelerator

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I never really was a fan of back boarding. I try to treat patient's how I would want medics treating my family and I would not want my mother placed on a hard board after breaking her hip. There are times when back boards are a must but I think we should have the understanding to admit that it is for our benefit mostly. Patients do benefit mostly from the time that the boards save.
 

Tigger

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When are backboards ever a must?
 
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