Who's still routinely c-spining?

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FiremanMike

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We basically have the Yale New Haven protocol, so ambulatory patients get a collar only

I remember back to emt school when we learned standing take down, and even then I thought "this is the dumbest thing ever!"

Also, I'll take patients off the board all the time.... Just like I'll take them off oxygen if a cop puts on a NRB that's not indicated. It's a treatment like any other

Cops give oxygen there?
 

Rialaigh

Forum Asst. Chief
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I saw a BLS crew do a standing take down the other day. I just shook my head.

I was on the truck with my supervisor the other day and he did one...really made me <_<....alas, low man on the totem pole...
 

Bullets

Forum Knucklehead
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Cops give oxygen there?

Yeah, they get the EMR/First Responder training class in the Academy. They spend the whole week doing it, so every cop carries a jump kit with 02 in it
 

medicsb

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Yikes? I see you're a PGY-0, so I'll excuse some of your condescension as just excitement over your new position in life..

My new job is pretty awesome and all, but my condescending tone predates it.

Do you really think that we should be wasting time on the roadside doing a full on neurologist-worthy neuro exam to evaluate tone as we're deciding whether or not to initiate full spinal precautions on someone?

Of course not, but I think you should be using a validated method to determining the need for immobilization (whether just a c-collar or full spine board). If you're going to use MOI and neuro exam findings alone, I just hope you're doing something more in depth than what the majority of prehospital neuro exams consist of: grips, planter/dorsal flexion, and asking if they have any numbness or tingling.

I really think you underestimate our ability to take mitigating factors into account such as PVD/distal neuropathy of unknown etiology, so that the 1:1,000,000 trauma patient with significant mechanism of injury with bilateral numbness can be ruled out for spinal injury in favor of "what's normal"? Of course, you do understand that "what's normal" would probably be pretty quickly asked in such zebra cases..

I don't think it's underestimation, it's more like I'm being realistic given the typical education of paramedics. Maybe you work at some great place that offers tons of extra education and training, or you all graduate from the best paramedic training program ever, but there is no way for me to know. Sorry for my skepticism?

I'll tell you what though, our medical director is actually very approachable and really loves to teach. If you'd like, I can pass along some contact info from you to him, I'm sure he'd love to hear from you about how we're underprepared and back boarding too many diabetics and too few trauma patients.

Clearly, you misunderstood some of what I said. But, ask your medical director if your protocol is evidence based. If it is not, then ask if he is prospectively studying it or if he plans to retrospectively study it and publish the results. If your simplified protocol works, then the rest of the world would like to know about it.
 

DrParasite

The fire extinguisher is not just for show
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I remember back to emt school when we learned standing take down, and even then I thought "this is the dumbest thing ever!"
totally agreed, and I have been directed by paramedics in NY to do it to ambulatory patients following a MVA. her justificiation was "your head is like a bowling ball on a broomstick, it's easy to hurt it at an MVA." still makes no sense to me, but I'm no paramedic...
Cops give oxygen there?
everyone gets oxygen. cut fingers, abd pn, panic attacks, any job where they don't have cop stuff to do (like traumas and MVA), EMS often walks up to find the pt on a NRB
 

johnrsemt

Forum Deputy Chief
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I think it is almost easier to find areas that do still do Full C-spine including Long Backboards now. Even here in Utah they are starting to go away from it, and Utah is about as far behind times in some ways in EMS as you can get
 

Handsome Robb

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Hey john what do you know about Davis County SO?

I'd love to pick your brain about Utah EMS when you've got time.
 
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GoldcrossEMTbasic

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The agencies, around MN, even while in route when dispatcher states rear end minor fender bender. The protocol is C-spine precautions and backboard even if the patient is alert and oriented x3 and GCS is 15. In class we had to go by the book of course. But I think the protocol is that even if we go on call where a patient fell, we collar the pt and backboard too. And the patient usually will state that this is not necessary. And some patients don't realize how quick the spinal cord can be severed even if the cervical part of the body moves even by a millimeter. Depending on the type of trauma they encountered.:excl:
 

Medic Tim

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The agencies, around MN, even while in route when dispatcher states rear end minor fender bender. The protocol is C-spine precautions and backboard even if the patient is alert and oriented x3 and GCS is 15. In class we had to go by the book of course. But I think the protocol is that even if we go on call where a patient fell, we collar the pt and backboard too. And the patient usually will state that this is not necessary. And some patients don't realize how quick the spinal cord can be severed even if the cervical part of the body moves even by a millimeter. Depending on the type of trauma they encountered.:excl:


So you are saying that dispatch info dictates what treatment you perform? That's crazy.
If so that is an area/ agency to avoid. Do they still use mast pants an EOAs?

I hope you do some research on smr and spinal injuries. The "war stories" often told to students and noobs to scare them are very often over exaggerated with little to no evidence to back them up.
Look up nexus and the Canadian Cspine rule if you haven't before. There are even entire states that now use the board for extrication only.
Does you area use regional/ state/ agency protocols?
 
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NomadicMedic

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The agencies, around MN, even while in route when dispatcher states rear end minor fender bender. The protocol is C-spine precautions and backboard even if the patient is alert and oriented x3 and GCS is 15. In class we had to go by the book of course. But I think the protocol is that even if we go on call where a patient fell, we collar the pt and backboard too. And the patient usually will state that this is not necessary. And some patients don't realize how quick the spinal cord can be severed even if the cervical part of the body moves even by a millimeter. Depending on the type of trauma they encountered.:excl:

This is ridiculous. Please supply a link to the protocol where it states
...C-spine precautions and backboard even if the patient is alert and oriented x3 and GCS is 15.
 

STXmedic

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And some patients don't realize how quick the spinal cord can be severed even if the cervical part of the body moves even by a millimeter. Depending on the type of trauma they encountered.:excl:

By far my favorite part of the post :lol: Its got me reminiscent of the story of the guy walking around on his cell phone, then turns his head and dies :lol:
 

Carlos Danger

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I guess she just doesn't understand the scientific-ness of that test.....
 

Tigger

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The part that we seem to have the most trouble with is that without traditional SMR procedures, the banged up trauma patient suddenly doesn't immediately have handles. Many of my coworkers recognize that our SMR techniques don't do anything beneficial, but the board and straps makes for an easy transportation and restraint method.

I'm pushing for more scoop use since it's easy to break it apart when they're on the stretcher but alas it's a struggle. We used it the other day (partner chose to keep the patient on it for the 40 minute transport :glare:) and when we got to the hospital (a large level II), none of the trauma team had any idea what the scoop was. Then they said something about "that's not how we c-spine people," so I suspect some education will have to occur on the receiving end.
 

Brandon O

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Of course not, but I think you should be using a validated method to determining the need for immobilization (whether just a c-collar or full spine board). If you're going to use MOI and neuro exam findings alone, I just hope you're doing something more in depth than what the majority of prehospital neuro exams consist of: grips, planter/dorsal flexion, and asking if they have any numbness or tingling.

I'm guessing he's not mentioning some inclusion and exclusion criteria that would probably get things pretty close to NEXUS, which is certainly validated.

Moreover, I think it may be a little optimistic to think that the neuro assessments done in NEXUS (or the Canadian studies) were OSCE-style. (Not a lot of tuning forks in most ED labcoats...) Nor do I think it would necessarily be for the better. I liked the TBI study where they had neurologists examine everyone in the ER lobby and found something like 10% with asymptomatic deficits. Predictive value and all that...

I would expect that the majority of at-risk patients with chronic issues, such as neuropathic diabetics, would be ruled-in by most providers unless it was abundantly clear there was no change from their baseline (probably impossible to say in most cases; in fact, by the spirit of NEXUS this would probably qualify as a condition preventing assessment, similar to inebriation or a distracting injury).
 

GoldcrossEMTbasic

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No dispatch does not do that! What I am indicating is that when the medics hear dispatch say that there is a mva, with minor injuries, that gives my local ambulance company, at which I do not work for. However, I do know somebody that works for that company and their protocol is that they board and collar the patient even if it it minor.
 
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