Who's still routinely c-spining?

[ILemt]

These are some of the most idiotic requirements I've ever seen. Spinal immobilization for penetrating trauma? Large bore IV for all falls? Utterly ridiculous.

I would tend to agree, but like I said, that is what the trauma docs have ordered.
It has only been in the last few years they quit demanding an NRB on all of the aforementioned pt.

 

[avdrummerboy]

Our county/ area has done away with it for every 'trauma' call. We use what's called NSAID criteria, which in reality is what we would c-spine for before the change anyway, but at least now we can rule it out and it has drastically cut down on needless back boarding.

 

[KTisaPhillyFan]

I had this issue just last night. MVC involving 4 cars, 3 total patients - all priority 3. My patient had self-extricated, ambulating around the scene. Airbag did deploy. Upon initial examination, he was A&O x4, no head injury, no complaint of back/neck pain. Only complaint was superficial lacerations on right lower leg from kicking out driver side window to self extricate and right ankle pain without swelling or ecchymosis. Initial BP was 193/140, all other vital signs within normal limits. No significant past medical history other than anxiety. Medications include Celexa, Prilosec, baby aspirin daily. The patient ambulated to the ambulance to be further evaluated. Due to his presentation and complaints, I did not feel that backboard and collar were necessary. I was questioned about it upon presentation to the ER. Gave reportr with my findings, etc. They put the patient in the urgent care. While at the hospital, an acquaintance who rides volunteer with one of our mutual aid stations and is an ER nurse said that in the future to CYA I should backboard and collar all of 'em. When I got back to the station, one of the captains (former EMS captain) and I were talking and he said absolutely due to MOI the patient should have been backboarded and collared. I do not agree. I still stand by my decision. I did take into account the MOI, etc, but after examining the patient and listening to the patient, I still feel that collar and backboard were not necessary. The patient was discharged early this morning after being given a clean bill of health.

I just feel that you need to examine the whole situation and not EVERY single patient involved in an MVC needs to be backboarded and collared. Why stress the patient even more with unnecessary treatments? Just because we can do it doesn't mean it needs to be done.

 

[DesertMedic66]

I had this issue just last night. MVC involving 4 cars, 3 total patients - all priority 3. My patient had self-extricated, ambulating around the scene. Airbag did deploy. Upon initial examination, he was A&O x4, no head injury, no complaint of back/neck pain. Only complaint was superficial lacerations on right lower leg from kicking out driver side window to self extricate and right ankle pain without swelling or ecchymosis. Initial BP was 193/140, all other vital signs within normal limits. No significant past medical history other than anxiety. Medications include Celexa, Prilosec, baby aspirin daily. The patient ambulated to the ambulance to be further evaluated. Due to his presentation and complaints, I did not feel that backboard and collar were necessary. I was questioned about it upon presentation to the ER. Gave reportr with my findings, etc. They put the patient in the urgent care. While at the hospital, an acquaintance who rides volunteer with one of our mutual aid stations and is an ER nurse said that in the future to CYA I should backboard and collar all of 'em. When I got back to the station, one of the captains (former EMS captain) and I were talking and he said absolutely due to MOI the patient should have been backboarded and collared. I do not agree. I still stand by my decision. I did take into account the MOI, etc, but after examining the patient and listening to the patient, I still feel that collar and backboard were not necessary. The patient was discharged early this morning after being given a clean bill of health.

I just feel that you need to examine the whole situation and not EVERY single patient involved in an MVC needs to be backboarded and collared. Why stress the patient even more with unnecessary treatments? Just because we can do it doesn't mean it needs to be done.

Brand new member with this view point?! We are going to like you here

 

[vcuemt]

I had this issue just last night. MVC involving 4 cars, 3 total patients - all priority 3. My patient had self-extricated, ambulating around the scene. Airbag did deploy. Upon initial examination, he was A&O x4, no head injury, no complaint of back/neck pain. Only complaint was superficial lacerations on right lower leg from kicking out driver side window to self extricate and right ankle pain without swelling or ecchymosis. Initial BP was 193/140, all other vital signs within normal limits. No significant past medical history other than anxiety. Medications include Celexa, Prilosec, baby aspirin daily. The patient ambulated to the ambulance to be further evaluated. Due to his presentation and complaints, I did not feel that backboard and collar were necessary. I was questioned about it upon presentation to the ER. Gave reportr with my findings, etc. They put the patient in the urgent care. While at the hospital, an acquaintance who rides volunteer with one of our mutual aid stations and is an ER nurse said that in the future to CYA I should backboard and collar all of 'em. When I got back to the station, one of the captains (former EMS captain) and I were talking and he said absolutely due to MOI the patient should have been backboarded and collared. I do not agree. I still stand by my decision. I did take into account the MOI, etc, but after examining the patient and listening to the patient, I still feel that collar and backboard were not necessary. The patient was discharged early this morning after being given a clean bill of health.

I just feel that you need to examine the whole situation and not EVERY single patient involved in an MVC needs to be backboarded and collared. Why stress the patient even more with unnecessary treatments? Just because we can do it doesn't mean it needs to be done.

But...! Look at that mechanism of injury!

 

[jrm818]

I had this issue just last night. MVC involving 4 cars, 3 total patients - all priority 3. My patient had self-extricated, ambulating around the scene. Airbag did deploy. Upon initial examination, he was A&O x4, no head injury, no complaint of back/neck pain. Only complaint was superficial lacerations on right lower leg from kicking out driver side window to self extricate and right ankle pain without swelling or ecchymosis. Initial BP was 193/140, all other vital signs within normal limits. No significant past medical history other than anxiety. Medications include Celexa, Prilosec, baby aspirin daily. The patient ambulated to the ambulance to be further evaluated. Due to his presentation and complaints, I did not feel that backboard and collar were necessary. I was questioned about it upon presentation to the ER. Gave reportr with my findings, etc. They put the patient in the urgent care. While at the hospital, an acquaintance who rides volunteer with one of our mutual aid stations and is an ER nurse said that in the future to CYA I should backboard and collar all of 'em. When I got back to the station, one of the captains (former EMS captain) and I were talking and he said absolutely due to MOI the patient should have been backboarded and collared. I do not agree. I still stand by my decision. I did take into account the MOI, etc, but after examining the patient and listening to the patient, I still feel that collar and backboard were not necessary. The patient was discharged early this morning after being given a clean bill of health.

I just feel that you need to examine the whole situation and not EVERY single patient involved in an MVC needs to be backboarded and collared. Why stress the patient even more with unnecessary treatments? Just because we can do it doesn't mean it needs to be done.

Basically everyone here will agree with you, but if you want something a bit more concrete to spread around, this is short enough to print out and sprinkle around liberally: http://www.naemsp.org/Documents/Pos...autions and the Use of the Long Backboard.pdf

 

[drl]

Basically everyone here will agree with you, but if you want something a bit more concrete to spread around, this is short enough to print out and sprinkle around liberally: http://www.naemsp.org/Documents/Position Papers/POSITION EMS Spinal Precautions and the Use of the Long Backboard.pdf

Good read, thanks for the share.

 

[Jason]

We have reviewed NEXUS and the Canadian c-spine rule. Our protocol follows the Canadian c-spine rule.
In our protocol book, the guidelines are pretty well laid out. There are inclusion and exclusion criteria, so we don't have to backboard everyone.

 

[KTisaPhillyFan]

Good read, thanks for the share.

Yes, thank you for that share!! That backs up my decisionmaking process.

 

[DEurich]

I recently got my basic about a month ago. I was taught to always immediately do C-Spine on unconcious trauma patients, and then to just ask if they fell if they were concious, so you can rule it out. Better safe then sorry.

 

[Medic Tim]

I recently got my basic about a month ago. I was taught to always immediately do C-Spine on unconcious trauma patients, and then to just ask if they fell if they were concious, so you can rule it out. Better safe then sorry.

Did you learn the nexus or Canadian c spine rules? Or any other clearance guideline?There is much more to clearing Cspine than asking if they fell. Research also suggests that boards do not prevent but may actually cause or worsen injuries. Unfortunately many schools and providers are stuck in the past and resist evidence based medicine.

 

[DEurich]

Did you learn the nexus or Canadian c spine rules? Or any other clearance guideline?There is much more to clearing Cspine than asking if they fell. Research also suggests that boards do not prevent but may actually cause or worsen injuries. Unfortunately many schools and providers are stuck in the past and resist evidence based medicine.

I have not heard any of those actually. I'll do some research though. I would much rather know a safer way, thanks for the input

 

[Fayettecong]

Just depends on the nature of illness/MOI. If the patient complains of any neck or back pain a board comes out. Severe MOI, patient gets the backboard. Patient who was in a fender bender complaining of knee pain, I don't see a need for a board.

 

[Medic Tim]

Just depends on the nature of illness/MOI. If the patient complains of any neck or back pain a board comes out. Severe MOI, patient gets the backboard. Patient who was in a fender bender complaining of knee pain, I don't see a need for a board.

It is a shame that so many services still do this to people.

 

[OnceAnEMT]

It is a shame that so many services still do this to people.

Specifically if "pain" and MOI are the only judges. There are so many other s/s that could be present without pain and still be indicative (hell, more indicative) of an injury to the spinal column or cord itself. Sure pain and MOI play a part, but its just like using vitals to fix your differential. Thready pulse doesn't mean shock. Thready pulse, low BP, and high/shallow resps indicate shock.

 

[Brandon O]

Specifically if "pain" and MOI are the only judges. There are so many other s/s that could be present without pain and still be indicative (hell, more indicative) of an injury to the spinal column or cord itself. Sure pain and MOI play a part, but its just like using vitals to fix your differential. Thready pulse doesn't mean shock. Thready pulse, low BP, and high/shallow resps indicate shock.

Well... I dunno. Cord-compromising injury without neck pain is awfully rare.

 

[vcuemt]

http://www.scancrit.com/2013/10/10/cervical-collar/

The Curse of the Cervical Collar

For many years, ATLS has dictated cervical collar as part of the A in ABC, and any patient that enters a trauma bay gets a cervical collar slapped on before anyone cares about airways, breathing and circulation. The last couple of years, some rougue docs have tried opposing the validity of the extreme focus on cervical collars, and it is finally starting to trickle into the system. Here’s the case against cervical collars – and for bringing the focus back on the important parts of the ABC to save your patient.