would you c-spine?

[AnthonyM83]

You get worked up about it because the people teaching teach what they know.

Have them start teaching vastly different ways of doing things and see how quickly the local EMS agency (and their medical doctors) shoot them down. What you must remember is that we ARE held to a standard of care, one that is enforced by agencies run by doctors who DEMAND that standard of care.

You're responsible for knowing how to appropriately treat your patients in spite of what your textbook said, what NREMT tests on, and what your protocols say.

You're also responsible to treat according to what they say.

Nice situation we're in.


Additionally, as the standard of care changes, it needs to be accepted by at least some communities (local agency, NREMT, etc) to be valid. Say someone read the first couple major spinal immobilization studies when they started gaining momentum a few years ago. Some of them had CRAPPY information. The authors were under the impression that we still used SANDBAGS as a standard for head immobilization! BUT what if some providers had taken that article and ran with it, started pushing for change and even violating protocols. That wouldn't be evidence based.

BUT NOW, as more evidence comes out, it IS evidence based. But I don't trust the individual or hell even most people at the local EMS agency to be deciding what the standard is. I want my medicine checked and double checked by various experts. SO THEN, if the local agencies don't apply the new information, THEN, they're in violation of evidence based medicine...

 

[Veneficus]

Have them start teaching vastly different ways of doing things and see how quickly the local EMS agency (and their medical doctors) shoot them down. What you must remember is that we ARE held to a standard of care, one that is enforced by agencies run by doctors who DEMAND that standard of care....

I think many in EMS seriously underestimate the actual amount of time or efforts doctors give to EMS.

Many of these practices (which are nothing more than outdated expert opinion) don't change because nobody actually wants to waste time doing studies on it.

You see one of the purposes of research is to get it published. It is an aweful lot of work to do for nobody to read it.

As well, in the US, a medical director is simply name on a paper. They are instantly replacable and in many agencies any doctor who tries to buck the status quo is replaced with a compliant one.

Many in EMS have never even met their medical director or would know what he/she looked like. Do you think that is the mark of an involved and caring leader?

Many US medical directors are not even compensated. How much time and effort do you think they spend with EMS. In my experience as little as possible.

If I said about EMS providers even 1/2 the things I regularly hear doctors (including US EMs) say about them, people here might start cutting their wrists.

There is a difference between a person who respects you and a person who is polite or nice to you.

I know more than a handful of docs who still try to advance and be involved in EMS. But they are less than 1% of all doctors.

Do you believe when a medical director asks his anesthesia or neuro surg collegue what could be improved in EMS (if she even has such collegues, and if they actually spend time talking about EMS for more than a second in the elevator) that they don't just decide there are too many variables, "keep doing what you are doing?"

Bottom line:

Doctors largely don't give a rat's *** about EMS. Certainly not enough to spend the effort to change things.

I also know many who have spent great effort and time trying to pull EMS up to speed. Most of them quit or are now just involved in critical care transport.

US EMS providers do not want to change a vast majority of doctors don't want to waste time trying to change them.

 

[mycrofft]

I wonder if there is a disconnect betwen NHTS and NIH about field EMS? Does NHTSA still hold the reins, and if so, is it becuase NIH doesn't want it?
That could explain why change from the top is slow, infrequent, hesitant, and seems not to recognize changs in the science.


SIDEBAR: I'm thinking about changing my signature line to "LSB + KED + C-COLLAR= MOTHER'S MILK". Any thoughts?

 

[stairchair]

Well he dose not meet my departments c spine clearing Protocol and our x ray is broke so I would say board him ( if he consented) after being informed about the procedure.

 

[KellyBracket]

Hospital staff readers: if a patient comes to the ER with a complaint suggesting spinal injury, are they immobilized? And if an xray shows a fracture are they then immobilized? In my experience they are not, which makes me wonder why we get so worked up about it prehospitally.

Your experience serves you well. The only time we use a backboard in the ED is to get a patient off the floor.

It's worth it to point out that ATLS (the standard trauma course for docs) teaches that the backboard is only utilized for transport to the ED. Everyone comes off the board in the ED.

In fact, patients with evident spinal cord injury (e.g. paraplegia) are supposed come off the board immediately, given the high risk of skin breakdown and subsequent infection.

The collar usually stays on. Remember; removing the backboard ≠ clearance!

 

[d_miracle36]

We recently had a trauma symposium in my state were some of the local hard hitting trauma docs attended. There was a paramedic who gave a lecture on spinal immobilization and brought up many of the references that many of you already know. There was one that was new to me and it has been hitting our area fast. Has anyone read it yet?

I uploaded the attachment, not sure if it worked or not but here is the short pubmed version. http://www.ncbi.nlm.nih.gov/pubmed/22962052

May not be new to many of you but it was to me. Anyway so after the lecture one of the docs stood up and said I have a question for the crowd. Would anyone say anything to ems if they brought a patient with a c-collar and no backboard, and no one stood up. Was interesting since the hospital who hosted the symposium is the most critical hospital I have seen when it comes to spinal immobilization.

 

[sneauxpod]

Personally no I wouldnt, but according to my protocol I have to for any fall or traumatic event where any type of back pain is involved.

 

[RocketMedic]

I think many in EMS seriously underestimate the actual amount of time or efforts doctors give to EMS.

Many of these practices (which are nothing more than outdated expert opinion) don't change because nobody actually wants to waste time doing studies on it.

You see one of the purposes of research is to get it published. It is an aweful lot of work to do for nobody to read it.

As well, in the US, a medical director is simply name on a paper. They are instantly replacable and in many agencies any doctor who tries to buck the status quo is replaced with a compliant one.

Many in EMS have never even met their medical director or would know what he/she looked like. Do you think that is the mark of an involved and caring leader?

Many US medical directors are not even compensated. How much time and effort do you think they spend with EMS. In my experience as little as possible.

If I said about EMS providers even 1/2 the things I regularly hear doctors (including US EMs) say about them, people here might start cutting their wrists.

There is a difference between a person who respects you and a person who is polite or nice to you.

I know more than a handful of docs who still try to advance and be involved in EMS. But they are less than 1% of all doctors.

Do you believe when a medical director asks his anesthesia or neuro surg collegue what could be improved in EMS (if she even has such collegues, and if they actually spend time talking about EMS for more than a second in the elevator) that they don't just decide there are too many variables, "keep doing what you are doing?"

Bottom line:

Doctors largely don't give a rat's *** about EMS. Certainly not enough to spend the effort to change things.

I also know many who have spent great effort and time trying to pull EMS up to speed. Most of them quit or are now just involved in critical care transport.

US EMS providers do not want to change a vast majority of doctors don't want to waste time trying to change them.

What do they say about us?

 

[RocketMedic]

Well he dose not meet my departments c spine clearing Protocol and our x ray is broke so I would say board him ( if he consented) after being informed about the procedure.

Corrected: "Well, he doesn't meet my department's c-spine clearing protocol..."

 

[rescue1]

Your experience serves you well. The only time we use a backboard in the ED is to get a patient off the floor.

It's worth it to point out that ATLS (the standard trauma course for docs) teaches that the backboard is only utilized for transport to the ED. Everyone comes off the board in the ED.

In fact, patients with evident spinal cord injury (e.g. paraplegia) are supposed come off the board immediately, given the high risk of skin breakdown and subsequent infection.

The collar usually stays on. Remember; removing the backboard ≠ clearance!

I figured. Well, maybe one day this standard of care will also be used pre-hospitally.