Prehospital Clearance of Spinal Injury

[FireMedic65]

I suppose EMS in PA or more so in my area is worse off than I had originally thought. We have a decent scope of practice, but the docs still get pretty pissy if you do most of the stuff. I got yelled at for doing an EJ or a cardiac arrest patient after failed attempts on the arm. I could only imagine the reaming for cleaning a spine (even with the proper training).

[island emt]

I suppose EMS in PA or more so in my area is worse off than I had originally thought. We have a decent scope of practice, but the docs still get pretty pissy if you do most of the stuff. I got yelled at for doing an EJ or a cardiac arrest patient after failed attempts on the arm. I could only imagine the reaming for cleaning a spine (even with the proper training).

We have had selective spinal immobilization as part of our statewide protocols for over ten years.

In the beginning it was based partly on MOI. After the NEXUS study the criteria were rewritten to a more evidence based method of making the determination on whether to immobilize or not.

The majority of the docs are 100% on board with our protocols as we have shown them we are capable of properly applying the SSI protocol in making a determination of probability of spinal injury. There is a 100% QA/QI on calls where the protocol has been applied to not immobilize and the results show it does work in not needlessly imobilizing customers that don't need it.

[FL_Medic]

Ok everyone. Check this out.

tell me what you think of this.

(Click to view this embedded page in a new window)

[JakeEMTP]

Here is the "New and Improved" North Carolina Spinal Clearance protocol. We haven't inplimented it yet locally, but our Medical Director says we will be doing so soon.

http://www.ncems.org/pdf/Pro12-SpinalImmob...onClearance.pdf

[AnthonyM83]

Of don't have it now, but do remember reading one journal article with the opposite conclusion as the two you posted, saying that there was no significant difference between the patients prehospital care providers and emergency physicians chose to c-spine. So, if there's one article, there might be more in the other direction, too...

[EmergencyMedicalTigger]

I suppose EMS in PA or more so in my area is worse off than I had originally thought. We have a decent scope of practice, but the docs still get pretty pissy if you do most of the stuff. I got yelled at for doing an EJ or a cardiac arrest patient after failed attempts on the arm. I could only imagine the reaming for cleaning a spine (even with the proper training).

You got yelled at after multiple IV attempts. If the EJ didn't conflict with other care the patient was receiving I don't see what the problem is. The doctor is a moron.

Edited June 1, 2009 by EmergencyMedicalTigger

[FL_Medic]

Of don't have it now, but do remember reading one journal article with the opposite conclusion as the two you posted, saying that there was no significant difference between the patients prehospital care providers and emergency physicians chose to c-spine. So, if there's one article, there might be more in the other direction, too...

Oh yea, there are plenty out there. In fact, since those two (1999), most of the evidence supports a guideline for clearance. This is still a controversial topic however.

[Doczilla]

There is no magic to clearing a c-spine in the field or in the ER. Some basic questions and a rudimentary exam work as well outside in the rain as it does in the hospital. There is not some year long class in nonradiographic c-spine assessment in medical school.

With NEXUS and the Canadian C-spine Rule and the subsequent follow-up studies, there is a staggering body of evidence that these clinical decision rules work. The thing is that you have to follow the clinical decision rule. The concept of the blogger's statement "I have developed my own systematic approach to these trauma patients" is ridiculous. Why use your own clinical gestalt when there is substantial literature that has developed a system for you? Granted, he's using many the same criteria as NEXUS or CCR, so there is probably little harm in him patting himself on the back for it. The point is, it's much easier to stand up in court and say that you adhered to a clinical decision rule that has been examined and validated with tens of thousands of patients rather than saying what you like to do in your own limited experience.

I'll wait for part II before I comment further.

'zilla

[FireMedic65]

You got yelled at after multiple IV attempts. If the EJ didn't conflict with other care the patient was receiving I don't see what the problem is. The doctor is a moron.

No, I was yelled at for doing the EJ. There was no access in the arms. Only other Access was an EJ, which was well within protocol. Just another doc swinging their schlong around to feel important and make excuses.

[FL_Medic]

There is no magic to clearing a c-spine in the field or in the ER. Some basic questions and a rudimentary exam work as well outside in the rain as it does in the hospital. There is not some year long class in nonradiographic c-spine assessment in medical school.

With NEXUS and the Canadian C-spine Rule and the subsequent follow-up studies, there is a staggering body of evidence that these clinical decision rules work. The thing is that you have to follow the clinical decision rule. The concept of the blogger's statement "I have developed my own systematic approach to these trauma patients" is ridiculous. Why use your own clinical gestalt when there is substantial literature that has developed a system for you? Granted, he's using many the same criteria as NEXUS or CCR, so there is probably little harm in him patting himself on the back for it. The point is, it's much easier to stand up in court and say that you adhered to a clinical decision rule that has been examined and validated with tens of thousands of patients rather than saying what you like to do in your own limited experience.

I'll wait for part II before I comment further.

'zilla

I believe the statement about my own systematic approach wasn't meant for praise. I was introducing how I am now questioning my own method. No where in paramedic school or the training of my agency was the afore mentioned literature mentioned or taught. Until now I hadn't seeked the evidence-based result. Basically I am calling myself negligent for not knowing more.