Spinal precautions

[DwayneEMTP]

Also have 'no idea what a 'sticky test' is...

A couple of things. I agree that assessment is the major component here, and that the legalities of of varying from your protocols should be considered.

Having said that, I can tell you that often this is what happens. I show up on scene, fire is holding manual c-spine, I take the cot while my partner gathers spinal precaution equipment, by the time he's ready I have log rolled the pt with manual c-spine in place, assuming your standard 'test like' supine position, and simply roll him back onto the LB, apply collar, etc, etc. Now, the argument can certainly be made that the collar should have already been in place before I arrived...but then you'd have no understanding of small town, rural EMS.

I've got next to no faith in c-collars being of more value than competent manual stabilization alone, in fact in my limited experience the majority of significant manipulation of c-spine comes from fighting against the collar, so this gives me no great crisis of conscience, but others will likely feel differently. But the science isn't there for any hardcore faith in c-collars.

Also, based simply on what you stated above, assuming you're using intelligent assessment skills, I see no problem with your logic. And I absolutely respect your desire to think around the corners of something that so many consider just a 'silly skill.' Good for you for asking questions, for questioning the status quo, for being brave enough to put your thoughts out for scrutiny. All of those are wicked strong EMS traits.

Good question!

Dwayne

[scubanurse]

I've got next to no faith in c-collars being of more value than competent manual stabilization alone, in fact in my limited experience the majority of significant manipulation of c-spine comes from fighting against the collar, so this gives me no great crisis of conscience, but others will likely feel differently. But the science isn't there for any hardcore faith in c-collars.

That is where I have an issue. How many people are competent at holding manual stabilization?? I have seen it too often in the field done improperly to have any confidence in manual stabilization alone.

With regards to the situation you provided though, why not apply the collar yourself once you get on scene to assure it's done properly? I would have a hard time moving a patient, with any degree of suspicion for a spinal injury, without a c-collar in place. I personally like to apply them because I am confident in my ability and if I am the primary provider, then I am ultimately responsible for how the collar is placed.

There are situations where you have to adapt and overcome, but priority should always be placed on maintaining control of the spine and not causing further damage.

[mobey]

I don't know about you, but I would LOVE to have my hands get covered in blood for the rest of the call.

Just saying

Does make for good newspaper pics....

Dwayne is right though.

IF you have a good reason to step outside the box, then use your own discression.

Hey.... some people get too claustrophobic and cannot tolerate a c-collar, sometimes with a clavical fracture it is too painful...

The point is, there are no 'PROVEN' spinal standards out there, backed with scientific evidence.

If you can back up your actions in court (or to your supervisor) and show it was in the best interest of the patient, then you gotta do what you feel is necissary.

[CBEMT]

A "sticky test" is basically a quick test to detect the presence of any leaking bodily fluids.

Is that what they call it at Safety these days?

[DwayneEMTP]

That is where I have an issue. How many people are competent at holding manual stabilization?? I have seen it too often in the field done improperly to have any confidence in manual stabilization alone.

But can you show me where there is any evidence that the collar is valuable? As I said before, in my experience often a patient that was calm and still with manual stabilization becomes much less 'safe' once the collar is applied due to pain from injury, fear of the collar for multiple reasons, or simply because they're drunk and pissed off that anything is happening. I've found the c-collar to operate much more often as a pacifier for the provider than a benefit for the patient.

Another thing I hate about c-collars is that more often than not, whoever is providing c-spine suddenly feels free to talk to their buddies, or check out the chicks instead of paying attention to in line immobilization. And I'm willing to bet that I'm not the only one that notices this phenomenon.

With regards to the situation you provided though, why not apply the collar yourself once you get on scene to assure it's done properly?

No reason really, it's just kind of how the flow of my calls has come to be. More habit than anything else I think.

There are situations where you have to adapt and overcome, but priority should always be placed on maintaining control of the spine and not causing further damage.

Exactly. And again, in my experience the collar seems to have the potential to cause harm, and has no scientifically proven benefit, so does that change your argument at all?

Thanks for your thoughts.

Dwayne

[scubanurse]

I would be curious to see any evidence against a C-collar and if there is any evidence against manual stabilization...

I agree there are arguments to both sides, and I can see where in some situations the collar would cause more harm either emotionally or physically, but what about the consequences of those people who are paying more attention to the hot chicks than keeping in-line stabilization? Without a collar to at least help hold them in a neutral alignment, couldn't the distracted people holding manual cause more harm if there is in fact a spinal cord injury?

[downsouth]

I don't know about you, but I would LOVE to have my hands get covered in blood for the rest of the call.

Just saying

I think both of you were right. But from what I think is depend on situation ,right? So the person who goes there will have to determine that.

Boy Down South

[DwayneEMTP]

I would be curious to see any evidence against a C-collar and if there is any evidence against manual stabilization...

Can't really help there as a quick Googling turned up nothing. But in science based medicine it's important to remember that a lack of evidence against should not necessarily be considered evidence for, and of course the opposite is also true. I'm afraid we're both stuck with intuitive and anecdotal reasoning on this one. (which makes for some gnarly good debates I might add!)

I agree there are arguments to both sides, and I can see where in some situations the collar would cause more harm either emotionally or physically, but what about the consequences of those people who are paying more attention to the hot chicks than keeping in-line stabilization? Without a collar to at least help hold them in a neutral alignment, couldn't the distracted people holding manual cause more harm if there is in fact a spinal cord injury?

Fair question. And perhaps I've simply been misapplying them all this time, but I've never really seen them prevent an uncooperative pt from doing anything except perhaps touch their chin to their chest. Other than that, without additional support pts have near full range of motion.

Actually, WinterMedic and I were talking about this earlier today, that sometimes there can actually be several right answers to a question. I'm not sure this is one of those times, but I think that it might be..

The contrary ass in me wants to say, "Bullshit, it makes people uncomfortable and seems, intuitively,, to be useless, plus there's no science to prove that it's useful! So I don't want to use it" And then, everyone around me WANTS to use them, which makes me REALLY not want to use them...grin. So perhaps I've gotten a little off in the ditch here simply for the opportunity to be stubborn. I can see where perhaps they help to mitigate the force of compression on the c-spine...not sure though.

I truly believe, at least in part, that we still consider long boards and c-collars 'vitally' important because it's the main, and sometimes only, skill of some providers. We can't logically devalue the equipment without also devaluing the people that consider them their only example of being important. See? In the short game, I'm ok with that, as long as the rest of us don't forget that we need to determine an actual applied value for everything that we do, and let the publics/Ricky Rescues perceived value be damned.

Thanks for you thoughts!

Dwayne

Hell, I took so long to post I guess BDS really said the same thing in way fewer words. Welcome to the site man!

[Timmy]

I've read an article called “cervical collars in patients requiring spinal immobilisation”. The researchers come to the conclusion that cervical collars provide minimal benefit to patients suffering from spinal injury. As with everything I guess it depends on what literature you stubble across, some people preach cervical collars while others say it provides minimal benefit.

I think spinal immobilisation is one of those things that just needs to be done to the best of our ability. I've been in an unfortunate situation at a Motocross race were no matter what we did or from what angle we approached the situation if we moved the dude we were going to cause further damage. What can you do? Leave the guy prone in the mud for the rest of his life or get him to hospital. Fortunately there was someone senior to me on the scene who made the call to move him, you need to provide adequate documentation and justification for your actions.

I'm a fan of evidence based research and best practise so until some new wiz bang guideline is published and recommended by the appropriate authorities I'm sticking to what I've been taught which is collar on, strapped to the board and head blocks.

[P_Instructor]

If you're treating someone of a suspected spinal injury, you're going to have your partner holding c-spine. When you go to log roll the patient to their side to palpate the spine and prepare them for boarding, the C-collar will actually help your partner keep the neck in a neutral inline position.

You'll see this thought process outlined as you cover the backboarding process.

I agree with 'Lone'...Hopefully your partner is providing manual cervical stabilization, and I emphasize the word stabilization, and properly before, during, and after the log roll. The cervical collar does not mean you can release the stabilization until fully secured to the backboard. Of course this is provided after all physical exam has been performed. The c-collar does assist with the neutral alignment when providing this manual stabilization. As when placing the c-collar itself, whenever you think necessary, as long as the c-spine is being attended too.