Oh how I despise the NREMT CBT...

[DwayneEMTP]

Ok, I found the article in Trauma journal about the study in which spinal immobilization was proven to be useless and harmful to patients by the docs. Good for them. I'll be happy to stop doing it provided that every single patient that sues for back and neck pain (which will be every single trauma patient, bar none) sues the docs instead of us...

Law suits are the rallying cry for all of the uneducated. Basically your statement says that "I will continue to hurt patients as long as I have a good excuse not to change and no one forces me to be more progressive." You're attitude is one of the many things that are wrong with U.S. EMS today.

...While I freely admit that in cases of penetrating trauma it can do more harm than good the idea that as soon as any patient is rolled into an ER the c-collar is ripped off and tossed is idiotic and probably harmful to innocent readers who haven't worked in ER. The first patient I treated in an ER setting was an accident victim who hadn't been wearing his seat belt. His jaw was dislocated by the steering wheel, he was basically scalped by the windshield(the entire crown of his head was connected by a 3 inch scrap of skin at the back). The doctor kept the c-collar on him til after the xrays and ct scan were complete. The doc who wrote the article was full of it. He acted like that here and he'd have some trouble finding a job the emergency medical field. Not because us lowly non doctor types would disapprove but because he'd be sued every damn patient he saw...

So your doc left the C-Collar on, what life altering spinal injury did that save this patient from? You forgot to mention that which, logically, should have been the culmination of the above nonsense. A dislocated jaw and scalp degloving does not a spinal injury make. And even though they should give us a reasonable suspicion for the possibility, please post your science based evidence that the C-Collar would have prevented further spinal harm.

...Still, in the case of penetrating trauma or internal trauma I understand what they mean. I simply feel the article overstated their case somewhat...

Your feeling is based on what? Your 'impression' of what's right and wrong? Your protocols, which have been proved archaic and faulty?

...And if you think the chosen cases couldn't have been chosen specifically to skew their findings I'll have to surmise a lack of experience in the field of academic experimentation. I'm not accusing the testers of dishonesty, not as such. I'm simply stating the fact that researchers are perfectly capable of deciding what their tests will discover before they're made...

Absolutely, there is always that possibility. But what motivation do you assign to the researchers of hundreds of studies all over the world that have created data strong enough to convince most of the world to stop using these devices? What benefit do they all have in common? How do you support your ideal that there is a world conspiracy to falsify research data in relation to LLBs and C-Collars? Perhaps you feel that the back board lobby is so rich and powerful that it can corrupt the world? For your point to have the slightest validity you need to have at least a theory where that question is concerned.

You come here with an apparent disrespect of published physicians and science in general and hold up as your proof of superiority your 'general impression' and anecdotal stories that show that you've actually seen an injured person in the past and seem to feel very self righteous in your argument. My wish for you is that you come to see that your line of thinking is a problem, not a solution to what's wrong with EMS.

Combine your apparent lack of ability to logically assess something as long standing and clearly supported as the LBB issue with your stated fantasies of being put in a position to scare and humiliate new EMS students and it seem clear that you need to take a few steps back and look at your basis for being in EMS or change to a forum that is more impressed with bluff and bluster over substance.

You show a common weakness of many relatively experienced but less than committed basics. The lack of education to more realistically assess medical issues, yet the confidence that comes with performing monkey skills that look cool on TV but provide very little benefit to patients.

Some of the most intelligent people on the City are basics, so it's not a slam at your cert level, it's just that you personally still have a lot to learn at this point...As do we all.

[JPINFV]

Warbargarble

Can I presume that you have some sort of evidence supporting the practice? Scientific evidence? Heck, even from a mechanical point of view spinal immobilization with a long back board doesn't pan out. After all, assuming an unstable spinal injury is present, what sense does it make to strap down a naturally curved structure to a flat board?

[ERDoc]

Bill, I'm going to reserve passing judgement but I am inclined to agree with Dwayne. Would you mind providing a link to the study you read so that we can all make sure we are discussing the same thing? It sounds to me like you are confusing a discussion about using a long board with a discussion of a c-collar. Do you use MAST pants anymore? Why or why not?

[BillKaneEMT]

Seems I've kicked a hornets nest. If I offended folks with my apparent dismissal of research studies then I apologize. I understand what you're saying and you're absolutely correct in that I do have a lot to learn. You say my protocols are wrong and harmful? It's impossible for me to dispute that given that all my knowledge was provided from books and instructors and that I have almost no experience in the field compared to you guys. I hereby withdraw my statements posted previously. Have a good one.

[Just Plain Ruff]

Now Bill you can't just put up your hands and say Mea Culpa. Dwayne asked you some pretty hard and fast questions and if you can't provide the answers to those questions say you can't but just to walk away, that's just not fitting to this discussion. That's just giving up and going down with the ship.

It's like you laid down a large amount of baseless charges and when called on them, you just say "oh, yeah I said them but I didn't mean them, don't be mad at me I didn't really mean what I said, I'm too inexperienced" That's bull.

You say you kicked a hornets nest. Yep ya did, but I'm sure Dwayne will have much to say as will ERDoc.

You just can't come into the argument and when called just slink away. That's immature, you gotta do better than that.

Edited April 10, 2012 by Captain Kickass

[BillKaneEMT]

Certainly. Regarding the first statement: Lawsuits may be the rallying cry of the uneducated. A fair amount of our training both in class and on the job was devoted to protecting yourself and the company from lawsuits. I have little experience but based on the training I was given I did not think I had hurt a single patient by providing spinal immobilization. Now, I read that spinal immobilization is harmful or, at best, unneeded. I will certainly bring this to the attention of my medical director. Whether I will be listened to is uncertain.

Point 2: The patient's xrays and ct scan were reviewed and he was found to have no spinal injury. Taking the collar off and tossing it right away would have caused no problem whatsoever. As for evidence that having a c-collar on in the case of a spinal injury would prevent further harm; all I can say is that my instructors, one of whom was a physician, assured me that applying a c-collar in case of a spinal injury was absolutely critical. Judging from what I read recently it seems that is not accurate. Not just what I read here, what I read in that trauma journal article as well. Frankly, they damn well better upgrade the books and teaching materials.

For the 3rd and 4th points I have no useful response. I haven't read nearly enough information on this topic to argue it, particularly since it seems obvious from the responses that I'm incorrect. What can I say? It was a stupid post. I make them from time to time. I'll certainly try to think before posting next time.

edit:clarification

Edited April 10, 2012 by BillKaneEMT

[Just Plain Ruff]

I respect your response BillK.

[ERDoc]

There is a lot you will not learn about medicine, especially at the EMT level. I can't count the number of times that I would bring in a pt and question what the ER staff did. Being on the other side now, I can see the error of my ways. In EMS, especially at the BLS level in the US, you have no idea what you don't know. To come out swinging the way you did will get you knocked down like Dwayne did. It's good to see that you are continuing in the conversation, it means that there is hope and you are not one of the weekend warrior, drive as fast as you can with lights and sirens type of providers. We do have ways of clearing a c-spine without xrays or CTs, it's called the NEXUS criteria. While I encourage you to learn what the NEXUS criteria are, I do not advise you to use them. I realize that you have to follow your protocols. One thing you will come to realize about EMS is that there is a lot of, "this is the way we have always done it and this is the way it should be." Run from these people. You should be asking, "Why do we do it this way ans what evidence is there to support it."

As for the long board/c-collar issue, there is quite a bit of evidence that the boards do harm, especially as the length of time spent on one increases, with very little data to support the fact that they provide any benefit. As for the c-collar, they have not been studied quite as much so there is not as much evidence either way. We all know that you can turn your head when you wear one so obviously it is not a perfect device. We all also have anecdotal evidence of people paralyzing themselves without one (had one at my institution). I think the best benefit comes from the fact that it reminds the pt not to move, most of the time.

[DwayneEMTP]

...Seems I've kicked a hornets nest...

Yeah, a little bit, but it's not your fault. Many of us when newer to EMS believed all that we were taught and that the things that are done locally are correct, and done everywhere. It can be a truly rude awakening to come to a point where you're forced to say, "Holy shit! I studied, and worked, and approached this process with a good heart and it turns out that I've been fed some bullshit?? And how do I now tell the bullshit from the truth?"

I learned pretty much all that I needed to know about you when you chose to stay in this thread and participate instead of disappear, or worse, make up bullshit stories to try and support your point. I'm grateful that you've posted and have no desire for you to recount your statements, though I'd like to recount one of mine.

Though some folks allowed you to get started with some misconceptions, the fact that you're still here and appear willing to change your opinion when given new evidence...well, that's the best of what happens in EMS. I'm afraid I somehow got the impression that you were a long time basic, it was my error to jump into the middle of you when you're newer to the field. My apologies for that.

... If I offended folks with my apparent dismissal of research studies then I apologize...

No need. We're at a point in the history of EMS where we're discovering that many of the things that we once believed intuitively correctly are not only not helpful but often harmful. We've been strutting around crowing about our awesomeness though we've been hurting people and denying our harm. We're also are having issues getting things changed because so many want to ride with lights and sirens but don't want to progress. Again, those comments towards you were made because I'd assumed that you were an experienced basic that debated the value of science as a way of maintaining the status quo...that was a foolish assumption for me to make...good on you for being a better person than I was and staying to play.

...I understand what you're saying and you're absolutely correct in that I do have a lot to learn. You say my protocols are wrong and harmful? It's impossible for me to dispute that given that all my knowledge was provided from books and instructors and that I have almost no experience in the field compared to you guys. I hereby withdraw my statements posted previously. Have a good one.

I don't accept your withdrawal, but given a bit of time to look into it, and discussion with others here, I'd be thrilled with an amendment. It's easy when you first come here to assume that those of us with strong opinions are just smarter and more experienced than you. I may be more experienced, but am almost certainly not smarter. I didn't come by my thoughts and opinions in a vacuum. The opinions I have on LBBs started with our doctors here, and others much smarter and experienced than myself, who supported them with scientific data.

When you're challenged to defend your point with data it's important that you understand that not a single challenge was made in the hopes of making you look stupid or impotent, but instead to teach you a better way to think, to present your arguments, and an uncommon way to look at EMS. Had you been able to support your opinion with scientific research you'd have made me look like a complete ass...and I'd have thanked you for it. Each time you prove me wrong I get stronger and smarter and if my ego can stand it there's no down side to that.

Don't every apologize for being contrary. For a new poster, and a new basic, you're posts are really good. It's simply not possible for you to come out of school without a bunch of ideas that are wrong. But that's what makes this forum so valuable.

It's good to have you here Brother...it's all about the learning, and the progression of EMS individually as well as nationally. Sometimes the conversation isn't wrapped in velvet, but it's always good. Should you get shut down when/if you choose to broach the subject of the value of LBBs to your peers or instructors, let us know and we'll give you all of the studies that you need to put the posers in their place.

[BillKaneEMT]

I hear what you guys are saying. In retrospect, the tone of my original post was probably caused by the fact that I studied my ass off to make sure I'd finish the class as high as I could, it was 12 hrs class a week plus volunteer shifts, plus 50-60 hrs working a week. I mean, I know it was just bls which is nothing compared to para or med school but I hadn't taken a class in over 10 years. Then I read that trauma journal thing and the gist was: "The core foundation of what you were taught is wrong. Haha!" It's never wise to post before you calm down and think logically, particularly in a case where you end up being incorrect .

The more important issue I think is to inform people. I mean, our main instructor had been teaching the class for nearly 30 years. None of my fellow students are aware of any of this as far as I know. All this info is basically 180 degrees from the way they teach the classes. The curriculum REALLLY needs to be updated, both from the teachers and the textbooks we used.

I'd be less annoyed with that if it changed once we started with a service. When I went to CDL school a decade ago they taught us to drive a certain way (double clutching etc) so we could pass the test. Then when we went out with our trainer after we were licensed it was explained that everything we were taught was totally wrong, this is how it's supposed to be done. Licensing boards want to see you do things their way, I get that. But our services damn well should have told us this stuff once we were certified and if the protocols don't work then they must be changed. I printed a copy of the Trauma Journal article and another one that was linked to it and I'm taking them in to George and the doc that helped teach our class. I can't actually bring it up to the medical director, only met him once and we're not on a first name basis. But George helped write the state test for the last 10 years so he certainly ought to be able to figure something out. I need to start auditing the classes at some point anyway, might as well be now:)