Backboarding policy change

[Bernhard]

Doczilla: Thank you, now I get it. And again, thank you for providing such an excellent collection of facts!

[Bieber]

I had a talk with our medical director the other day after one of our medics suggested that we broaden our spinal immobilization protocol to include ALL neck and beck pain (as opposed to only pain over the spinal processes), and I was pleased to hear that our medical director is looking in the direction of using the boards for patient movement alone as opposed to using them as immobilization devices.

Edited August 25, 2012 by Bieber

[Job13_5]

Great information here! Just a quick question, for the potentially spine injured patient that is nauseous and vomiting, in what position are they to be placed/immobilized and how is that patient secured?

I admit that though I really like the new evidence based approach to this topic, and the general change in the way we should be thinking about the use of LBBs, I still have it so ingrained in me that it is the best thing for these patients, that there are certain notions that are hard to let go of. With that caveat, I am picturing a retching and vomiting patient not on a LBB (that warranted and got a c-collar) half hanging off the gurney, vs the same patient fully immobilized to a LBB. For the patient on the board, leaning them to the side and allowing them to vomit and assisting them with clearing their vomitus, seems like a more stable "package" in regards to reducing motion of the spine. While the patient that is not restrained onto a board will likely put their spine through much increased ROM.

Now, I understand that the patient's who are at high risk are those with unstable fractures, and that these generally produce pain that make the patient limit their own ROM. But vomiting sucks, and to my mind may produce reflexive actions that could compromise even these patient's spines.

On a seperate note: Doczilla, are you guys still log-rolling patients?

[Doczilla]

Job: We've not addressed the n/v thing specifically. We are still log-rolling, but if adequate personnel are at hand, the lift-and-slide is encouraged.

One of our FD LTs is at the NFA this week training. Someone from another state 2 time zones from here showed him a copy of our own spinal memo, and said they were adopting it. I think that is kind of cool, but I'm wondering where they got it from, since I haven't sent it out nationally until tonight.

'zilla

[island emt]

Was it a copy of yours ? Or a version that is similar from another state.

We have had selective spinal immobilization as a protocol in place for over ten years, that came about originally from the Wilderness medicine folks and progressed after the Nexus study verified that we really could do the procedure correctly, and were having proper results.

[Doczilla]

No, it was a copy of ours. We use selective spinal clearance with NEXUS like everyone else, and have for many years. This memo is specifically a back boarding/transport policy.

[RuralKSEMS]

We're looking at ways to implement this in the service I am with along with doing away with log rolling pts. Service director says that log rolling actually has the potential to do more damage because it can't be controlled exactly (no two people can move at exactly the same time at exactly the same pace in exactly the same way)