What do your protocols say about spinal immobilization for penetrating trauma?

[BEorP]

(Note: Australians and New Zealanders need not respond to the question - this thread is not for that fancy evidence-based practice you guys think is so cool.)

Hey all,

I'm just wondering what your agency's protocols are for immobilizing penetrating trauma patients. Is this something that you would routinely do for someone who is short or stabbed in the head or torso?

I don't particularly care to discuss what the best practice is (there's not much to discuss there anyway!) but I'm just curious what is actually done where you work.

Thanks!

[BushyFromOz]

(Note: Australians and New Zealanders need not respond to the question - this thread is not for that fancy evidence-based practice you guys think is so cool.)

modified version of NEXUS

[emtdennis]

If possible do not remove the penetrating object. Secure it in position as best as possible to possibly prevent more internal bleeding.

[Richard B the EMT]

If possible do not remove the penetrating object. Secure it in position as best as possible to possibly prevent more internal bleeding.

This is a given of NY State protocols. As I understand it, the penetrating object may be acting as a "plug" against bleeding, so don't remove.

Seems dj and I are operating on presumption the penetrating object is an impaled one.

Is this something that you would routinely do for someone who is short or stabbed in the head or torso?

...and taking the time to poke fun of the typo, as being short is not a physical injury.

Being shot, however, has combined dynamics of the impact, penetration, and internal injuries.

The impact energy of a bullet can throw someone around, even someone the size and build of Arnold Schwarzenegger, while wearing soft body armor (NO vest is truly bulletproof).

Where did the penetration happen on the body? What did the penetrating? What was penetrated before the object stopped penetrating? If a knife, did the assailant remove the knife?

Questions like these will determine if Long Spine Board Immobilization is required, and if the local ER or Trauma Hospital is the destination of choice or necessity.

[Kiwiology]

The impact energy of a bullet can throw someone around, even someone the size and build of Arnold Schwarzenegger, while wearing soft body armor (NO vest is truly bulletproof).

Where did the penetration happen on the body? What did the penetrating? What was penetrated before the object stopped penetrating? If a knife, did the assailant remove the knife?

Questions like these will determine if Long Spine Board Immobilization is required

Richard, please be assured I have the utmost respect for your decades of experience and do not wish to appear condescending but unless the bullet or knife has actually transected or lodged in the spinal cord there there is absolutely no point in doing any sort of spinal immobilisation whatsoever.

I recall watching a grou pf American EMT's trying to fit a rigid cervical collar around somebodies neck, he had been stabbed in the back of the neck and they had a real hard time doing this because of the difficulty in covering the wound and applying the collar. They must have pissed around muppeting about for probably 10 minutes trying to do this and all the while the patient was happily moving around without any neurological defecit or neurological symptoms.

Unfortunately a lot of what EMS does is based on broad emperical epidemiology or biologic plausability and has not been subjected to the laws of evidence based medicine. There is much supersition around spinal immobilisation and it needs to stop because it is more than likely doing harm to patients who actually have a spinal injury while subjecting those who do not to unnecessary intervention which in itself may be harmful. And lets not forget it makes those blindly doing it without question a bit silly too.

[BEorP]

If possible do not remove the penetrating object. Secure it in position as best as possible to possibly prevent more internal bleeding.

Thanks, but would you also do spinal immobilization for penetrating trauma?

...and taking the time to poke fun of the typo, as being short is not a physical injury.

I should have known better to think that I could type a typo-free post sans glasses!

[Arctickat]

No, unless the MOI indicates a potential spinal injury. ie. MVC with ejection and impaled on a fence post.

[Mateo_1387]

Richard, please be assured I have the utmost respect for your decades of experience and do not wish to appear condescending but unless the bullet or knife has actually transected or lodged in the spinal cord there there is absolutely no point in doing any sort of spinal immobilisation whatsoever.

I recall watching a grou pf American EMT's trying to fit a rigid cervical collar around somebodies neck, he had been stabbed in the back of the neck and they had a real hard time doing this because of the difficulty in covering the wound and applying the collar. They must have pissed around muppeting about for probably 10 minutes trying to do this and all the while the patient was happily moving around without any neurological defecit or neurological symptoms.

In regards to your first statement about transected spinal cord or objects lodged on the cord, and then placing that patient on a backbaord, it is ludicrous !!! You are seriously going to advocate that Kiwi's and their supposed evidence based practice do not place any patient on a backboard, but rather use a scoop stretcher and cervical collar, yet on this thread say patients should be placed on a backboard? Did the Kiwi's just change this policy in the past 5 days?

It makes no sense to waste time placing a patient on a backboard with the evidence that is out there about its effectiveness in reducing neurological injury. The patient with such a devastating injury does not need the backboard, as the damage is already done. While you waste time placing the patient on that backboard, I'm going to go ahead and get them to a trauma center, so they can take care of all the internal hemorrhaging or other injuries that are more important than that backboard.

Where were these "American" EMT's? Sounds like some sloppy Central American medicine.

And to quote you from this thread

Oh my eyes, have seen the glory! can I get an amen! ... no, not a long backboard that is the work of Satan!

Long ago New Zealand adopted the position that there is no evidence spinal immobilisation in the form of a rigid board, head blocks, straps and eleventybillion other things is helpful and we use the scoop stretcher and a well fitted hard collar +/- KED for patients in an RTA where appropriate. Australia is very similar although there are minor variances between states and the UK still uses board and blocks.

I have never understood the logic in strapping somebody to a hard, rigid board that is uncomfortable and trying to say its helping them.

I applaud you sir!

Oh, if you want to tube somebody with a cervical collar on, undo the front and use a bougie, but you really should be using a bougie anyway regardless ....

[Kiwiology]

I never advocated placing somebody on an LSB if my post inferred that i apologise. The scoop stretcher or combi carrier now is used more to move patients who have had a cervical collar placéd than it is for its pure spinal immobilisation properties

I saw the EMTs on some documentary on YouTube i think ill see if i can find it

[BEorP]

No, unless the MOI indicates a potential spinal injury. ie. MVC with ejection and impaled on a fence post.

Thanks!