More on backboards and spinal immobilization

[paramedicmike]

This article is by Bryan Bledsoe from the beginning of August of this year. It provides more support to the overuse and harm caused by backboards and spinal immobilization.

Of course, I don't think this is new information to our regular contributors. However, it's good to get the word out to those still working with an outdated thought process drilled into their heads.

[Just Plain Ruff]

this could be added to the wiki too.

[ERDoc]

Let's combine this with high flow oxygen for everyone when we do the wiki

[Just Plain Ruff]

And that we transport all dead people regardless of level of rigor or decomp.

Call it the myths of EMS Wiki page

[MariB]

Well we are taxi ambulance drivers

[HellsBells]

This post makes me pissed off that spinal immobilization is even a technique that exists anymore.

Dogma is right. All the evidence points to the fact that this is a pointless procedure. Yet we do it because it makes health care workers uncomfortable not to.

[island emt]

I recently had the riot act read to me by a young snotty ER nurse who went running to the ER doc about me bringing in a 92 yo male with only a collar on and not boarded.

I told her my boots are older than she is and to go bother someone else.

{I know , must play nice with the ER folks even if they are idiots ]

He was A+OX3 with no pain or deficits on spinal exam. He had fallen an hour prior to his daughter calling 911 as he did have a minor <1inch lac to his forehead which was still bleeding. Full head to toe exam and pressure dressing to forhead. Placed collar just because he wasn't sure of exact mechanism and stair chaired him out of house and up 80 ft in elevation to the paved parking area..

He has kyphosois so the thought never entered my mind to force him to lie flat on a board for a 35 min ride to ER.

After several X-rays and sending him to cat scan they were ready to send him home when the radiologist consult service called and noted that he had a c-6 fx of undetermined age. They packaged him up and sent him by ambulance to the trauma center an hour south where the ortho folks redid x-rays and determined the fx to be several weeks old and of no consequence or risk of insult to the cord. They sent him home in a soft collar 5 hrs later with a huge bill plus the original ER tab and transport ambulance taxi ride south. Problems developed were extreme lower back pain and tissue breakdown from being tied down flat to a board for the ride south.

We have a spinal protocol for a very good reason. To allow us to rule out with reasonable certainty & avoid torturing pt's by putting them on a board.

Edited December 7, 2013 by island emt

[Just Plain Ruff]

I recently had the riot act read to me by a young snotty ER nurse who went running to the ER doc about me bringing in a 92 yo male with only a collar on and not boarded.

I told her my boots are older than she is and to go bother someone else.

{I know , must play nice with the ER folks even if they are idiots ]

I"ll go one better for you, I brought my father into a local ER. He had stood up too fast and hit his head on the door jam of his car and sustained a 1 inch lac to the top of his head.

I made the mistake of mentioning that I was a medic when they asked why the wound was so clean and bandaged up so well. The nurse proceeded to tell me that I must not be a very good medic if I brought him in myself and didnt' call an ambulance to transport him due to the fact that he had a head injury and he was elderly.

I proceeded to tell her that it was my decision on how I transported my father to the ED and it was none of her fuc ing business how he got there. He had no complaints other than a cut on the top of his head.

The PA arrived and proceeded to tell me that there was good possiblity of him having a bleed due to his age and tried to get us to do a cat scan and my father refused, they made him sign a refusal for the cat scan and then when he didn't want to be transported to the trauma center for head trauma in the elderly, they also made us sign a refusal for that.

I had a long talk with the medical director of the ER the next day and he throroughly reviewed my fathers chart and agreed that a ct was unnecessary and that the nurse was out of line for berating me for not calling the ambulance. But I also had a discussion with her manager about her attitude that night.

I got a nice letter from the director of nursing apologizing for how we were treated.

We nearly left before treatment was done.

[Kiwiology]

Initial consensus statement on immobilisation by the Faculty of Prehospital Care of the Royal College of Surgeons (Ed.)

http://www.fphc.co.uk/content/Portals/0/Documents/2013-12%20Spinal%20Consensus%20COMPLETE.pdf

[island emt]

Ruff: thats the whole problem with the "system".

Because some elderly have a higher risk for a bleed thay all have to be treated as if they due in "COVER YOUR ARSE MEDICINE".

The cost of healthcare has skyrocketed because every pt with a simple head lac needs to go to CAT scan or MRI, depending on whats available in order for the facility to covers it's butt and run up the bill.