More on backboards and spinal immobilization

[Just Plain Ruff]

Yep, I was 99.9999999999999999992999999% sure he didn't have a bleed but he needed stitches so I took him there. I'm surprised they didn't want to put him in a helicopter and fly him to the trauma center.

We held our ground and refused the CT. Plus I knew the nurse was just being an idiot so I let that one go until I talked to her boss.

[yakc130]

At my old urban job, we had the option of clearing C-spine in the field if certain criteria were met. If there was any doubt, put them on the board.

If all services had access to vacuum matresses, it might be different. I think that they have a bit more padding.

[Bernhard]

If all services had access to vacuum matresses, it might be different. I think that they have a bit more padding.

Sadly, not necessarily: vacuum mattresses are standard here since the 1970ies, but since backboards were introduced a few years ago, it gets more common to strap down each and every trauma patient on them. I'm fighting against it wherever I can, but can't argue much on-scene when I'm not happen to be the responsible medic. Discussions are fruitless. It's something new and therefore it HAS to be used. ITLS procedures seem to promote this (really?) and a recent external ITLS trainer giving some update lessons countered my arguments with some blunt statements instead of logic and/or evidence. Kind of frustrating how most colleagues follow this "new" paradigm of backboarding here.

[Just Plain Ruff]

Kind of frustrating how most colleagues follow this "new" paradigm of backboarding here.

time to think outside the paradigm and follow the research and not the long standing conventional wisdom but until every medical director re-writes the protocols and the ED nurses get up to snuff, it will not change and I've been doing this off and on for over 20 years

[Bernhard]

time to think outside the paradigm and follow the research and not the long standing conventional wisdom but until every medical director re-writes the protocols and the ED nurses get up to snuff, it will not change and I've been doing this off and on for over 20 years

Bad thing is: this just STARTS here...my last 20 years in german EMS before 2009 (when they started equipping our units with them) I lived well without any backboard.

However they prove useful in certain situations, but not in all - just as any tool in our hands.

Still glad, ED nurses haven't much to tell us here...

[croaker260]

For what its worth: We have had a SSI protocol officially written since the late 1990's very early 2000's..but IF you did immobilize someone , it was all or nothing (read "full LSB/colalr immobilization").

6 months ago we finally got a new protocol in place that we have been working on over the previous 18 months getting buy in from all stakeholders...trauma, neuro, ED, Fire, etc.

NOW (as defined over the previous 6 months) we Still have an SSI protocol that the assessmnet/ exclusion criteria are very similar...., but the defalt is c-collar only immobilization with the patient in a supine position on a soft matress, self extrication from cars/couches/bar-stools is clearly allowed (two step rule AKA "traveling", with assitance from providers). The KED/LSB ONLY when specifically justified. Scoop is prefered for supine patients when possible.

This is the new every day standard. NOT the rarity. And we are a medium sized service (22K/year calls)

In all seriousness, I have used the scoop more than the past 6 months than I have in the past 23 years. And I have used the LSB less than 10 times over the same period.

Edited January 27, 2014 by croaker260

[ERDoc]

Croaker, do you have a link to your protocols? I'd love to have a look at them. Sounds like a great place to practice.

[croaker260]

Croaker, do you have a link to your protocols? I'd love to have a look at them. Sounds like a great place to practice.

http://www.adaweb.net/paramedics/AboutUs/StandingWrittenOrders.aspx

The specific protocol that pertains is here:

http://www.adaweb.net/LinkClick.aspx?fileticket=_jCsKmENMhE%3d&tabid=4660

The protocol as written does not sufficently emphasise the true paradigm, shift. As a single sentance states, the KED and LSB are for extrication, not for immobilization.

As anywhere, there are always some things to complain about...it is EMS after all...but yes, its a great place to practice. I've been here 15 years and counting.

Edited January 28, 2014 by croaker260

[island emt]

Wow Steve:Has it been that long since you left Tennessee?

Time flies as we get old & gray.

[croaker260]

Wow Steve:Has it been that long since you left Tennessee?

Time flies as we get old & gray.

Hehe

I left TN in 1998, arrived at ACP for academy "December 7th, a day wich will live in infamy forever"... So yeah, its been a while. I try not to think about it too much. And its a good thing you put WE in that statement about old and gray...