Spinal Immobilization: Are we doing more harm than good ?

[Ace844]

If I had it at hand I would post it but why would I make something like that up? In a Trauma situation where you have callled it a Level one or two for example and you have the team working a patient then its obvious the board is going to go, but if the patient is stable and gets put in line in an ER then they may expect to wait awhile to get off the board. Why is this so hard to believe? Do we really believe that every single patient that says they have "neck pain" or whatever needs to be put on a board? I understand many systems protect themselves from the liability of mistake by boarding everyone, but to you as health professionals do the studies show we are doing any good by boarding everyone? Don't use the whole "well this one time ten years ago I had a patient that x" line either, what good are we doing people if we don't look at the bigger picture, do studies, research and change when the evidence says we should have years ago. We are never going to get anywhere as a medical profession if we refuse to act like the rest of the medical world.

[marq=left:3600578e43]I ADVISE YOU TO READ THIS THREAD ENTIRELY AND THEN DO A SEARCH AND READ THOSE IN THEIR ENTIRETY AS WELL!!! THEN COME BACK HERE AND RE-READ WHAT YOU POSTED AND THEN YOU'LL SEE WHY YOU GOT THE RESPONSE YOU DID...THANKS...ACE844[/marq:3600578e43]

THE BURDEN OF PROOF AND EVIDENCE IS ON YOU!!!

Out Here,

ACE844

[Ridryder 911]

I believe other are right, actually you are examining for selective immobilization. True clearing is describing there is no fxrs., as well I wonder why they would do CT scan on necks?... Unless there is associated injuries or needs clarification a simple cross table and lat will be significant enough on an adult.

R/r 911

[paramedicmike]

If I had it at hand I would post it but why would I make something like that up?

You tell us! We don't know you from Adam. You might make it up to sound important. You might make it up because you're not smart enough to know any better. But what's worse, you *did* make it up and now you're being called on your false information (because Herbie, who initially called you on it, and I know better).

I'll let you in on a little secret though. The PA BLS protocols are available with a five second google search! :shock: You have internet access to get here. It stands to reason you'd have it for that, too.

In a Trauma situation where you have callled it a Level one or two for example ...

This bugs me. Only the hospital will call it a level one or level two trauma. As far as EMS in PA (or anywhere else for that matter) is concerned it's a Class one or two trauma alert/transport or a class three patient (or insert your priority listing there). Designation of a trauma "level" doesn't take place in the field. Tell the hospital what you have and let them decide their response.

and you have the team working a patient then its obvious the board is going to go, but if the patient is stable and gets put in line in an ER then they may expect to wait awhile to get off the board.

How long have you ever had a patient wait to come off a board?

Why is this so hard to believe?

What is what so hard to believe? That you do c-spine clearance in the field? It's hard to believe because you don't do it! Read on...

Do we really believe that every single patient that says they have "neck pain" or whatever needs to be put on a board?

Every patient we come across does not need spinal immobilization. That's why we practice selective spinal immobilization. We conduct our complete assessment and then determine based on our findings if that patient needs to be immobilized.

You said you cleared c-spine in the field. I'm telling you that you do NOT clear c-spine in the field. As Ridryder pointed out only the doc can clear a c-spine after his/her exam.

I understand many systems protect themselves from the liability of mistake by boarding everyone,

Care to cite an example? Bet you can't do that either!

but to you as health professionals do the studies show we are doing any good by boarding everyone? Don't use the whole "well this one time ten years ago I had a patient that x" line either, what good are we doing people if we don't look at the bigger picture, do studies, research and change when the evidence says we should have years ago. We are never going to get anywhere as a medical profession if we refuse to act like the rest of the medical world.

I suggest you follow Ace's suggestion and search the forums for this particular topic. What you find will astound you. :shock:

Also, as you are finding out, this is a pretty rough crowd that demands excellence among all participants. We expect that if you post something you have the ability to back it up. When you fail to do so you're called on it.

Basic high school writing teaches that if you claim something you'd better cite a source. If you haven't been to high school yet that would be one thing. But I'm inclined to think you've already been down that road.

And one last little piece of advice. When you realize you're in a hole you can do one of two things. You can keep digging or you can put the shovel down and step out of the hole. I suggest you follow the latter of the two.

-be safe.

[Ace844]

Excellent points and well written "Paramedicmike,"!!! In addition to "Mike's," last point I'd also recommend you admit you made the mistake, man up and take responsibility. At that point you may find the reception you get is abit more welcoming....

ACE

[stcommodore]

I don't recall hearing the term "selective immobilization" before but for what we are trying to refer to that works fine. Following the NEXUS criteria the doctor doesn't have to do xray, ct, or any scan like that to get someone off the board. I have also seen situations where the hospital took the word of EMS and called a level, and cases where they waited, nothing I'm sure we haven't all seen before. It all varies depending on the hospital, and tons of other factors.

[Ace844]

I don't recall hearing the term "selective immobilization" before but for what we are trying to refer to that works fine. Following the NEXUS criteria the doctor doesn't have to do xray, ct, or any scan like that to get someone off the board. I have also seen situations where the hospital took the word of EMS and called a level, and cases where they waited, nothing I'm sure we haven't all seen before. It all varies depending on the hospital, and tons of other factors.

Because I have been warned that i must be PC and kind... I will again say this...ALSO ADD THIS PAGE TO THAT LIST

[marq=UP:40d37741d3]PLEASE [/marq:40d37741d3]

[marq=left:40d37741d3]I ADVISE YOU TO READ THIS THREAD ENTIRELY AND THEN DO A SEARCH AND READ THOSE IN THEIR ENTIRETY AS WELL!!! THEN COME BACK HERE AND RE-READ WHAT YOU POSTED AND THEN YOU'LL SEE WHY YOU GOT THE RESPONSE YOU DID...THANKS...ACE844[/marq:40d37741d3]

THE BURDEN OF PROOF AND EVIDENCE IS ON YOU!!!

Out Here,

ACE844

[paramedicmike]

First you said,

We have to remeber that by putting a pt on a LSB we are putting them in line for Cat Scan when they get to the hospital and an unknown amount of time on that board.

Then you said:

In a Trauma situation where you have callled it a Level one or two for example and you have the team working a patient then its obvious the board is going to go, but if the patient is stable and gets put in line in an ER then they may expect to wait awhile to get off the board.

Now finally, this:

I don't recall hearing the term "selective immobilization" before but for what we are trying to refer to that works fine.

It works fine to call it that because that's what you're doing.

Following the NEXUS criteria the doctor doesn't have to do xray, ct, or any scan like that to get someone off the board.

So you're not doing the c-spine clearance after all (not that it's a surprise to us)! It's the doc who's doing it. And suddenly now no mention of any kind of radiographical study? What happened to the need to wait on a board for a CT? Or, as Rid pointed out, the more appropriate x-ray?

And then there's this little gem:

We are never going to get anywhere as a medical profession if we refuse to act like the rest of the medical world.

You mean by exhibiting qualities like honesty, integrity and accountability for our actions? I agree we need these qualities just as much as the rest of the medical profession. Too bad you're having a hard time following them yourself.

Please, stop digging this hole for yourself. It's only getting deeper.

-be safe.

[Scaramedic]

Because I have been warned that i must be PC and kind... I will again say this...ALSO ADD THIS PAGE TO THAT LIST

Did someone get called to the principal's office?

Peace,

Marty

:roll:

[Ace844]

:!:

Did someone get called to the principal's office?

Peace,

Marty

:roll:

In a manner of speaking yes, one may safely arrive at that conclusion :arrow: :!: :!: :shock: :shock: :shock: you have a PM.... :arrow:

[mediccjh]

Well, stcommodore, you said that the PA BLS Protocols state that we can clear C-Spine in the field, yet you have not shown us where in the protocols it says so.

Do me a favor and don't practice EMS in my neck of PA.