C-collar without a backboard?

[Ridryder 911]

I think we are totally loosing perspective of what cervical collars are and their function..

Basically, it is irrelevant if you use cervical collar, blanket roll, duct tape, or staple their ears to a LSB... :wink:

The purpose is to prevent movement of the cervical region, thoracic region.. short and simple. How it is maintained is not as important as long as it is performed and performed correctly..Unfortunately, we cannot perform tongs in the field so we will have to rely upon standards in basic immobilization.

Again, utilizing what works the best is the key.. to prevent potential spinal cord injuries and movement is the key. There is yet an absolute device.. but; taking precautions and making sure the client as much comfortable as possible is the key.

However, if you have recognized and addressed the potential injuries by placing a cervical collar, you should immobilize. Can you really make the determination of differential of C3 and T-1 referred pain ? Unless you want to hold traction en route... you will need a LSB. If you immobilize you should use straps.. again, the standard of care is what you will be based upon. If the patient moves off the board, or slides off during moving of board etc.. you are responsible.

Let's not complicate simplistic measures such as cervical immobilization.

Be safe,

R/R 911

[nsmedic393]

:notworthy:

[Thunderchild145]

No, I'm saying if they want treatment, they'll get it. LSB is "treatment" in my book. As far as no choice, what I ment is before I move you into the ambulance, you're going on a board if you have spinal compromise. If they don't want I board I'm more than happy to do what I can on scene but I'm not moving a pt like that who isn't on a board unless, like you said, they sign that they refused said treatment. As I've found, there are some who aren't willing to sign papers, and I really don't want them shuffleing around to try and see it and sign it if they might have that cervical injury, but who knows. Maybe that pain in their neck is something else. I know that I can't tell without an X-ray. :dontknow:

[Just Plain Ruff]

ok, clarify something. do they have to accept all your treatment modalities or are they able to pick and choose.

someone in a car wreck, they do not want a board but want transport, are you going to tell them they cannot go with you unless they consent to your full treatment?

i don't understand your logic or maybe I'm missing someting or misreading you.

[zippyRN]

A significant mechanism.............

so if he was in a gun fight and had a GSW, was holding a gun, whilst bleeding all over the place, do they also not have a choice?

if the pateint was alert and conscious they ALWAYS have the choice.

woe and behold the medic that physically restrained the patient to a board with straps and head box AGAINST the PATIENTS EXPRESSED WISHES.....have you heard o assult?

stay safe

dunno what it says in your guidlelines guys but i'm with Craig here

if the patient doesn't want immobilisation i'm not going to force it on them and make them struggle, if they don't want the full range of care - fine document , and if the patient is competent they sign the refusal - if they aren't it's judgement call - but it's a poor judgement call where you have to fight a patient whose injuries could be worsened by struggling....

[nsmedic393]

Once again I don't think anybody here has expressed that they will wrestle a patient onto a spine board. More to the point patients do not always have all the knowledge to decide which treatments are best for them and which treatments can go by the wayside. Thats why we are here, to bring our expertice in pre-hospital emergency care to people who need it. If I think that a patient may have a c-spine injury and they do not wish to be immobilised I am going to do everything in my power to convince them to do what I want because 99% of the time I know what is medically best for them more than they do. I'm not going to physically fight them but i will use tact and diplomacy through to telling them they might die. Its our responsability to try to do what is in the best interest of the patients weather they want to our not, without violating their rights.

[THUMPER1156]

I f the patient is in there right mind & don't want to be packaged, i try to tell them the reprocusions that could acure.If they still insisst on not being imobalized, Document-Document-Document. If you don't write it down,it didn't happin.Also might come back to haunt you later :wink:

[bandaidpatrol]

A patient of sound mind, who is mentally able to make their own decision.. Can at any time or place refuse to be either treated and/or transported. In many, hopefully all, US States, EMS cannot refuse to transport, if they refuse to be treated. If this pisses you off, take it out on a congressman, not me. Get their name, info, etc.. and twiddle your thumbs.

Forcing a patient into treatment, not allowing them to refuse, has a name. In the legal world, they call this entrapment. If the patient feels entrapped, or mental anguish because you did something that they did not want done, having voiced their "NO".. Regardless of their life being saved, the door for legal action has been opened. And there is nothing you can do about it, except work in the guidelines of the law and protocols.

Then send them the bill. Because 9 of 10 insurance companies aren't going to pay if the patient didn't need EMS. They will assume they didn't need you, if the patient felt this way. If they don't pay... Sue them. I know many services that take their patients to court.

[scootyboy2]

c spine just reminds the patient that they shouldn't move their neck. What really pisses me off is when i saw a crew. not mine company thank god, tell the patient well go ahead and step out of the vehicle and then we will back board you while you stand up. thats bull crap and is a lawsuite waiting to happen. now this makes me wonder if the crews that do this actually care about who they are treating. If you dont think that theres any thing wrong with them fine think that, but as emts we do not diagnoss pts. So if they say they want to go to the hospitial then treat them as if they had a back and spine injury. I Know there will be a time when i will think theres nothing wrong and end up there being somthing really wrong however i will not let that injury be my fault because i will do my job right.

[medik8]

Pt has the right to decide what they want. If I suspect spinal injury...will try my darndest to talk them into the full package. If they refuse...document. That's all you can do.

If they "need" the c-collar.....they are getting the board...and that's exactly how I put it to them. "These two things go together. It's not an option with me, to pick just one. If I let you do that...then I'm not doing my job to protect you. Do you understand what I'm saying?" 95% of the patients sit there a minute looking dazed.....think....and opt for the full treatment. Sometimes it just takes a moment to get them to see the whole picture. Patience is a good thing sometimes.

xoxoxo

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