Question about defibrillation

[emt3225]

I have a quick question which i'm sure many of you will be able to answer...Can you shock a pt on a ambulance stretcher without any backboard?

[webby2525]

Can and should are two very different things. Sure, CAN shock someone on a stretcher with no backboard. I've seen it done with the pt on a reeves and on the stretcher. A hard surface just makes compressions much more effective, not sure it effects defib. Just don't touch the frame.

[emt3225]

Can and should are two very different things. Sure, CAN shock someone on a stretcher with no backboard. I've seen it done with the pt on a reeves and on the stretcher. A hard surface just makes compressions much more effective, not sure it effects defib. Just don't touch the frame.

Ok...Thanks for the info..I figured you could shock someone on a stretcher as long as u didnt touch the metal side rails..My darling friend and co-worker was telling me that u need to use a short board. I thought maybe i missed something in my training..Thanks again... :wink:

[ROOKIE(95)]

Well, I have defibrillated patients on a spine board, on a short board, on the stretcher, on the floor, in vehicles, and on the ground. I have never been able to tell any difference in any of these. You just have to be careful that you, as a caregiver, are not touching the patients or anything conductive. Such as one of my co-workers did one time, on an elderly patient who went into cardiac arrest in the bathtub. When he defibrillated the patient, he himself received the shock also which rendered him unconscious momentarily.

Just remember while treating patients your safety is first.

[akroeze]

I was told years ago an ER doc was touching the ER stretcher when they shocked and it arrested him. They got the doc back but not that patient.

[Dustdevil]

The backboard makes absolutely no difference whatsoever. It's not going to keep somebody's arms or fat arse from hanging over onto the side rails, which is really your only concern. With almost all defibrillation going to pads these days, accidental shock of EMS personnel is an increasingly rare probability. Of bigger concern now is that a patient grounded out on metal cot rails will dissipate some of the energy that was meant for the heart, rendering the conversion ineffective.

On the old thin Ferno cot mattresses, a backboard didn't even make that much difference on CPR. But with the newer, thicker mattresses, it is definitely an asset.

[Don1977]

With that being said Dust, there still teaching here in PA that a LBB should be used in an arrest for a flat surface. I had an arrest last week and we used the floor just fine, then the reeves for extrication out of the house.

[Kiwiology]

Absolutely no reason you can't defibrillate somebody on the ambulance stretcher. Might want to watch out tho if it was one of the old metal ones.

If you still carry longboards (we do not) it would make sense to take one of those in as your extrication device or use the stretcher.

[AnatomyChick]

If you still carry longboards (we do not) it would make sense to take one of those in as your extrication device or use the stretcher.

Ok.. Pardon my stupidity... I'm lost. Why wouldn't you carry a longboard anymore? How do you prepare your Trauma Patient for transport? Is there a new device that I am unaware of? I'm sooo confused, which many here will tell you is not a new thing?

[Kiwiology]

Ok.. Pardon my stupidity... I'm lost. Why wouldn't you carry a longboard anymore? How do you prepare your Trauma Patient for transport? Is there a new device that I am unaware of? I'm sooo confused, which many here will tell you is not a new thing?

We haven't carried longboards in maybe five years. Our primary device is the scoop stretcher either the old metal one or the new yellow plastic Ferno. There is no real evidence that a longboard is anything but a held over relic from the days of old.

1.3 CERVICAL SPINE IMMOBILISATION

Consider the possibility of cervical spine injury in all patients suffering from trauma. High risk patients are those with injury secondary to road crash or significant fall (especially head first), and patients with pre-existing cervical spine abnormalities (e.g. ankylosing spondylitis or rheumatoid arthritis).

Life threatening abnormalities within the primary survey always take priority over the cervical spine.

Patients should have cervical spine immobilisation unless all of the following criteria are met:

• GCS 15, alert, cooperative and

• No neck or upper back tenderness on palpation or active movement and

• Normal peripheral sensation and movement and

• No painful or emotional distractions.

These criteria may be used for children provided they are old enough to understand and cooperate with examination.

Immobilising the cervical spine

• Immobilisation must not impair maintaining adequate airway, breathing and circulation.

• Place the patient supine in a well-fitted hard collar with the head in a neutral position. If the patient is placed on their side keep their spine in alignment.

• Head blocks (or lateral padding) are not required as a routine.

• The head and shoulders must not be independently immobilised unless the entire body is also immobilised. Entire body immobilisation is not required as a routine but should be considered if significant movement (e.g. over rough terrain) is anticipated.

• Spine boards and other rigid flat boards are to be used as sliding or extrication devices only. Patients must not be transported on such boards.

• Devices such as the KED should not be used as a spinal immobilisation device in their own right. Their primary function is to keep alignment of the spine during extrication. KED should only be used in patients with a normal primary survey.

• Clinical judgement must be used for uncooperative patients. If attempts to immobilise the cervical spine result in the patient ‘fighting’ then it is appropriate not to formally provide immobilisation if this approach minimises cervical spine movement.

• If significant respiratory distress is present gently sit the patient to 45 degrees, with a cervical collar in place and the spine in alignment.