Question about C-spine immobalization.

[JPINFV]

Well, I think that C-spine immobalization protocols are just sometimes to general. The biggest indications of a needed CSI for me are poor sensation/motor skills, visible damage, obvious MOI that is known to cause C-spine damage, head/neck trauma, etc. For example, if someone falls off a small ladder and hits a rock that breaks their arm (lets say he fell from 4 ft high) we would splint their arm. Obviously, this would be done after the proper examination. Let's just say the examination revels this patient to not have any other complaints or obvious problems besides the broken arm. On the other hand, some people could say well maybe this guy didn't show signs of internal nerve damage but it would be on the safe side to board him. That arguments is hard to counter because you can't prove them wrong or right. So most people would just say just to be careful board them.

Its about as hard to counter as saying every patient gets 15 LPM via NRB unless they can't stand the NRB. MOI isn't always the best predictor of c-spine injury. http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

http://www.jtrauma.com/pt/re/jtrauma/abstr...9856144!8091!-1 (doesn't explicityly state that MOI shouldn't be used, it just doesn't utilize it, either).

Saying everyone gets a board would be like saying every trauma, reguardless of severity, should get a full body CAT scan just in case. Both sound ludicrious. Every prehospital provider (be it a EMT-B, EMT-I, EMT-P, PCP, ACP, CCP, or any other letters) who does something, "just in case" with out a clinical basis should be given a set of voodoo beads, just in case it might work.

[Ridryder 911]

Geez this is not rocket science.. are they not teaching how treat patients anymore? The question in the initial scenario is a lot different than having a specific or isolated injury. I did not watch the video nor do I want to, too many idiots in action. Each patient and situation should be guided by the incidence, the mechanism of injury (MOI), the potential injuries and the findings of the detailed assessment. If there is potential injury, pain, paresthesia, they get immobilized.. period If your service has field clearance protocols and the examination, MOI, meet those then use them. But, even those usually are vague enough to state, "when suspicion, or possibly indicated, err on the behalf of the patient"; if they don't they should.

Please if you are going to post or cite journals as well be sure they are pertinent to the case. This article was not for initial spinal precaution (s) , but eluded to the length of stay and having patients remain on LSB. Anyone that works in ER should know that removal of CID and LSB should occur ASAP (after clearance, preferred x-ray or CT) to prevent pressure sores, neuropathy, and other potential injuries.

All this material should had been well covered in the basic curriculum and in detail in PHTLS or a BTLS course.

R/r 911

[JPINFV]

Please if you are going to post or cite journals as well be sure they are pertinent to the case. This article was not for initial spinal precaution (s) , but eluded to the length of stay and having patients remain on LSB. Anyone that works in ER should know that removal of CID and LSB should occur ASAP (after clearance, preferred x-ray or CT) to prevent pressure sores, neuropathy, and other potential injuries.

The purpose of that study was to show that placing a person on a LSB was not a fully benign procedure. I acknowledged the limitation of the study to prehospital care in that post.

[MedicTroll]

We are taught the basics, what to look for, what signs/symptom are of some things. We are given a general outlay, and knowledge. We take that in the field and use it with common sense, every event is not the same and every patient reacts in different ways. Worse thing anyone can do is play Monday morning quarterback, I hate when people sit around and make judgments on jobs they were not a part of, if you were not on the scene to know what all the factors were, then you have no right to comment on it. Which brings me to my point, you size up your scene and your patient finding and treat that patient with what you feel is the best treatment you can provide for them. That is our job and what we are trained to do, period. Follow your state protocol's, and do what you feel is right. If you feel this village idiot should be collared and boarded, then do that.

[EMS-Cat]

We are taught the basics, what to look for, what signs/symptom are of some things. We are given a general outlay, and knowledge. We take that in the field and use it with common sense, every event is not the same and every patient reacts in different ways. Worse thing anyone can do is play Monday morning quarterback, I hate when people sit around and make judgments on jobs they were not a part of, if you were not on the scene to know what all the factors were, then you have no right to comment on it. Which brings me to my point, you size up your scene and your patient finding and treat that patient with what you feel is the best treatment you can provide for them. That is our job and what we are trained to do, period. Follow your state protocol's, and do what you feel is right. If you feel this village idiot should be collared and boarded, then do that.

Detailed dissection of events we haven't physically been present for is a large part of this forum. It can be a good teaching tool. Docs do it all the time. It's called 'morbidity and mortality conference'. Most places I've worked in EMS or in hospital as an RT, etc, have ongoing reviews of policy and procedures and certainly get together and go over any events that may have been more 'out of the norm' than usual.

Some see it as 'Monday Morning Quarterbacking'. Others see it as an after event self evaluation.

To be right up front: you're new here. This is what happens all the time. Sometimes the discussion is ... well... quieter than others. Other times you need an 1&1/2 inch hose to separate the parties. The divisions here get intense. EMT-Ps vs EMT-Bs. This country vs that country. FF vs EMS. Pick a pair and you'll find them going at it.

Sometimes you share and learn a lot. Sometimes the best thing you can do is bite the bullet, not reply and move on. Just remember: you don't work with anyone here, they don't write your performance review and it really doesn't matter, at the end of the day, what anyone thinks of you but yourself, your employers and your patients.

[Star09]

If I believe that a c-spine injury was possible and I can't rule it out, then I'm going to be boarding them. I'm not likely to regret making that decision, however I could regret not making it.

[whit72]

I believe in some areas I thought it was Boston but that not be correct they are actually clearing c-spine in the field. Is this true?

[TechMedic05]

NH has a 'C-Spine Rule-Out' protocol now: Clicky here for links.

[Arachne]

I don't know about Boston, but in Region III of MA c-spine clearance is decidedly not in protocols. Even most of the services physically located in Region III that have withdrawn from the region's control don't allow it.

[Ace844]

I believe in some areas I thought it was Boston but that not be correct they are actually clearing c-spine in the field. Is this true?

This is an unfounded rumor. Neither the state OEMS nor EMCAB will approve it being done at less than the paramedic level and even then they have shot down all proposals for it to be done 'in the study setting'. Maine and NH are the only 2 states in NE that I am aware which allow this.

Hope this helps,

ACE844