Field Clearance of C-Spine; Help me if you can

[ccmedoc]

Boy, sure showed my arse on that one.. All I wanted to say was that I don't think that everybody that gets a c-collar needs to be backboarded. admittedly, the length of time on a backboard is an ED problem and not EMS in most cases. It hurt my feelings to be put with the firemonkey. I've seen the error of my ways, mostly anyway :wink: . This is one study that was done on the necessity of backboards.. obviously post-ems.

I guess I will cave.. LBB- prehospital=good, inhospital=bad :oops:

http://emj.bmj.com/cgi/reprint/18/1/51

The use of the spinal board after the pre-hospital phase of trauma management

D Vickery

Emerg. Med. J. 2001;18;51-54

doi:10.1136/emj.18.1.51

[Cookie]

I am sitting here reading and trying to understand some of this debate , and my opinion such as it is. BULL WHACKY. Unless I missed something in all them classes I attended and still attend, the cervical spine is not the only part of the spine. There are several other components such as thoracic, lumbar to name two, and we were taught that in order to immobilize any one part of the spine you immobilize the entire spine. It just makes sense, common sense that is. I also know for a fact that if we showed up in an emergency room at our to community hospitals with someone with just a c collar the Dr. would rip us a new one. Basically our local Dr.s were our instructors in some of our classes in trauma and spinal immobilzation. Here the Dr.s are a big part of our EMS system and are very involved with our education and continuing education.

Off soap box now.

[JPINFV]

^

That's because splinting the spine is no different than splinting any other bone in the body. What you are really trying to do with any splint in most cases is keep the muscles from moving the bone. Skeletal muscals are attached at both ends to a bone. If a bone is broken, you don't want just the half that the muscle is attached to moving and the other side of the break staying where it is. This is why you splint above and below a fracture, not just the site of the fracture.

[Dustdevil]

It hurt my feelings to be put with the firemonkey. I've seen the error of my ways, mostly anyway :wink: .

LOL!

That was, admittedly, a low blow that was uncalled for. I apologise for that.

Sometimes I just get carried away. :oops:

[iMac]

C-spine clearance in the field all depends on where you work. Most of the services I have worked for there are very specific things that they have to do on scene and ask the patient in order to clear c-spine. One of the services I worked for you couldn't clear it in the field. All service dependent.

[spenac]

Any new research about this subject?

[mobey]

Spenac, thanks for bringing this back up.... it leads me to a question

If you KED someone why do they need to be boarded?

OK, OK I realize the vest is an "extrication tool" but if it immobilizes them from head to lumbar, then they are laid on a cot and secured with staps... why do we need to board them? to immobilize the pelvis? can't we do that with straps on the cot?

I did not read all the links on the last page but I can choose not to immobilize based on the following criteria:

Minor MOI

No confusion, head injury, ETOH/Drug use, Loss of Cx

No distracting injury

No degenerative disease (osteoporosis, osteogenesis imperfecta, spinal surgeries etc etc)

No pain to spine or pelvis

[tniuqs]

Spenac, thanks for bringing this back up.... it leads me to a question

If you KED someone why do they need to be boarded?

OK, OK I realize the vest is an "extrication tool" but if it immobilizes them from head to lumbar, then they are laid on a cot and secured with staps... why do we need to board them? to immobilize the pelvis? can't we do that with straps on the cot?

I did not read all the links on the last page but I can choose not to immobilize based on the following criteria:

Minor MOI

No confusion, head injury, ETOH/Drug use, Loss of Cx

No distracting injury

No degenerative disease (osteoporosis, osteogenesis imperfecta, spinal surgeries etc etc)

No pain to spine or pelvis

Agreed: There is no means of way to state that the LSB actually prevents "possible" further spinal injury, in fact dependant on transport time stress ilieus has been a factor that has just started to be evaluated. mobey looks like you have read the ACoP position paper ... thing is there are better devices than the KED .. very old school in fact ... ever see the OSS ? Oregon Spinal Splint ....? Big thing with LDT and on board is one requires far more sedation to keep the patient comforable, my preferance is a Scoop or Clamshell as the BC types call it.

cheers

[mshow00]

Just a point of order here: the term "spinal immobilization" is out the new PC term is "SMR= spinal motion restriction"

At least here where I am from anyway, thanks to Mr. Lawyer; apparently in a court case it went like this: "How can he be immobilized and still be able to move? So you lied!".

[spenac]

Just a point of order here: the term "spinal immobilization" is out the new PC term is "SMR= spinal motion restriction"

At least here where I am from anyway, thanks to Mr. Lawyer; apparently in a court case it went like this: "How can he be immobilized and still be able to move? So you lied!".

Good point. And your right alot of ambulance chasers look for that little details to make those involved pay.