Re: C-Spine... why should we?

March 31, 2009

If you Goggle Selective Spinal Immobilization you will get a number of hits.

This is one of those things where while still controversial it seems to be

at a point where its time has come.

Louis N. Molino, Sr., CET

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In a message dated 3/31/2009 10:12:19 A.M. Central Daylight Time,

lpowell@... writes:

A good number of folks are going to the NEXUS criteria for spine

assessment and clearance protocols with excellent outcomes - I have used

it and would recommend it.

Here are two links - an article and a ppt

http://publicsafety.com/article/article.jsp?id=2221&siteSection=8

http://www.state.me.us/dps/ems/documents/Maine_EMS_Spinal_Assessment_Pro

gram.ppt

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator

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________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of coolclay84

Sent: Tuesday, March 31, 2009 09:33

To: texasems-l

Subject: C-Spine... why should we?

I have a question.

Do any of you think that EMS, as a whole, backboard and c-spine too many

patients?

I often find that we are able to assess people with resp issues, cardiac

issues, strokes, ect. However when faced with someone who fell down from

the standing position with no neck, back, or neuro deficits we insist on

backboarding them.

Now I'm not saying we shouldn't backboard people. If they have severe

neck pain, point tenderness, neuro deficits, or other obvious signs of

signs of a neck injury then we should backboard them. If they have

significant mechanism (i.e. ejected out of car, fall >15', ect) then we

should backboard them.

But say they were rear ended at <15 mph, with NO damage or very little

damage to their vehicle, or the little old people who tend to land on

their hips and break them - we insist on straping them to a hard board

which causes them MORE discomfort and PAIN then they initialy had... are

we really doing them any good? Are there any studies out there to prove

or disprove that what we do helps or harms?

What kind of injuries are we causing ourselves from lifting and moving

people onto backboards when they " don't " need them?

I'm not out to stop immobilizing people. It has its place just like

everything else we do, but I do wonder sometimes if we are really doing

them any good. Wouldn't a c-collar be sufficient for thoose people?

Just wondering what the rest of you all think about that...

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March 31, 2009

Ah but Maxine the whole point of selective spinal immobilization is not to

do away with c-spine precautions but apply them in a way that makes sense.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 3/31/2009 11:35:17 A.M. Central Daylight Time,

bpems@... writes:

Yes! EMS as a whole does backboard and c-spine far too many patients!

If I am ever the patient I do not want it done and, if I am capable of doing

so, I will refuse it.

Many departments are successfully using " field clearance " protocols.

It is my opinion (and worth nothing more than that--just opinion) that EMS

may be not too many years away from doing away with backboarding patients.

But, which department wants to be first?

Maxine Pate

hire EMS

---- Original message ----

>Date: Tue, 31 Mar 2009 14:33:05 -0000

>

>Subject: C-Spine... why should we?

>To: texasems-l

>

> I have a question.

>

> Do any of you think that EMS, as a whole, backboard

> and c-spine too many patients?

>

> I often find that we are able to assess people with

> resp issues, cardiac issues, strokes, ect. However

> when faced with someone who fell down from the

> standing position with no neck, back, or neuro

> deficits we insist on backboarding them.

>

> Now I'm not saying we shouldn't backboard people. If

> they have severe neck pain, point tenderness, neuro

> deficits, or other obvious signs of signs of a neck

> injury then we should backboard them. If they have

> significant mechanism (i.e. ejected out of car, fall

> >15', ect) then we should backboard them.

>

> But say they were rear ended at <15 mph, with NO

> damage or very little damage to their vehicle, or

> the little old people who tend to land on their hips

> and break them - we insist on straping them to a

> hard board which causes them MORE discomfort and

> PAIN then they initialy had... are we really doing

> them any good? Are there any studies out there to

> prove or disprove that what we do helps or harms?

>

> What kind of injuries are we causing ourselves from

> lifting and moving people onto backboards when they

> " don't " need them?

>

> I'm not out to stop immobilizing people. It has its

> place just like everything else we do, but I do

> wonder sometimes if we are really doing them any

> good. Wouldn't a c-collar be sufficient for thoose

> people?

>

> Just wondering what the rest of you all think about

> that...

>

------------------------------------

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March 31, 2009

While perfection may be a lofty goal it is unobtainable. We will board and

collar many that don't need it just because they are drunk or otherwise

impaired but we have to have a line in the sand.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 3/31/2009 1:25:27 P.M. Central Daylight Time,

bpems@... writes:

Oh, yes, that is the point, and I am all in favor of the selective

immobilization. We've been doing it here for several years with good results.

I have to wonder, though, if a few years down the road we will discover that

even the selective immobilizations are unnecessary and nonproductive. So

many things we have done in the past made sense at the time we did them, but

didn't make sense as we learned more.

As I said before, if I am the patient I do not want to be backboarded. But,

that's just my personal choice, not department policy.

Maxine