Better c-spine?

[Seaglass]

I've been getting stuck holding c-spine for rather long periods, and I've noticed that my ability to keep a good hold goes down fairly rapidly after the first several minutes, especially if I have a patient that keeps trying to move. Does anyone have suggestions for exercises that would help me improve the right muscles? Or is this one of those things, like CPR, that can only be done for so long?

[akflightmedic]

Originally Posted by Seaglass

I've been getting stuck holding c-spine for rather long periods, and I've noticed that my ability to keep a good hold goes down fairly rapidly after the first several minutes, especially if I have a patient that keeps trying to move. Does anyone have suggestions for exercises that would help me improve the right muscles? Or is this one of those things, like CPR, that can only be done for so long?

Question is, why are you holding cspine for so long?

How long does it take to immobilize someone?

If they are in a car and need extrication, utilize your resources better. Are they conscious? Tell them not to move their head.

Are you able to gain access to treat the patient while the extrication takes place? If so, place a collar, tell them not to move. You are there to care for them should anything else develop and if your hands are committed to holding them still when they are perfectly capable of doing after a collar placement, then you now need another provider possibly.

Take actual hands on cspine when you are going to move the patient or if they need assistance in maintaining an airway. Other wise keep your hands free.

[daedalus]

Originally Posted by akflightmedic

Question is, why are you holding cspine for so long?

How long does it take to immobilize someone?

If they are in a car and need extrication, utilize your resources better. Are they conscious? Tell them not to move their head.

Are you able to gain access to treat the patient while the extrication takes place? If so, place a collar, tell them not to move. You are there to care for them should anything else develop and if your hands are committed to holding them still when they are perfectly capable of doing after a collar placement, then you now need another provider possibly.

Take actual hands on cspine when you are going to move the patient or if they need assistance in maintaining an airway. Other wise keep your hands free.

I fully agree with this, even more so in light of the fact there is little evidence to suggest the need for spinal immobilization in the first place and even some evidence suggesting it is not needed. However, other people on scene (FD and partners) and my supervisors would find this unacceptable since everyone believes that c-spine is a commandment delivered from God Himself.

I also find the OP's comments very interesting. In fact, my hands to get very tired rapidly and I am sure that after a few minutes holding c-spine, my grip is probably as effective as no grip at all. Potential area to study....

[akflightmedic]

While you say potential area to study, I say a weakening grip while holding cspine is a useless study, IF you address the actual need for cspine to begin with as we both mentioned already.

To say you need exercises to improve your cspine holding ability or a study should be done on the effects of a lesser grip, is quite simply addressing the wrong issue and is a complete distractor from the root cause of it all to begin with.

[Akulahawk]

A person who doesn't have spinal cord compromise can limit their own movement far better than probably any external device can... assuming they're going to cooperate.

Personally, I'd wonder why you're in a position for a long time having to hold manual c-spine. Quite simply, you shouldn't be. Hold manual cspine only as long as necessary to put mechanical methods in place and recruit your patient's assistance in not moving as much as possible. As to why you weaken... the muscles that get tired are likely the ones you don't exercise on a regular basis. When you figure out which muscles those are, search for how to strengthen those muscles.

It's not rocket surgery...

[RyanMidd]

Additionally, there are wildly varying theories vs. practices for C-spine immobilization.

In class, they may have taught you things like "Never do it from your knees, as you can be knocked over", etc.

I find that if I'm going to be holding it, I get myself into whatever position I can that will let me keep doing so. If all else fails, make eye contact with somebody and ask them, "Can you hold c-spine for a moment while I readjust my legs?".

[mycrofft]

I tend to get up really close and support my arms on my thighs. I also have to fight sweating into the pt's face. In a pinch your thighs can offer lateral immob, but there are other issues there as well, such as falling over and newsphotos.

Back extensors and not assuming a tenuous position as you accept traction will help also.

Oh, and be sure you empty your bladder before starting.

[karaya]

Originally Posted by daedalus

However, other people on scene (FD and partners) and my supervisors would find this unacceptable since everyone believes that c-spine is a commandment delivered from God Himself.

Not God as much as that is how you were taught. The fact is that for now at least, c-spine immobilization is the current standard of care. Exception of course to EMS providers that have adopted c-spine clearance protocols. None of my publishers (Elsevier Mosby, Prentice Hall Brady, Jones and Bartlett) will take any photos of mine that do not show proper c-spine maintenance.

Yes, your right, there are arguments that evidence does not support this; however, until that evidence is brought up and accepted as the standard of care, the OP would be well advised to maintain what he was taught and not heed contrary advice from social networks. Particularly networks where advice is drawn from members who hide their identity behind monikers. He should consult his company supervisor or training officer for such specifics.

[akflightmedic]

At no point does it say you need to immediately take and hold cspine, especially if the situation does not warrant it.

A standard of care is placing the collar and telling them not to move. You are not committed to holding them with your hands until such time you actually place your hands on them. Once you have done that, then yes you should maintain it.

What good is it if he is on scene say 10-15 mins before the ambo gets there? Do you immediately seize cspine or do you keep the victim calm and keep reminding them to restrict their movement and then take cspine when it is time to move the patient.

What if he takes cspine but then something with the patients condition changes requiring him to release cspine. Oh boy, he will get chewed out on that one for sure; however if he never assumed it to start with....

It is all about common sense and utilizing critical thinking skills.

Having said that, yes your service dictates what you should do, but then we get back to my original question which was "why are you finding yourself holding cspine for long periods of time"?

[Seaglass]

My county protocols dictate that I, as a basic, need to take it immediately upon suspiscion of head or neck injury, and that I don't get to release it until a patient is backboarded, not just collared. Simply telling them not to move or putting on a collar isn't enough. C-spine can be cleared by a medic, but they're not going to clear it if there's a reason to suspect head or neck injury.

As for why it might take awhile to get a backboard, it depends. Maybe we were dispatched to a call that had nothing to do with trauma with a patient that's well away from the nearest road, and we need to send someone back to the road to get the backboard. Maybe we're waiting on lift assist. Maybe extrication is taking forever.

As for why me, in particular... I'm often the most junior member of a crew, so tasks like endless c-spine, holding the vomit bucket, and the like typically fall to me. As such, I'm not in a position to dictate the best use of resources, or dispute our protocols. If we have enough people on scene, I can trade off once I get tired. But that isn't always the case.

As for position, it depends on the situation and patient. But it's most often sitting in the car seat behind the patient and reaching over the back of their seat, kneeling, or sitting cross-legged. I'm not having any trouble with staying in the positions I assume. It's my forearms and hands that are getting tired.