Backboarding / C-Collar When Patient Refuses

[Brandon O]

Guys. Keep it real.

There is not an avalanche of evidence for the harm, or even the ineffectiveness, of spinal immobilization techniques.

What there is, probably, is equipoise, since there's no evidence for their use either, and reason to question the rationale. And hopefully people start realizing that. But don't get ahead of things or you'll be disappointed.

 

[Jim37F]

I hope we don't fully remove the boards from our ambulances. Had a nice self inflicted GSW to the head the other day where the board became really handy.

Or the 250lb unconscious patient in the basement of a hillside house, the board becomes a great tool to get them to the gurney....but yeah, otherwise, in my mind, a scoop makes more sense than a rigid board anyway for spinal injuries...you don't need to log roll the patient to put it on, and that it's curved seems to fit a person more comfortably the a straight flat rigid board....at least anecdotally from playing patient for new EMTs training on boards and scoops I always felt more secure in the scoop lol

I think once I'm a medic I'll use the scoop a lot more.

 

[Chewy20]

No such thing as a refusal, protocol says board them? FREAKIN BOARD THEM

 

[medichopeful]

No such thing as a refusal, protocol says board them? FREAKIN BOARD THEM

 

[LACoGurneyjockey]

He's obviously serious. Look at the MOI. Even if they don't have any pain in their neck or back, board them. By the time you get to the hospital they'll have neck/back pain. And that's because the adrenaline wears off. It's better to be safe than sorry and just like O2, backboards help most patients and don't do any harm, why not use it unless you're lazy!

 

[Jim37F]

Don't forget the high flow O2 and lights and sirens transport...

 

[LACoGurneyjockey]

Don't forget the high flow O2 and lights and sirens transport...

WEE WOO WEE WOO WEE WOO!!!
Oh the patient wants to refuse? They must be altered if they're refusing a transport in ma bambulance. Implied consent like a boss.

 

[benasack2000]

Just make sure you stress the scientific-ness of the poke the spine test, and that the patient really understands that they could wake up a para-pa-legic if they don't let you place the collar.

If all else fails, request ALS to administer a ketamine dart in order to subdue the obviously not-mentally-competent patient.

"Whoa look at that mechanism of injury". "Why isn't she C-Spined yet?"

 

[Underoath87]

Why? And "because protocol" isn't an answer that anyone can't figure out on their own.
Backboards aren't shown to better immobilize the spine than a gurney, break-away flat, or scoop? So what if they're paralyzed. Use a flat, use a sheet, if you're really jonesing for a backboard use that. But just to move them to the gurney. Paralyzed or not, obvious deformity or not, backboards don't work. They're just fancy extrication devices.
So again, why would you opt for a board for the paralyzed patient, but not the "mundane" complaints of neck/back pain?

Because I don't want a freshly crippled trauma alert flopping around on my stretcher. And because if they can't feel anything below the neck, the discomfort and lingering back ache from a backboard shouldn't be an issue. And because we live in a litigious society, this patient is going to be out of work for life and drowning in bills, and an EMS provider who broke spinal immobilization protocol would make a nice scapegoat (assuming the patient didn't metaphorically fight you tooth and nail to not be backboarded).

 

[LACoGurneyjockey]

Freshly crippled from an SCI =\= flopping... Really, they shouldn't be moving much at all.
But let's try a different approach. I'm sure you're a competent provider, but how long does it take you to c-spine and board a patient? Got it, ok. Now how much time do you save going l/s to the hospital, risking your and your partners life to save a couple important minutes. You can't do anything to help your major trauma patient but get them to a trauma center 5 minutes ago, so why remain on scene any longer than absolutely necessary? Especially if the procedure delaying transport has not been shown to benefit outcomes?
But "because protocol" is a fine answer too, and I can't fault you there.

 

[Chewy20]

Because I don't want a freshly crippled trauma alert flopping around on my stretcher. And because if they can't feel anything below the neck, the discomfort and lingering back ache from a backboard shouldn't be an issue. And because we live in a litigious society, this patient is going to be out of work for life and drowning in bills, and an EMS provider who broke spinal immobilization protocol would make a nice scapegoat (assuming the patient didn't metaphorically fight you tooth and nail to not be backboarded).

Ugh

 

[Handsome Robb]

There'd a reason malpractice insurance for paramedics is so cheap.

Because we really don't get sued or at least have suits against us win very often.