Smash
Forum Asst. Chief
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If anyone has read the above article by Hauswald in the latest edition of EMJ I would love to hear from you via PM.
Many thanks
Smash
Many thanks
Smash
A re-conceptualisation of acute spinal care.
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mycrofft
Still crazy but elsewhere
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I read the extract in NIH.
http://www.ncbi.nlm.nih.gov/pubmed/22962052
Without reading the article, I'd want to see proofs and pro/con for each measure considered. Ned cadaver studies and such correlating need to field-useful indices.
I think there is a potential need for spinal immobilization especially during extrication to avoid iatrogenic injury. That is why EMT's were invented, so Earl and Wilbur-Joe would stop pulling wreck victims out of crashed cars by their ears. I think generically as long as spinal injury is suspected and extrication or transport pose a reasonable threat of iatrogenic injury, then some sort of effective spinal immobilization is called for. "KED and careful" ought to be enough for most urban and suburban incidents. Padding for any prolonged period ought to be standard. Airway must trump.
http://www.ncbi.nlm.nih.gov/pubmed/22962052
Without reading the article, I'd want to see proofs and pro/con for each measure considered. Ned cadaver studies and such correlating need to field-useful indices.
I think there is a potential need for spinal immobilization especially during extrication to avoid iatrogenic injury. That is why EMT's were invented, so Earl and Wilbur-Joe would stop pulling wreck victims out of crashed cars by their ears. I think generically as long as spinal injury is suspected and extrication or transport pose a reasonable threat of iatrogenic injury, then some sort of effective spinal immobilization is called for. "KED and careful" ought to be enough for most urban and suburban incidents. Padding for any prolonged period ought to be standard. Airway must trump.
OP
OP
Smash
Forum Asst. Chief
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I think the piece from Hauswald is essentially an op-ed. However he does usually bring an interesting slant to the conversation. From what I can read from the literature, combined with my experience, spinal immobilisation by EMS is pretty much an intervention in search of an indication.
I think that spine-boards and collars are one of the strongest bastions of dogma and myth in EMS. I agree that in some circumstances care must be taken and the potential for spinal cord injury considered, however I think that the ritualistic application of collar and board to everyone who drove past an accident at some stage is counterproductive, especially when we have progressed to the stage of "standing takedowns". What? They are walking around and we want to "take them down" to put them on a hard board and stretch their neck with an unproven, possibly harmful adjunct?...
Anyhoo, that is why I was hoping to read the whole article. I'm constructing a post of my own, but it is nice to get other perspectives before I rant to much.
I think that spine-boards and collars are one of the strongest bastions of dogma and myth in EMS. I agree that in some circumstances care must be taken and the potential for spinal cord injury considered, however I think that the ritualistic application of collar and board to everyone who drove past an accident at some stage is counterproductive, especially when we have progressed to the stage of "standing takedowns". What? They are walking around and we want to "take them down" to put them on a hard board and stretch their neck with an unproven, possibly harmful adjunct?...
Anyhoo, that is why I was hoping to read the whole article. I'm constructing a post of my own, but it is nice to get other perspectives before I rant to much.
MSDeltaFlt
RRT/NRP
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Especially with the studies showing that geriatrics can aqurire decubiti after only a few minutes (I believe 20min?) and with my own personal experience, I think long spine boards should be used for the reason they were invented: patient moving. As in the patient should be slid from the LSB onto ER bed once at the hospital and only in rare occasions left under the patient while still in said ER bed.
Cheap rigid cervical collars should be banned. Either use the real Phillips type C-Collars or use the soft ones. The ones with "butt-loads" of padding. I was in my Phillips collar at my Level I trauma center for 10 days after my crash until I got my halo for my unstable C2 fracture. And I have no deficits. I am a triathlete. I swim, cycle (when I don't crash my road bike [currently nursing a fractured clavicle]), and run.
People (healthcare providers and especially EMS) tend to think that musculoskeletal pain from trauma to anywhere within the central nervous system (cranium to sacram) requires rigid restrictions and "hurry, hurry, hurry" mentality. You're not time sensitive until there's neuro deficits. You don't waste time, but don't rush. It only hurts the patient.
No deficits = no rush
Cheap rigid cervical collars should be banned. Either use the real Phillips type C-Collars or use the soft ones. The ones with "butt-loads" of padding. I was in my Phillips collar at my Level I trauma center for 10 days after my crash until I got my halo for my unstable C2 fracture. And I have no deficits. I am a triathlete. I swim, cycle (when I don't crash my road bike [currently nursing a fractured clavicle]), and run.
People (healthcare providers and especially EMS) tend to think that musculoskeletal pain from trauma to anywhere within the central nervous system (cranium to sacram) requires rigid restrictions and "hurry, hurry, hurry" mentality. You're not time sensitive until there's neuro deficits. You don't waste time, but don't rush. It only hurts the patient.
No deficits = no rush
I think the biggest stigma in EMS is when some believe they "rule out" spinal injuries totally by the field exam. Spinal injuries can come in many degrees and even physicians get caught up in that to where they make huge mistakes. It does not necessarily mean all should be collaring and placing on a rigid board. But, it does not mean you should make them walk into the ambulance either because your simple field test indicated they appeared to be fine either. In EMS it seems the principle is "all or nothing". Paramedics are just not that accepting of alternative methods much like the alternative airways.
In the hospital some leave the board under the patient for easy transfer in the CT scanner which some physicians are relying on to clear spine and head at the same time. Flat plates don't always give a clear view of the upper cervical.
In the hospital some leave the board under the patient for easy transfer in the CT scanner which some physicians are relying on to clear spine and head at the same time. Flat plates don't always give a clear view of the upper cervical.
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Most of the new protocols I'm seeing pretty much are "all-or-nothing", not because paramedics "are not accepting of alternate methods", but because that is what the research indicates we should do.
The literature is very clear that in an oriented patient without distracting injuries, spinal column injuries capable of threatening cord damage almost always present with signs & symptoms. Those people still get c-spine precautions.
If a person presents without signs or symptoms, nobody is saying that it means they definitely have no injury; just that if they do, the injury is unlikely to result in cord damage and more importantly, that decades of research proves that backboards don't help those patients.