Backboarding / C-Collar When Patient Refuses

[BecomingaBetterEMT]

Hey Guys,

I'm running into this problem more often. I don't know why, but people who show signs of back and neck pain that needed to be c-collared and boarded are refusing a c-collar. I know new state protocols are calling for selective c-spine, but for now I have to stick to the basics and what I know.

What I want to know is what do you guys do if someone refuses a c-collar. For me, I try to reassure the patient that it is absolutely necessary and explain to him/her c-spine stabilization and the precautions that I'm trying to take into account. I also document it in my narrative. Now, should I even put them on a backboard (with head-blocks) if I don't have a c-collar on them? Is it even worth? I think it kind of defeats the purpose. I'm planning on asking my supervisor, but in the meantime I want to get your opinions on this subject manner.

 

[Carlos Danger]

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.

 

[Underoath87]

Just make sure you stress the scientific-ness of the neck poke test, and that the patient really understands that they could die 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.

Lmao!
Op, what Remi means is that your patients are probably much better off without spinal immobilization, especially if they can verbally decline it. Just realize that they are doing everybody a favor and document that they declined that intervention (as they may do, so long as they are in a competent state).

 

[cprted]

FYI, I'd have to be unconscious before you're going to strap me to a backboard.

Competent adults can refuse medical treatments, including spinal motion restriction, even if you were taught it is absolutely necessary (which it isn't).

 

[Carlos Danger]

Sorry, I couldn't resist:

 

[OnceAnEMT]

Love that video. For whatever reason it is also the only real "good" one in that series, but I suppose that's because its the only one I relate to, and the series is focused towards LEOs. LEOs...

 

[rescue1]

If they refuse treatment, they refuse treatment. Let them know the risks (not in some overhyped way, just explain that it's to keep the neck still in case of an fracture), have them sign a refusal (at least our refusal form has a box to check if they refuse a specific procedure) and continue.

If they refuse a collar I would not board them. Not only do new studies show that backboards are useless, even if they were helpful, they wouldn't be with the patient's head flopping around. In my experience, more patient's will refuse the board but not the collar.

But yes, the takeaway is full spinal immobilization is on it's way out, so I wouldn't worry too much about all your patient's suddenly becoming paraplegics.

 

[NYBLS]

Its sad when the citizens we serve are better understanding of the science than we are. Just tell them your rules say you need to. If they don't want to have them sign a refusal.

 

[Flying]

If they refuse, don't push the matter. Please.

Also, less collars and boards = simplified job. You're going backwards to the "basics".

 

[Tigger]

Patients have the right to determine their care, provided they are competent to do so. If they don't want it, feel free to educate them on the risks and benefits of said interventions but know that they are welcome to make an informed final decision, even if you disagree with it.

If you want to become a better EMT, maybe look up why backboards are not effective so you are not lying to patients about their benefits, since there are none.

 

[Underoath87]

NYBLS:
Just to be clear: you mean sign a refusal for that specific "intervention" (not transport in general), right?

 

[DrParasite]

if they want to a refuse a treatment with no scientific basis, and they are alert and oriented, than you have to do only one vitally important thing: have them sign the appropriate part of the refusal saying they are refusing that specific treatment.

not really rocket science here....

 

[BecomingaBetterEMT]

if they want to a refuse a treatment with no scientific basis, and they are alert and oriented, than you have to do only one vitally important thing: have them sign the appropriate part of the refusal saying they are refusing that specific treatment.

not really rocket science here....

Our call sheets don't have a refusal sign off for given said interventions. All we have is for RMAs. When I document how should I do so? I don't want to be over detailed but at the same time I think I should do so.

 

[BecomingaBetterEMT]

Patients have the right to determine their care, provided they are competent to do so. If they don't want it, feel free to educate them on the risks and benefits of said interventions but know that they are welcome to make an informed final decision, even if you disagree with it.

If you want to become a better EMT, maybe look up why backboards are not effective so you are not lying to patients about their benefits, since there are none.

Yes I have read numerous documents that say backboards are not effective and in some cases cause more harm then actually help the patient. My only problem lies in the fact is that the state protocols are different then what I'm reading. I can't tell a patient that backboards are not effective when at this time the state says that they are. I'm at a crossroads.

 

[luke_31]

Speak with your management how they want it handled. If there isn't a specific place they may have wording you can use in the narrative section and have the patient sign there.

 

[medichopeful]

For me, I try to reassure the patient that it is absolutely necessary and explain to him/her c-spine stabilization and the precautions that I'm trying to take into account.

The sooner people realize that this isn't the case, the quicker this will become a non-issue.

 

[medichopeful]

Our call sheets don't have a refusal sign off for given said interventions. All we have is for RMAs. When I document how should I do so? I don't want to be over detailed but at the same time I think I should do so.

"Patient refused ... (whatever the procedure may be). Risks explained, patient still refused." If they state why they refused it, put that in too!

 

[OnceAnEMT]

Not quite on topic here but not worth making a new topic. Given all of the evidence out there that opposes routine SMR, what about when spinal cord damage is already obvious? Pt head locked to one side, Pt apprehensive to move head, Pt has no motor or sensation of the lower extremities, Pt has clearly suffered spinal cord damage. Do you backboard? I haven't found much that talks about when the injury is truly present.

 

[Flying]

Really, all that has to happen is to move the person gently. Backboarding for reasons outside of extrication really does nothing but waste time and add complexity.

 

[LACoGurneyjockey]

Not quite on topic here but not worth making a new topic. Given all of the evidence out there that opposes routine SMR, what about when spinal cord damage is already obvious? Pt head locked to one side, Pt apprehensive to move head, Pt has no motor or sensation of the lower extremities, Pt has clearly suffered spinal cord damage. Do you backboard? I haven't found much that talks about when the injury is truly present.

All SMR protocols are talking about the assumption there's a spinal cord injury, so whether one is apparent or not is somewhat irrelevant. They'll be treated the same with what you called an obvious injury as they would with midline spinal tenderness and no deformity/neuro deficits.
A backboard won't keep their spine any more immobilized than seatbelts on a gurney. The studies I've found suggest the body's own inflammatory response to a spinal cord injury will be far more effective than a backboard and collar at stabilizing and preventing further injury.