Backboarding w/out collar

[shademt]

In regards to backboarding a patient, do we always automatically use a C-collar if we need to backboard a patient or can we backboard without a collar?

For example, say a patient fell and fractured a thoracic bone in the middle of her back but with no specific NECK pain, C-collar?

Thanks for the info

 

[OnceAnEMT]

I would. The argument of whether they immobilize effectively or not aside, C-collars serve as a reminder that the Pt really needs to try and be still. Forces at the neck most certainly transfer to some extent to more distal vertebrae.

 

[shademt]

makes sense. thanks

 

[mycrofft]

1. See your protocols.
2. No way to know how many locations are hurt nor how bad in the field, so that single thoracic injury could be that and a subluxated C1-2 that hasn't displaced far enough to cause disastrous results until you walk them to the ambulance litter then roll it up to the stops in the ambulance. Or hit a pothole on the way to the hospital.

I am still grinning ruefully at studies that show a PROPERLY selected and PROPERLY sized collar PROPERLY applied doesn't immobilize the neck versus say being unconscious or riding in an ambulance on the road, especially if combined with KED and/or a properly blocked long spine board.I'd like to tell these researchers to try it some time then get back to me. It may not be perfect, it may not resist someone fighting it, and it may not treat insults to the neck, but it's a tool which when used by a competent and well supplied provider offers benefit during extrication and possibly transport when iatrogenic movement is not improbable.

Don't throw the baby out with the bathwater.

 

[Tigger]

There are many things that seem to make intuitive sense that are not born out by research. That does not invalidate the research.

 

[mycrofft]

VERY true, or we'd all still be pulling people out of wrecks by their hair a'la 1960. Or pushing chests 60 times a minute instead of 100.

But as I said, try it. Like tourniquets, many spinal immobilizations were done in the wrong cases, the wrong way, with the wrong tools. Don't discard science, but don't discard practical observation, or you get an "Emperor's New Clothes" situation…everyone bows, but no one acknowledges the warts and the seams in any approach.

Which was exactly how spinal immob became so abused.

 

[Handsome Robb]

Did you know turning your head manipulates your thoracic spine?

Also, spine boards are falling out of favor.

 

[TransportJockey]

The patient you have identified in the first post is the perfect patient for a vacuum mat/board {A} {B}

And they even make some of the vacuum boards w/ a portion that acts as head blocks and can make it so you don't need a c-collar at all

 

[OnceAnEMT]

The patient you have identified in the first post is the perfect patient for a vacuum mat/board {A} {B}

And they even make some of the vacuum boards w/ a portion that acts as head blocks and can make it so you don't need a c-collar at all

Your system has to have the vacuum board before you're able to use it. That said, I've seen a lot of EMS systems (and their dispatchers) avoid vacuum splinting and tell us ATs not to vacuum splint limbs. If they think that, I doubt they'd even consider a full body one.

 

[TransportJockey]

Your system has to have the vacuum board before you're able to use it. That said, I've seen a lot of EMS systems (and their dispatchers) avoid vacuum splinting and tell us ATs not to vacuum splint limbs. If they think that, I doubt they'd even consider a full body one.

I'm hoping with backboards going away (finally!) that we can start progressing to them. I'm seeing them in the ABQ metro area lately. And my service is getting one per truck to supplement our existing vacuum splints. We are doing away with boarding altogether it's lookign like

 

[OnceAnEMT]

I'm hoping with backboards going away (finally!) that we can start progressing to them. I'm seeing them in the ABQ metro area lately. And my service is getting one per truck to supplement our existing vacuum splints. We are doing away with boarding altogether it's lookign like

Glad to hear y'all are making that switch. Vacuum splints work wonders, and are dumby proof. The only catch is that it requires that the splint and pump be together, and there is a fairly high cost. At the same time though ,they are durable and very much so reusable.

 

[TransportJockey]

Glad to hear y'all are making that switch. Vacuum splints work wonders, and are dumby proof. The only catch is that it requires that the splint and pump be together, and there is a fairly high cost. At the same time though ,they are durable and very much so reusable.

Exactly why we carry them. In fact the set we have is the same ones we had when I worked here three years ago (TX). My NM service, and other NM services are just not playing with them.

 

[OnceAnEMT]

Exactly why we carry them. In fact the set we have is the same ones we had when I worked here three years ago (TX). My NM service, and other NM services are just not playing with them.

Very cool. Just out of curiosity, how does your system retrieve them? I've never used them in the EMS setting, but what we do in AT is 1 of 2 things:

1. Pt sent to ED with vacuum splint applied, with note to parents saying to keep splint when it is removed to return it to the school (or their AT, if its an athlete on a different team)

2. Pt send to ED, AT meets them there after the game and takes the splint themselves.

I understand with backboards and sheets and such its more of a here's mine, now I'll take yours type of deal, but vacuum splints are a bit harder to come by, and I wouldn't expect to see one IN an ED.

 

[Tigger]

Our sports medicine ones were very clearly labelled and someone would just go down to the hospital later and get it out of the EMS equipment bin. Fire, AMR, and some of the outlying places like mine all use the same semi disposable ones so we just grab one out of the bin before we clear.

 

[TransportJockey]

Very cool. Just out of curiosity, how does your system retrieve them? I've never used them in the EMS setting, but what we do in AT is 1 of 2 things:

1. Pt sent to ED with vacuum splint applied, with note to parents saying to keep splint when it is removed to return it to the school (or their AT, if its an athlete on a different team)

2. Pt send to ED, AT meets them there after the game and takes the splint themselves.

I understand with backboards and sheets and such its more of a here's mine, now I'll take yours type of deal, but vacuum splints are a bit harder to come by, and I wouldn't expect to see one IN an ED.

We are just about the only service to drop off at our little ER, so that's easy and we just hang around to get it. If I fly them, our flight team usually brings them back (if it's our fixed wing) or another base will get them for us if they get flown somewhere else on rotor.

 

[OnceAnEMT]

Roger that, figured as much. Thanks guys!

 

[mycrofft]

I remember hearing about the vacuum boards around 1981! They said that "The Germans have them or something" and that they weren't as in love with supinating the whole pt like we were/are.

I'll go learn more.

 

[mycrofft]

Back already

Here is a well-done article with references about the drawbacks of traditional spine immobilization. It has some shortfalls of ignoring some practical aspects, but not makes its point:

http://www.boundtreeuniversity.com/news/1680079-Vacuum-spine-boards-Transport-devices-of-the-future

Cutting it quickly to the chase, they say straps and blocks do not immobilize the bones which can still move about in the muscles and skin; if you bind the pt ever more tightly in an effort to stop that, the pt can't breathe. (They didn't mention halo cranial devices….ouch). Somehow, probably by allowing a generalized blocking and binding which doesn't have a lethal limit, a vacuum back board works where others don't.
It seems they are comparing common mouse of traditional spinal immobilization versus subjective reports of vacuum splint types being more comfortable, faster to apply (true?), some "sometimes" causing claustrophobia. US Army study showed no improvement in pressure ulcers but the article author raises possibility this is due to the acuity of those pts requiring longer immobility of thoracolumbar injury.

 

[OnceAnEMT]

vacuum splint types being more comfortable, faster to apply (true?),

Will take a look at the article over the weekend. Vacuum splints are definitely more comfortable and much less "awkward" to have on. Pt with a bunch of boards and crevettes tied to them aren't exactly happy or appreciative. Vacuum splints are comfortable and professional looking. About being faster to put on, they are if you know what you're doing. I'm not talking PASG (lol, I said it) type of complicated, but its juuuust above the acuity of giving it to a bystander to immobilize the Pt. If you know how to do it, you've done it before, etc, yeah, it slaps right on. I've seen a few and heard a plenty stories of ATs fumbling with them.

 

[mycrofft]

Anyone find a video of an auto extrication using vacuum mattress or device? I'm finding a lot with the "rescue boa" idea, but nothing where the entrapped pt is being immobilized; they are all out and supine.