Bye bye everyday c-spine

[SandpitMedic]

I noticed in another thread that LA County has already adopted (6/1/14) new protocols that do not require every little trauma to be backboarded. Stellar!!

Here in my system, the Medical Advisory Board(MAB) which is a collective of MDs and Health Dept folks that set the EMS protocols, recently passed and approved this as well.

I am eagerly awaiting the next protocol update due out this fall, so I can stop being forced to spine every lawsuit seeking patient in a fender bender, among other BS.

Any one else working in an area where this is being adopted?

 

[TransportJockey]

We are going to this too out here in TX. My old agency in NM already has had this protocol update, as does the other ABQ metro providers

 

[DesertMedic66]

We have been using the NEXUS or something very similar since 2012 or 2013. Rumor next protocol update (April 2015) will be doing away with backboards for the minor injuries and only used for critical patients and as a means of moving people.

 

[bunyan830]

yes.

 

[Tigger]

Well we weren't routinely c-spining to begin with and have had Nexus for a fair bit. I always thought that the whole Nexus or whatever rule out criteria was a bit overblown. If you assess the patient and there is nothing to point towards a spinal injury, why would you c-spine someone to begin with?

The next protocol revision will reflect that backboards are for moving people and patients are not to remain on them. Apparently there is some regional grant that will be giving us a bunch of vacuum mattresses. Yay, yet more tools with no evidence of help.

 

[firemedic0227]

My department has a "Selective C-Spine Protocol" already. It's awesome, I use it all the time. Our protocol states that we only use backboards on patients with neuroligic deficits that are caused by a spinal injury. The hospital's we transport to love that we do it also.

 

[rmena]

When I did my rides in medic school we could ditch the backboard if we walked their spine and the pt denied any pain or tenderness, and we didn't feel step off or swelling.

 

[EpiEMS]

New York State is behind the curve on this one, way behind. If you collar, you HAVE to board them.

 

[Rialaigh]

Well we weren't routinely c-spining to begin with and have had Nexus for a fair bit. I always thought that the whole Nexus or whatever rule out criteria was a bit overblown. If you assess the patient and there is nothing to point towards a spinal injury, why would you c-spine someone to begin with?

The next protocol revision will reflect that backboards are for moving people and patients are not to remain on them. Apparently there is some regional grant that will be giving us a bunch of vacuum mattresses. Yay, yet more tools with no evidence of help.

Our county protocols specifically state that all patients with a MOI that could cause spinal injury are supposed to be backboarded...specifically stating all MVA', Sports injuries, Falls, Trauma, Etc..etc..

really cruddy protocol, quite frankly we are given a lot of leeway to use the protocol as guidelines and not rules, but if it ever shows up in court they will point at that...needs to be rewritten badly

 

[epicEMT]

Really glad they're switching to this, I fell like c-spine has kind of gotten out of hand with most services having protocols to backboard pretty much every trauma patient.

 

[Pond Life]

The UK has gone away from the USA model and are now embracing the European model. i.e. we use spinal boards as extrication boards. We package patients on Vac Matts nowadays (since 2005) or use Plastic scoop stretchers. I believe London have been doing this since late 90s.

Around the same time (2010) we also adopted the Canadian c-spine rule which has dramatically reduced the number of patients inappropriately packaged.

along with this we have 'alternative care pathways' which allow us to identify an alternative to the ED. This may be seeing the patients own doctor or calling out one of our Paramedic Practitioners (PP/ECP) to offer alternative treatment options at scene.

 

[hops19]

As we are seeing more of a move away from the long backboards, what are the thoughts in the EMS world about their use in athletics? For example, the potential head/neck injured football player with helmet and shoulder pads on?

 

[SandpitMedic]

Same thoughts. Mechanism is one thing, but how do they present? Do they have obvious spinal fractures or neuro deficits from the injury? Were they/ are they ambulatory after the event? Do you think they require immobilization? Likely, looking at the same guidelines for any trauma mechanisms. Some will require full c-spine, others less invasive immobilization, and still others whom would not benefit and/or possibly deteriorate or beget discomfort from such packaging.

 

[hops19]

Current protocol in sports medicine says any kind of head/neck injury or suspicion of such, requires immobilization. I think for now most athletic trainers are going to want to keep doing the same thing. Definitely a conversation to be had between EMS and sports medicine team before an incident happens...

 

[SandpitMedic]

Well then... There's that. But who's medical direction are you under? The athletic trainer or the physicians' that write your protocols and have official standing over your company/certification?

Are you talking professional sports teams with MDs on the field? Or high school football...?

It all depends on the scenario. And if the latest data shows that a medium velocity car vs telephone pole does not require back boarding than what would suggest a tackle does?

The entire outlook will not change overnight. Change is slow.

 

[SandpitMedic]

Not to mention... You could leave the helmet and support in place if the pt's condition allows.

 

[hops19]

Well then... There's that. But who's medical direction are you under? The athletic trainer or the physicians that write your protocols and have official standing over your company/certification?

Are you talking professional sports teams with MDs on the field? Or high school football...?

It all depends on the scenario. And if the latest data shows that a medium velocity car vs telephone pole does not require back boarding than what would suggest a tackle does?

The entire outlook will not change overnight. Change is slow.

So the question comes down to whose protocol takes precedence? Prefer to not get into a pissing match over the top of an injured athlete. But you realize the athletic trainer works under the direction of a physician too, right?

And I guess it depends on the collision that occurs. I would hazard to say that most times immobilization is considered in football, it is the result of an axial load of the spine. Does that occur in your scenario of car vs telephone pole?

I'm just asking the question. I work as an athletic trainer and in less than 4 years I've spineboarded two athletes. One for a seizure and the other had a C5 fracture.

 

[Tigger]

Current protocol in sports medicine says any kind of head/neck injury or suspicion of such, requires immobilization. I think for now most athletic trainers are going to want to keep doing the same thing. Definitely a conversation to be had between EMS and sports medicine team before an incident happens...

I worked as a student-trainer/EMT for a D1 Hockey program for several years, and this was not at all how we approached spinal immobilization. Non-symptomatic athletes were not immobilized, period We needed to actually step in and educate the local EMS crews about being a touch more conservative.

Also in Colorado ATCs do not work under a physician's license, not sure about other states. Yes we had a physician adviser, but his advise was "do as you see appropriate."

 

[SandpitMedic]

So then our two different outlooks arrive at the same point, seeing as how you've only used it twice in four years.

Most of the time, it is not necessary. And to your specific question I refer back to mechanism and patient presentation. Such as... Pt hanging, still gets full packaging with purchase of ambulance ride.


To the question of who do I listen to: as the primary provider I will render the most appropriate care that I believe is warranted under the current best practices and standards of care, relative to the protocols I am under. I say relative because well, I mean not to infer I'm some cook book medic.

 

[ZombieEMT]

I am volunteering with a very proactive and modern department in New Jersey. Our county is currently working with the first aid council and medical directors, to remove long boards and c-spine as an everyday practice. The longboards will still be available for moving purposes, if needed. On an additional note, our department currently has immobilization in place using a scoop vs longboard. This started after developing the appropraite training and getting approval from our medical director and OEMS.