OK, so suppose long spine boards were banned tonight.

[mycrofft]

TOMORROW'S SCENARIO: motor vehicle accident, unrestrained rear seat passenger in Ford Mustang c/o neck pain, tingling in hands and fingers, and lower back pain (burning/tingling) radiating down back of left leg (exacerbation of extant injury). The pain is excruciating when he attempts to exit the car.
What will you do to extricate this patient? Do you feel immobilization en route is necessary?

 

[usalsfyre]

TOMORROW'S SCENARIO: motor vehicle accident, unrestrained rear seat passenger in Ford Mustang c/o neck pain, tingling in hands and fingers, and lower back pain (burning/tingling) radiating down back of left leg (exacerbation of extant injury). The pain is excruciating when he attempts to exit the car.
What will you do to extricate this patient? Do you feel immobilization en route is necessary?

Roof removal and KED. The KED stays on simply because it requires too much manipulation to get it on an off.

Front seat passenger gets slid over to the stretcher with a scoop (since LSBs are banned) and transported in a position of comfort on the stretcher. No board needed, the mattress dies a fairly good job of conforming to an limiting spinal movement.

 

[mycrofft]

Front seat passenger is fine. You still have someone on a KED.

And is "somewhat" adequate immobilization enroute?

Would the KED be left on enroute?

 

[8jimi8]

CAreful use of a med would be indicated in this scenario. Probably needs to be in a seated position if that is what is comfortable to him without movement. Everyone has seen the Indonesia study. I dont care about longboards except the ease of carrying someone. Of course I will follow "local protocol.". Heh.

 

[Dober317]

After securing the backseat patient in the KED and extricating him from the vehicle, I would have the patient moved onto a stretcher and have only the patient's legs released, then secured to the stretcher and transported. Patient would be supine.

 

[MrBrown]

Scoop, KED and hard collar - basically what we have been doing for years

We do not carry longboards, neither does Australia (Brown knows at least NSW, QLD and Victoria do not) and Brown thinks the UK don't either

 

[8jimi8]

CAreful use of a med would be indicated in this scenario. Probably needs to be in a seated position if that is what is comfortable to him without movement. Everyone has seen the Indonesia study. I dont care about longboards except the ease of carrying someone. Of course I will follow "local protocol.". Heh.

*Ked*

 

[mycrofft]

Let me float some ideas about "clearing C spine"

..or any spine for that matter.
1. "Spinal injury" is both ortho AND neuro, does not always show on simple xray except for fractures, and sometimes not easy to see minor ones that go back into place). Injury can be to the nerves and other soft tissue alone, or at least the boney materials all reassume their proper placement.

2. Spinal immobilization was adopted and pounced upon because the MVA victim in the 1950-60's era autos (no restraints, hard dashboards, no headrests, no airbags, room to accelerate before your legs or torso or head hit anything, hard steering columns, etc) who survived the initial collision and mechanical sequelae was most likely to have experienced fractures including the face and neck and the rest of the spine.

3. Strict spinal immobilization does not address soft tissue injury per se, is frequently refused or fought, uncomfortable, and has acheived mythic status when all it is, is splinting.

I feel field clearance allows some cases to go without potentially beneficial precautions unless the practitioners and the protocols are really on top of neuro evals adapted specifically to rule out neuro injury, or even the ortho-muscular insults most likely to result in neuro compromise. (And remember, neuro insult symptoms can sometimes be seen later once swelling has set in). Maybe we need a national change in protocols and even tools? Or does careful application of current art allow for sufficient treatment and avoidance of iatrogenic transport injuries?

 

[lightsandsirens5]

Scoop, KED and hard collar - basically what we have been doing for years

We do not carry longboards, neither does Australia (Brown knows at least NSW, QLD and Victoria do not) and Brown thinks the UK don't either

Just out of curiosity, do you all do a lot of c-spine clearing? Or does everyone get KEDed and scooped like everyone here gets longboarded?

 

[MrBrown]

Just out of curiosity, do you all do a lot of c-spine clearing? Or does everyone get KEDed and scooped like everyone here gets longboarded?

Lot of spinal clearing - KED only for getting people out of cars and maybe once or twice out of some other tricky spot, a KED is not common place here

 

[mycrofft]

The longboard can be considered "the people's scoop".

I can build a useable long board (using salvaged but seviceable automobile nylon straps and buckles) with vollie labor for under $100 in one day (two if I use polyurethane or such as a sealer instead of all-wax). I can't touch a scoop for close to that (not to mention the execrable "build-a-board" scoop derivatives). Maybe there can be a place for the long board such as developing nations with the understanding that it is a "frontier" measure?
Ditto the short spine board, except make it a higher priority to replace it with generic KED.
The concept of mechanical spinal immobliztion as extrication adjunct and field transport expeditor instead of a treatment mode needs, NEEDS, to be injected into the educational stream right now.
Anyone see anything for sale better than KED?

 

[MrBrown]

A longboard is bloody rubbish, you end up with pressure sores and patients who move because they are uncomfortable

There have been several studies supporting the use of a scoop stretcher over a long board and Brown will find them when Brown gets up

 

[Aussie_Medic_Girl]

Scoop, KED and hard collar - basically what we have been doing for years

We do not carry longboards, neither does Australia (Brown knows at least NSW, QLD and Victoria do not) and Brown thinks the UK don't either

Let me just correct you here Brown. QLD carries LSB however, they are "extrication boards" and are used to extricate pt's such as in the situation above. However, pt's are not to remain on them for tx.

 

[Epi-do]

First things first - there would be a brief happy dance to celebrate the banning of LSBs.

Then, most likely a KED, as already mentioned by others. As far as immobilization goes, most people aren't going to move something if it hurts. Assist them in finding the position of least discomfort, and then transport. It is amazing how well most people can self-immobilize when they are in pain.

 

[mycrofft]

SIdebar: how long does it take to form "pressure sores"?

Are we talking classic decubiti? Is the archtypical patient we are thinking about a protein-starved eighty year old lady, or a water polo player, or what?

 

[Epi-do]

I would have to look up some of the studies I have read, but if I remember correctly, after an hour on an unpadded board, a healthy adult of "average" size will begin to have tissue damage where ever there are pressure points between the body and board. Not all of those with tissue damage end up with pressure sores, but those with severe injuries, who are prone to long hospital stays have a higher likelihood of developing them.

 

[nemedic]

First things first - there would be a brief happy dance to celebrate the banning of LSBs.

and then lashing two side by side with saw horses beneath, thus making an EMS themed beerpong/beirut table.


Sent from my iPhone using Tapatalk

 

[mycrofft]

Fasten a scag under it, remove the belts...

Kawabunga!

 

[mycrofft]

See new thread about restraints

:deadhorse:
This thread is pretty well over, thanks!