Firefighting & Rescue Social / Professional Network
using the spine board too much
There is one case yesterday night we responded (Aug. 27 '09 PST) as a first responder firefighters to an MVA involving two SUV's about 25 meters from our station. On scene, including our fire chief who happens to be a senior EMT in our group done a head to toe examination, the vitals are very good, no visible cuts and we found out that she already walked from the front seat of the car to the back and lie on her back to rest. The only chief complaint is - her bump on her forehead. While our chief is doing the head to toe, the lady keeps on calling and texting her cellphone. Then the neighboring township ambulance and rescue units arrives. They insisted to put the lady on the spineboard and package her. But we said NO, because she doesn't have a spinal injury. We ask if they got the chair but instead they put her on a gurney. The patient was transported to the nearby hospital.
In our experience with this neighboring township unit, we noticed on previous incidents. Like another example we responded to a motorcycle accident when the motorcycle lost control because of the wet and too much debris on the road because after the heavy rain. The two male riding the bike slide out and sustain some abrasion to the legs, and arms and some abrasion wounds at the face. When we got there, the two are already walking around and looking to his personal items lost on the road. The other guy is already walking and conferring with the traffic cop. And we ask the two to sit down and to have better look. Then the neighboring ambulance team arrives and to our surprise they put the two at the spineboard and package them up. Despite telling them the situation. We were not able to object because they have the resources and felt we kindaof bullied.
But the last night incident as I mentioned already. We said NO and this time their supervisor is with them and told him right away.
So the question is... Do you need to put her on the spine board. I've heard some units put patients on the spine board because the rationale is "precautionary."
Another question, other than we learned from first responder, EMT courses. Is this depends on their departmental SOP that they put patients in a spineboard when they are in doubt and the nature of the incident is MVA's or trauma.
any thoughts?
Thanks,
Mike
In our experience with this neighboring township unit, we noticed on previous incidents. Like another example we responded to a motorcycle accident when the motorcycle lost control because of the wet and too much debris on the road because after the heavy rain. The two male riding the bike slide out and sustain some abrasion to the legs, and arms and some abrasion wounds at the face. When we got there, the two are already walking around and looking to his personal items lost on the road. The other guy is already walking and conferring with the traffic cop. And we ask the two to sit down and to have better look. Then the neighboring ambulance team arrives and to our surprise they put the two at the spineboard and package them up. Despite telling them the situation. We were not able to object because they have the resources and felt we kindaof bullied.
But the last night incident as I mentioned already. We said NO and this time their supervisor is with them and told him right away.
So the question is... Do you need to put her on the spine board. I've heard some units put patients on the spine board because the rationale is "precautionary."
Another question, other than we learned from first responder, EMT courses. Is this depends on their departmental SOP that they put patients in a spineboard when they are in doubt and the nature of the incident is MVA's or trauma.
any thoughts?
Thanks,
Mike
Tags: board, ems, first, responder, spine
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Replies to This Discussion
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Permalink Reply by Dustin J. Millis on -
Mike, it may very well seem that the medics you respond with use a long spineboard too often. The fact is though... they are only doing their job. As EMT's or medics, they are trained to take C-Spine precautions when there is ANY doubt of head/neck injury.
Head and neck injuries do not always present right away... the pt. may seem fine in every respect when in fact they have a serious injury. So yes 90% of the time, it is just a precaution. But I guarantee that the 1st time a medic doesnt take that precaution and the pt. ends up with a head/neck injury that was then made worse during transport, the medic is going to be fired and the dept./company he is from is going to be sued.
Yeah... sometimes its a pain for us and the pt. to go through all that when your 99% sure that the pt. is fine but it has to be done.
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Permalink Reply by Paul Montpetit on
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Nothing is 100% in medical.....BUT, you cannot use a Spine board "Too much" just as you cannot deliver oxygen "too often"...this is just not possible...Training now teaches us that we have a certain amount of leeway in the use of immobilization....but think of it....if we make one mistake what might happen....not only are you looking at a very costly lawsuit but also at a patient that could end up paralyzed or dead because of it...."walking wounded" does not mean that there are no spinal involvement...some of the worst injuries that I have seen have been on this type of patient....I am a firm believer in the addage....If in doubt board them. Stay safe..........Paul
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Permalink Reply by Ron Ayotte on
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It's called "covering thy ass". Any perceived wrong will be jumped on by some personal injury lawyer faster than a dog jumping on a pork chop.
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Permalink Reply by Ben Waller on -
CYA medicine is poor medicine, and spinal packaging has never been shown to do anything for the patient's well-being. It's accepted practice, but not a single study shows that spinal packaging is efficacious.
We have a well-written spinal packaging clearance protocol, and it's worked well for us for three years or so.
Total bad outcomes - zero. Total better spinal assessments - virtually all of them.
And...spinal packaging isn't harmless. There are studies that show that uninjured test victims develop neck pain, back pain, hypertension, and other real medical problems including distal paraesthesias in high percentages when placed in a spinal package for as little as 20 minutes.
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Permalink Reply by Dustin on -
Mike,
Around here in my county we always use a c-collar, head blocks, spine board for any trauma call. Its just to protect our "butts" in case there might be a spinal injury. So we don't get a lawsuit filed against us.
Dustin Cornell,
Four Oaks EMS & Rescue, Four Oaks, NC
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Permalink Reply by Jim Owens on
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Our state allows EMTs to use a state defined spinal protocol checklist in which we are pemitted to rule out c spine and not do complete immobilization. I have not heard any complaints from this or lawsuits. Im sure if there were a lawsuit, the protocol would be revoked immdiately. In rural areas where transport times can be up to 1 hour and roads are in rough condition, placing a patient in full c spine for a long transport where there is no spinal injury could cause additional pain.
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Permalink Reply by Oldman on -
In December of 1982, I was on an ambulance working a single vehicle rollover. The 19 year old female driver of the vehicle was self extricated, ambulatory, with no complaints of injury and adamantly refusing transport. Troopers arrived to investigate the incident, and starting interviewing the driver. One trooper standing beside her asked a question, and when she turned her head to answer him, dropped to the ground as if someone cut her legs off.
She died right there. The Post Morten revealed severed spinal cord due to fracture C1/ C2 vertebra. I will never forget the look in her eyes when the lights went out.
Things are not always as they appear. Always error on the side of the patient. Spinal immobilization is never overdone.
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Permalink Reply by Ben Waller on
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Never is a long, long time, and there are studies that show that spinal packing itself can be harmful to patients, and even to uninjured test subjects. Further, there's no study that proves that any spinal packaging is actually good for a patient or that it actually protects the spine. There's a theory that says so, but until science proves it, basically we're following 30 years of urban legend every time we put a patient into a spinal package.
And, while tragic, there's nothing you could have done for a patient with a hangman fracture that died before you could even get a c-collar out.
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Permalink Reply by Bill Brierton on
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Always err on the side of caution. In the area where I live the SOP is to collar and backboard any patient involved in an MVA or other accident where the spine could of been compromised.
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Permalink Reply by Jim on -
Allow me to relate a story to you, Mike...
Back in 1980, I responded as a member of EMS to a jeep rollover where 2 subjects were thrown out. Both had been unrestrained. One subject was supine with C-Spine complaints and we properly boarded him up with no problems.
His passenger was a slightly different story. He was upright and walking around, very ORAOB, and threatening anyone to fight who came near him. He was beligerant and even "invited" the local po-lease to a little battle royale...
He had a small laceration to his forehead and after the constabulary placed him under arrest, he finally calmed down enough to allow me to reason with him and we were finally able to do a standing take down on him, with all the approriate C-spine precautions, even though he repeatedly denied any such type injuries.
Halfway to the hospital, he began complaining of tingling in his lower extremities and then nausea. His demeanor had calmed considerably and by the time we arrived at the ER, he was losing feeling in both legs and was a fully compliant patient in all aspects.
Approximately 18 months later, after I had moved from EMS into the Fire Service, I sat in front of his attorney giving a deposition concerning his lawsuit. The patient was a parapalegic. He and his buddy
had filed a lawsuit against-----
the vehicle manufacturer, not us.
Long story short, my EMS had established protocols in place for C-spine precautions and they worked as designed. I had evaluated the mechanism of injury and insisted that this patientbe boarded just as protocols dictated. It probably saved me from being named a co-defendant in this case. I did receive thanks from the attorney for my actions (believe that or not).
This was 1980, back when hardly anyone sued us or anyone for anything. Today someone is looking to sue you for farting in their presence. If your dept does not WAKE UP, they are going to find themselves named as defendants out here on the street someday. Does your EMS not assume ultimate responsibility for patient care? They allow the NON TRANSPORTING fire dept to dictate patent care or lack thereof?And you feel bullied when they exercise WTF they are SUPPOSED to be doing????
Please tell you're joking....
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Permalink Reply by Michael Vito on -
Well the sad truth is... EMS Law in the Philippines is non-existent. We heard that there is a bill in Phil. congress but its getting cobweb for being in the shelf too long (10 years). Our unit and their unit are independent to one another and that's we are trying to work things out. ICS is still at infancy sad to say. So that's why when a unit have big guns (good resources), they tend to bully small units.
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Permalink Reply by Jeff Cole on
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The remark about the cell phone got my interest. I have found this to become a new challenge in patient assesment, as well as in investigating various other incidents which require occupant information. Several times now, including a few incidents at which I was first on scene by way of being in the right (wrong?) place at the right (wrong?) time. One incident involved a vehicle into a merchantile building which involved several injuries. Initial efforts to triage, and evacuate the building were severely hampered becouse almost everyone involved was on the cell phone calling various family and friends and completely ignored any attempts to begin incident stabalization.
I can only see this getting worse.
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