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Mon, 22 Jul 2002 08:08:37 +0100

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Let us not forget that the spine board was devised as an EXTRICATION
device, not a patient storage device. It is best used for extrication
from vehicle seats after the rof has been removed. Once out of the
vehicle, the patient is left on the board simply for convenience. I did
hear of a spine board with an attached small vacuum mat, but it never
appeared. The London (UK) ambulance service are using the old scoop
stretcher again, but that has a huge hole in the middle that the spine
falls through, and does not answer the question of handling the lumbar
lordosis. 

Bottom line? There is nothing more than adequate out there.

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Nanto Cielens
Sent: 19 July 2002 08:55
To: trauma-list@trauma.org
Subject: Re: Prehospital Spinal Immobilization

Re Rule Number Three: Why do we continue to splint a curved back to a
flat board? Is there a more contoured spine board available on the
market nowdays? I have seen some ambos use a half arm air splint that is
lightly inflated and placed in the lumbar spine region on the spine
board prior to the Pt being placed on the board. This seems like a start
but a little hap-hazard. Any solutions anyone?

Nanto Cielens

Blood is thicker than water and considerably more difficult to get out
of the carpet

----- Original Message ----- 
From: Bjorn, Pret <mailto:pbjorn@emh.org>  
To: 'trauma-list@trauma.org' 
Sent: Thursday, July 18, 2002 5:26 AM
Subject: RE: Prehospital Spinal Immobilization

Dr. Coats,

The Cochrane conclusion, as I recall, actually (and quite publicly)
inferred a potential for harm without supportive data.  

Curiously, the Cochrane Group failed to infer a potential for good, in
spite of the fact that splinting ANY suspected bony injury--especially
that which involves an articulating joint--is universally considered a
pretty smart idea before transport.  Or should we not splint injured
knees and ankles until somebody suckers Zambia's EMS system into running
an RCT? 

In my view, the proximity of the spinal cord is but a secondary, if
wholly compelling, point of the debate.  

Rule Number One: Splint suspected bony injuries for transport.  
Rule Number Two:  Vertebrae are bony.  
Rule Number Three:  A spine board is nothing more or less than a big
frigging splint.

Pret Bjorn, RN, etc.
EMMC Trauma Program
Bangor, ME USA

-----Original Message-----
From: Timothy J Coats [ <mailto:t.j.coats@qmul.ac.uk>
mailto:t.j.coats@qmul.ac.uk]
Sent: Wednesday, July 17, 2002 5:17 AM
To: trauma-list@trauma.org
Subject: Re: Prehospital Spinal Immobilization

Bob,
Good statistics do not exist (hence the continuing opinion based
discussion).
The statistic that might help is the ratio between bony spinal injury
and
bony spinal injury with spinal cord injury. You would hope that with
pre-hospital immobilisation the proportion of bony injuries without
spinal cord involvement would go up. However no-one looked at this
prior to the advent of spinal immobilsation. There may be some third
world countries where pre-hosptial care services are just developing
where this could be studied, trouble is these undeveloped systems do
not have good Trauma Registries.
The Cochrane review looked for all the evidence - and concluded that
there was not enough to say whether pre-hospital immobilisation does
the patient good or harm.
Tim.

> Does anyone on the list know where I may find statistics that show a
> decrease (or lack thereof)in neurological deficits from spinal
> injuries due to the advent of prehospital spinal immobilization?
>
> In other words, were is the proof that putting every patient in a
> motor vehicle accident in a cervical collar and strapping them to a
> long board producing any positive results. We have all seen the
> studies showing the negative results.
>
> I am sure somewhere, at sometime it was studied and decided it should
> be done this way. I would just like to see how we are doing.
>
> Thank you,
> Bob St. Martin
>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
>  <http://www.trauma.org/traumalist.html>
http://www.trauma.org/traumalist.html

Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
 <http://www.trauma.org/traumalist.html>
http://www.trauma.org/traumalist.html

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<BODY bgColor=3D#ffffff>
<DIV><SPAN class=3D990312612-21072002><FONT face=3DArial color=3D#0000ff =
size=3D2>Let us=20
not forget that the spine board was devised as an EXTRICATION device, =
not a=20
patient storage device. It is best used for extrication from vehicle =
seats after=20
the rof has been removed. Once out of the vehicle, the patient is left =
on the=20
board simply for convenience. I did hear of a spine board with an =
attached small=20
vacuum mat, but it never appeared. The London (UK) ambulance service are =
using=20
the old scoop stretcher again, but that has a huge hole in the middle =
that the=20
spine falls through, and does not answer the question of handling the =
lumbar=20
lordosis. </FONT></SPAN></DIV>
<DIV><SPAN class=3D990312612-21072002><FONT face=3DArial color=3D#0000ff =

size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D990312612-21072002><FONT face=3DArial color=3D#0000ff =
size=3D2>Bottom=20
line? There is nothing more than adequate out there.</FONT></SPAN></DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
  <DIV></DIV>
  <DIV class=3DOutlookMessageHeader lang=3Den-us dir=3Dltr =
align=3Dleft><FONT=20
  face=3DTahoma size=3D2>-----Original Message-----<BR><B>From:</B>=20
  trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] =
<B>On=20
  Behalf Of </B>Nanto Cielens<BR><B>Sent:</B> 19 July 2002 =
08:55<BR><B>To:</B>=20
  trauma-list@trauma.org<BR><B>Subject:</B> Re: Prehospital Spinal=20
  Immobilization<BR><BR></FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Re Rule Number Three: Why do we =
continue to=20
  splint a curved back to a flat board? Is there a more contoured spine =
board=20
  available on the market nowdays? I have seen some ambos use a half arm =
air=20
  splint that is lightly inflated and placed in the lumbar spine region =
on the=20
  spine board prior to the Pt being placed on the board. This seems like =
a start=20
  but a little hap-hazard. Any solutions anyone?</FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>Nanto Cielens</FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>Blood is thicker than water and =
considerably more=20
  difficult to get out of the carpet</FONT></DIV>
  <BLOCKQUOTE=20
  style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
    <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
    <DIV=20
    style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
    <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, =
Pret</A> </DIV>
    <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
    =
href=3D"mailto:'trauma-list@trauma.org'">'trauma-list@trauma.org'</A> =
</DIV>
    <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Thursday, July 18, 2002 =
5:26=20
    AM</DIV>
    <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Prehospital =
Spinal=20
    Immobilization</DIV>
    <DIV><BR></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Dr. =
Coats,</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>The Cochrane =
conclusion, as I=20
    recall, actually (and quite publicly) inferred a potential for harm =
without=20
    supportive data.&nbsp; </FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Curiously, the =
Cochrane Group=20
    <EM>failed </EM>to infer a potential for <EM>good</EM>, in spite of =
the fact=20
    that splinting ANY suspected bony injury--especially that which =
involves an=20
    articulating joint--is universally considered a pretty smart idea =
before=20
    transport.&nbsp; Or should&nbsp;we not splint injured knees and =
ankles until=20
    somebody suckers Zambia's EMS system&nbsp;into running an=20
    RCT?&nbsp;</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>In my view, the =
proximity of the=20
    spinal cord is but a secondary, if wholly compelling, point of the=20
    debate.&nbsp; </FONT></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT>&nbsp;</DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Rule Number One: =
Splint suspected=20
    bony injuries for transport.&nbsp; </FONT></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Rule Number =
Two:&nbsp; Vertebrae=20
    are bony.&nbsp; </FONT></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Rule Number =
Three:&nbsp; A spine=20
    board is nothing more or less than a big frigging =
splint.</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Pret Bjorn, RN, =
etc.</FONT></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>EMMC Trauma =
Program</FONT></DIV>
    <DIV><FONT face=3DArial color=3D#800000 size=3D2>Bangor, ME =
USA</FONT></DIV>
    <P>&nbsp;</P>
    <P><FONT size=3D2><FONT face=3DArial><BR><BR>-----Original =
Message-----<BR>From:=20
    Timothy J Coats [</FONT><A =
href=3D"mailto:t.j.coats@qmul.ac.uk"><FONT=20
    face=3DArial>mailto:t.j.coats@qmul.ac.uk</FONT></A><FONT =
face=3DArial>]<BR>Sent:=20
    Wednesday, July 17, 2002 5:17 AM<BR>To: =
trauma-list@trauma.org<BR>Subject:=20
    Re: Prehospital Spinal Immobilization<BR><BR><BR>Bob,<BR>Good =
statistics do=20
    not exist (hence the continuing opinion based<BR>discussion).<BR>The =

    statistic that might help is the ratio between bony spinal injury=20
    and<BR>bony spinal injury with spinal cord injury. You would hope =
that=20
    with<BR>pre-hospital immobilisation the proportion of bony injuries=20
    without<BR>spinal cord involvement would go up. However no-one =
looked at=20
    this<BR>prior to the advent of spinal immobilsation. There may be =
some=20
    third<BR>world countries where pre-hosptial care services are just=20
    developing<BR>where this could be studied, trouble is these =
undeveloped=20
    systems do<BR>not have good Trauma Registries.<BR>The Cochrane =
review looked=20
    for all the evidence - and concluded that<BR>there was not enough to =
say=20
    whether pre-hospital immobilisation does<BR>the patient good or=20
    harm.<BR>Tim.<BR><BR>&gt; Does anyone on the list know where I may =
find=20
    statistics that show a<BR>&gt; decrease (or lack thereof)in =
neurological=20
    deficits from spinal<BR>&gt; injuries due to the advent of =
prehospital=20
    spinal immobilization?<BR>&gt;<BR>&gt; In other words, were is the =
proof=20
    that putting every patient in a<BR>&gt; motor vehicle accident in a =
cervical=20
    collar and strapping them to a<BR>&gt; long board producing any =
positive=20
    results. We have all seen the<BR>&gt; studies showing the negative=20
    results.<BR>&gt;<BR>&gt; I am sure somewhere, at sometime it was =
studied and=20
    decided it should<BR>&gt; be done this way. I would just like to see =
how we=20
    are doing.<BR>&gt;<BR>&gt; Thank you,<BR>&gt; Bob St.=20
    Martin<BR>&gt;<BR>&gt;<BR>&gt;<BR>&gt;<BR>&gt; --<BR>&gt; =
trauma-list :=20
    TRAUMA.ORG<BR>&gt; To change your settings or unsubscribe =
visit:<BR>&gt;=20
    </FONT><A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-July/3D"http://www.trauma.org/traumalist.html" =
target=3D_blank><FONT=20
    =
face=3DArial>http://www.trauma.org/traumalist.html</FONT></A><BR><BR><BR>=
<BR><FONT=20
    face=3DArial>Timothy J Coats MD FRCS FFAEM<BR>Senior Lecturer in =
Accident and=20
    Emergency / Pre-Hospital Care<BR>Royal London Hospital,=20
    UK.<BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings =
or=20
    unsubscribe visit:<BR></FONT><A =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-July/3D"http://www.trauma.org/traumalist.html"=20
    target=3D_blank><FONT=20
    =
face=3DArial>http://www.trauma.org/traumalist.html</FONT></A><BR></P></BL=
OCKQUOTE></BLOCKQUOTE></FONT></BODY></HTML>

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Prehospital Spinal Immobilization