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Fri, 1 Feb 2002 09:26:54 -0500

Rowley,

The patient has isolated neck pain.  I think that deserves at least
perfunctory attention.  John's approach seems judicious.

To your specific question (probability of bony injury), I'd respond that a)
bony injury isn't all there is to worry about, and b) even if the odds are
1000:1, the stakes are pretty freaking high for both patient and provider.

Now we get into the discussion which begins, "Well, if you're concerned
enough to immobilize at all, you should be concerned enough to immobilize
all the way."  Tough to argue against such logic: a rigid collar won't
provide much protection all by itself.  But what I'm mostly interested in,
in an otherwise uninjured and cooperative patient, is simply a reminder to
be still.  I think that can be accomplished without restraints.

Where I come from, the whole issue becomes academic: neck pain buys a long
board by protocol.  And as much against fixating on fixation as I am, you
won't find me arguing against protocol.  Better safe than sorry, and there
are places where reliance on judgment only serves to feed the civil courts.

Pret Bjorn, RN
Bangor, Maine USA

-----Original Message-----
From: rowley@rowleys-host.compulink.co.uk
[mailto:rowley@rowleys-host.compulink.co.uk]
Sent: Friday, February 01, 2002 4:13 AM
To: trauma-list@trauma.org
Cc: rowley@cix.co.uk
Subject: RE: Spinal Immobilization question

> Vertebrally I say unto you - the spine board is an instrument of 
> torture.
> 
> Put on a stiff collar.
> 
> Watch how you lift 'em and lay 'em flat and keep 'em still.  No need 
> for a
> back board in this circumstance.
> 
> Get to hospital.
> 
> Cheers,
> 
> John L Holmes
> Director Emergency Medicine
> Mater Misericordiae Hospitals,  Brisbane

Au contraire. No need for anything. What is the probability that this
patient has any bony injury? Let's be realistic!

Best wishes,

Rowley Cottingham

rowley@cix.co.uk
http://www.emergencyunit.com

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Spinal Immobilization question