List Archives

Fri, 18 Apr 2003 12:29:35 +1000

Gordon,
I think the difference between Australia (most states, anyway) and other=
 parts of the worl is that we are not bound by rigid protocols that must be=
 adhered to. We have Clinical Practice GUIDELINES. With regards to spinal=
 immobilisation, I agree with you that if there is an indication to=
 immobilise, the patient should be immobilised. Our Ambulance Medical=
 Officers do not dictate that all patients must be immobilised regardless=
 of clinical presentation, however. We have the option to immobilise,=
 transport in the position we see fit, or even clear in the field if we are=
 convinced there is no need for futher examination (NEXUS guidelines). 

Where we are probably differing in our approach is via the means of=
 immobilisation. I am yet to be convinced, or find any studies that=
 suggest, that strapping a patient to a rigid spine board is the best or=
 only form of immobilisation. I may not have expressed myself clearly=
 enough previously on this point. 

I do not find the rigid spine board to provide enough support, or stop all=
 movement of a patient in transit. Granted, we use it for extrication,=
 because it slides a patient out of cars, hallways, stairwells whatever.=
 BUT, if I have a walking patient, or one who has self extricated and has=
 no neuro signs but a good mechanism, I will use the other approach of=
 asking them to lay still on the stretcher. 

As Andy pointed out earlier, it is merely a reminder to the patient that=
 they must lie still until we get them to hospital. It is not, strictly=
 speaking, immobilisation. If anyone can pooint me in the direction of=
 information that shows that this is a harmful practice, and contributes to=
 iatrogenic spinal injury, please do! I have not been able to find any=
 cases of iatrogenic injury following transport lying still on a stretcher,=
 but not strapped down.  

Thanks for an interesting discussion
jenny

*********** REPLY SEPARATOR  ***********

On 17/04/03 at 3:15 PM Panorama71@aol.com wrote:

>Jenny,
>
>Maybe I'm missing something, but I still don't get the reasoning behind
>this 
>'soft immobilisation' in a patient with no obvious injuries or signs and 
>symptoms but a 'suggestive mechanism'. If the mechanism suggests the 
>possibility of an injury and you are still suspicious after an examination=

>which has found nothing significant then you do the full nine yards. If
>you 
>are happy to trust your examination findings then you do not. The point is=

>that you either immobilise or you don't. There is no in between.
>
>Gordon McNeill
>Scottish Ambulance College
>
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>trauma-list : TRAUMA.ORG
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