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Fri, 7 Feb 2003 12:57:50 -0500

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Pret,

I agree, with significant blunt trauma situation the last thing the =
medic should be concerned with is clearing the c-spine.  However, I feel =
that this type of protocol eliminates the knee-jerk reflex by many EMS =
personnel that a bump on the head equals c-spine injury.  Not all EMS =
(and not all medical people in general) keep up to date with advances in =
their respective disciplines, preferring to do it "just like I always =
have".  Anecdotally, I can tell you that fewer "minor"traumas are =
arriving to my ED with c-collar and LBB.  However, and rightly so, the =
"major"traumas still have it in place.

Andrew
  ----- Original Message -----=20
  From: Bjorn, Pret=20
  To: 'trauma-list@trauma.org'=20
  Sent: Friday, February 07, 2003 12:30 PM
  Subject: RE: Non-traumatic cervical immobilization!

  Andrew et al,

  This approach closely approximates Maine's protocol, which is based on =
NEXUS recommendations, which in turn essentially attempt to provide an =
evidentiary foundation for common sense.  There are virtually no =
significant blunt trauma scenarios in which conventional rule-out =
criteria would predictably lower the rate of unnecessary spinal =
immobilization. =20

  I'm not criticizing, mind you; the end effect might simply be that =
we've been doing the right thing for decades.  I'm just not sure what =
all the excitement's about.

  I'm interested to know if anyone has shown such guidelines to usefully =
alter prehospital practice or performance.  My guess is that for =
otherwise conscientious trauma care providers, they don't. =20

  Pret Bjorn
  Trauma Coordinator
  EMMC Trauma Program
  489 State Street
  Bangor, ME 04401

  207.973.7260 (office)
  207.973.7673 (fax)
  207.941.5085 (voice pager)

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<META http-equiv=3DContent-Type content=3D"text/html; =
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<BODY bgColor=3D#ffffff>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Pret,</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>I agree, with significant =
blunt trauma=20
situation the last thing the medic should be concerned with is clearing =
the=20
c-spine.&nbsp; However, I feel that this type of protocol eliminates the =

knee-jerk reflex by many EMS personnel that a bump on the head equals =
c-spine=20
injury.&nbsp; Not all EMS (and not all medical people in general) keep =
up to=20
date with advances in their respective disciplines, preferring to do it =
"just=20
like I always have".&nbsp; Anecdotally, I can tell you that fewer =
"minor"traumas=20
are arriving to my ED with c-collar and LBB.&nbsp; However, and rightly =
so, the=20
"major"traumas still have it in place.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Andrew</FONT></STRONG></DIV>
<BLOCKQUOTE dir=3Dltr=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> Friday, February 07, 2003 =
12:30=20
  PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Non-traumatic =
cervical=20
  immobilization!</DIV>
  <DIV><BR></DIV>
  <DIV><FONT size=3D2><FONT face=3DArial color=3D#800000>Andrew et =
al,<BR><BR>This=20
  approach closely approximates Maine's protocol, which is based on =
NEXUS=20
  recommendations, which in turn essentially attempt to provide an =
evidentiary=20
  foundation for common sense.&nbsp; There are virtually no significant =
blunt=20
  trauma scenarios in which conventional rule-out criteria would =
predictably=20
  lower the rate of unnecessary spinal immobilization.&nbsp;=20
</FONT></FONT></DIV>
  <DIV><FONT size=3D2><FONT face=3DArial =
color=3D#800000></FONT></FONT>&nbsp;</DIV>
  <DIV><FONT size=3D2><FONT face=3DArial color=3D#800000>I'm not =
criticizing, mind=20
  you; the end effect might simply be that we've been doing the right =
thing for=20
  decades.&nbsp; I'm just not sure what all the excitement's=20
  about.</FONT></FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>I'm interested to =
know if anyone=20
  has shown such guidelines to usefully alter prehospital practice or=20
  performance.&nbsp; My guess is that for otherwise conscientious trauma =
care=20
  providers, they don't.&nbsp; </FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN =
class=3D030133519-19052000>Pret=20
  Bjorn</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000>Trauma Coordinator</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN =
class=3D030133519-19052000>EMMC=20
  Trauma Program</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN =
class=3D030133519-19052000>489=20
  State Street</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000>Bangor, ME 04401</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000>207.973.7260 (office)</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000>207.973.7673 (fax)</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D030133519-19052000>207.941.5085 (voice=20
  pager)</SPAN></FONT></DIV></FONT></DIV></DIV>
  <DIV>&nbsp;</DIV></BLOCKQUOTE></BODY></HTML>

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Non-traumatic cervical immobilization!