Spinal immobilization

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It's an interesting thought...
Our problem is that the injured or ill patient is inevitably nauseous and if
he's been immobilized and strapped to a spine board he has no way to protect
his own airway in the case of active vomiting. He can't just sit up can he?
He's strapped down! And just how quickly does a patient vomit? If we take
into consideration that, in addition to being ill or injured, he suffers
from motion sickness (tied down travelling head first in a large diesel
ambulance, anxious, probably slightly shocked) how fast can the ambulance
technician alone in the back with him lean over and turn him lateral when he
does actively vomit?
In the case of a more serious injury with a patient with a decreased level
of consciousness, he can't even tell you that he's feeling nauseous and may
give absolutely no warning that he's about to vomit.
Beyond that is the patient who has a seriously diminished GCS (6 - 12 out of
15) who may passively aspirate stomach contents into his airway. If lying
supine... aspiration Pneumonia is a no-brainer.
If the EMT looks away for a second or (lord forbid) doesn't pick up that the
patient has aspirated... on top of that is the fact that a suction unit is
only effective if we leave the catheter in place and suction constantly...
Our EMT-B equivalent have only Guedel Airway as an airway adjunct and may
suction... beyond this it's manual airway manoeuvres. No more than that.
And if there's no logic to it why is the "recovery position" so strongly
advocated in non trauma patients with decreased level of consciousness?
Thoughts please??


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of p.bjorn
Sent: 06 June 2006 07:58
To: Trauma & Critical Care mailing list
Subject: Re: Spinal immobilization

Bren,

I think this is an over-solution.  I doubt it's been studied, because it's
of no logical benefit: if your spinal immobilization is adequate that you
can turn the patient on his side for the entire transport, why not just let
him lie supine and turn him as needed?  Being strapped to a backboard is
uncomfortable enough without hanging in a half-turn for the duration.  If
you must pursue this odd course, I'd suggest requiring that all providers be
immobilized for twenty minutes both ways as part of their training.  I think
you'll find the enthusiasm waning.

And by the way, secure airways can be properly maintained in a BLS
environment, if you're confident in your BLS.

Pret Bjorn, RN
Bangor, ME USA


----- Original Message -----
From: "Bren" <brendan at emstraining.co.za>
To: <trauma-list at trauma.org>
Sent: Tuesday, June 06, 2006 6:07 AM
Subject: Spinal immobilization


> Hey, we're having some really good arguments regarding the pre-hospital
> immobilization of trauma patients.
> The big concern is one of airway management. Since most of our ambulances
> run with primarily Basic Life Support crews (equivalent of EMT-B) and are
> not trained in advanced airway management, what methods do we have of
> properly maintaining a secure airway?
>
> The argument seems to center around Immobilization on a long spine board
> with full head immobilization, using a commercial head block device and
then
> turning the board, patient and all, into a lateral position to minimize
the
> chances of aspiration. Purely anecdotal perhaps, but it appears to be very
> effective if the pre hospital providers ensure that the immobilization is
> correct. We have come up with a method that prevents lateral movement of
the
> body and secures the patient to the board and allows little or no lateral
> movement of Cervical Region. Does anyone on the list know of any studies
> conducted in this regard? Currently we're training people to place all
> spinal (or possible spinal) patients in the lateral position after
ensuring
> proper immobilization
>
> Your comments are awaited with baited breath!
>
> --
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