Spinal immobilization

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G'day Pret,
I'm not 100% sure what the protocols say, I'll have ask our paramedics and
get back to you on that one.

The patients come in on a standard stretcher with a hard c-spine collar on
generally.

PB



On 6/9/06, Bjorn, Pret <pbjorn at emh.org> wrote:
>
> Dr. Bailey,
>
> I only slightly disagree: in our rural environment (more than 95% blunt
> mechanism), we see all manner of unstable spinal fractures without
> neurologic deficit.  Indeed, it has led to my suspicion that these
> patients often splint themselves during the acute phase, by means of
> local muscle spasm and edema.  Regardless, there's been no suggestion of
> abandoning protective splints.  The risk of non-immobilization will
> always dwarf the benefits.
>
> I'd be interested in hearing what Australian EMS protocols have to say
> about transporting suspected spinal injuries.  Are their no
> recommendations for immobilization?
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Paul Bailey
> Sent: Friday, June 09, 2006 8:40 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Re: Spinal immobilization
>
> Pret,
> whilst it's certainly true that the absence of evidence of effect is
> different to evidence of absence of effect, it may surprise you that
> there
> are entire continents (eg Australia) where spinal boards are not in
> common
> use and there does not seem to be any alteration of outcome.
>
> It is extremely unlikely that any high quality evidence will ever become
> available on this subject because (a) patients with potential spinal
> injuries are common and (b) patients with unstable spinal injuries and
> an
> intact cord are particularly uncommon.  Any randomized trial of these
> patients would thus require a huge undertaking and it is, in my opinion,
> highly unlikely to ever be undertaken.
>
> Paul Bailey
>
>
> On 6/9/06, Bjorn, Pret <pbjorn at emh.org> wrote:
> >
> > Dr. Mazur,
> >
> > That the Cochrane review found no PRCTs does not in any way suggest we
> > should dispense with spinal immobilization.  There are no studies
> > comparing control of external hemorrhage to letting the patient bleed;
> > but we still dress wounds.
> >
> > Certainly if we believe that splinting the spine is useless or
> > excessive, then it stands to reason that ANY splinting of suspected
> > fractures should be reconsidered pending supportive research.  Good
> luck
> > finding your experimental group.
> >
> > Pret Bjorn, RN
> > Bangor, ME USA
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of
> > stefmazur at ausdoctors.net
> > Sent: Wednesday, June 07, 2006 11:32 PM
> > To: Brian Curry
> > Cc: Trauma &amp, Critical Care mailing list
> > Subject: Re: Re: Spinal immobilization
> >
> > This thread appears to has created some interesting discussion (with
> > some  implying it is a discussion that has been had previously, but
> for
> > those of us "newish" to the list please humour)
> >
> > I believe the original question was "What is the best way to transport
> a
> > patient on a spinal board to protect their airway" with discussion
> about
> > the pro's and con's of a lateral position.
> >
> > Does the question need to go back on step...are their any benefits in
> > transporting a patient on a spinal board at all?  If their are
> benefits,
> > then which patients get those benfits?
> >
> > Have asked myself these questions recently and been disapointed with
> the
> > answers I was able to find.  I can't seem to find any evidence that
> > spinal immobilisation as is practiced with hard backboard and
> headblocks
> > etc confers any benefit.
> >
> > Most useful piece of literature I found was a Cochrane review.
> >
> > Spinal Immobilisation for trauma patients.  Kwan I, Bunn F, Roberts I
> on
> > behalf of the WHO Pre-hospital Trauma Steering Committee most recently
> > amended August 2003 and they were unable to find any evidence to show
> > the effect of spinal immobilisation following injury to prevent spinal
> > cord damage.
> >
> > Vacmats have their own problems i.e can conceal occult haemorrhage,
> > firmness varies with altitude (consideration in airmedical transport),
> > overheating (not usually a trauma patient problem but can occur here
> in
> > Australian summer esp with paeds) and they take up a lot of space.
> > Though to be honest I due use these in my clinical practice for the
> > known or high risk spinal trauma patient undergoing secondary
> retrieval
> > or those I am transporting supine for a long period esp if paralysed.
> > Primarily a comfort thing.
> >
> > Is anyone able to shed more light on this? (light....not heat!)
> >
> > Stefan Mazur
> > Emergency Physician/Retrieval Doctor
> >
> > >Simon,
> > >
> > >I'm a fan of the vacuum matresses myself.  My primary concern with
> > >regard to turning the boarded patient has to do with the degree to
> > >which backboard straps allow lateral movement on the board.  If the
> > >body can move laterally, then the patient's c-spine is not protected
> > >when rolling the board (It is, of course, a given that the patient's
> > >airway is of first concern).
> > >I am not in general a big fan of the backboards I have encountered
> > >thusfar.  In addition to the concerns addressed in previous posts
> > >(pressure sores, discomfort, etc.), the inferior quality of
> > >immobilization offered by backboards (relative to the quality offered
> > >by options such as the vacuum matress) as well as the inability to
> > >adequately immobilize patients of "nonstandard" size make me fairly
> > >conservative with the application of such immobilization.
> > >The vacuum matresses, however, create a monolithic spinal splint that
> > >resolves most, if not all, of these concerns.
> > >
> > >Brian
> > >
> > >On 6/6/06, Simon Houstoun <shoustoun at hotmail.com> wrote:
> > >> Hello Bren
> > >>
> > >> We get around this using a commercially available vacuum matress
> from
> > Ferno.
> > >> It allows us to 'comfortabley' immobilise patients, wraps around
> them
> > >> stabilising them head and all, no need for head blocks, and has a
> > harness
> > >> and handles to assist in processes like turing them lateral. As an
> > ALS
> > >> operator it is one of the best pieces of BLS equipment I have ever
> > used for
> > >> trauma patients and having been immobilised on a 'spine board'
> myself
> > I know
> > >> which I prefer for anyone I care about.
> > >>
> > >> Cheers
> > >> Simon
> > >> Intensive Care Paramedic
> > >> QAS Toowoomba
> > >> ----- Original Message -----
> > >> From: "Bren" <brendan at emstraining.co.za>
> > >> To: <trauma-list at trauma.org>
> > >> Sent: Tuesday, June 06, 2006 4:07 PM
> > >> 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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