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Fri Aug 17 03:40:56 BST 2007

I am really letting my mouth run tonight.

  I would have to say "definately not a good idea." I haven't figured out the obsession with rigid spine boards, I could argue at length against them, but even if you don't use a spineboard, if you suspect a spinal injury by mechanism*, making a patient walk and then climb into an ambulance doesn't exactly reduce the motion of the spine, nor vertical compression.

  * intrusion depth and vehicle speed for spinal immobilization has not changed in a significant number of years. As such I don't think it accurately predicts injury, considering cars are now designed to absorb impact rather than transfering it. 

  In addition, there is no mention of a seatbelt, but a head laceration would lead me to believe there was some sort of force transfer that could possibly cause a spinal injury. particularly a compression or flexion/extention. 

  There is the possibility that the patient refused to be boarded and collared and was convinced to be after they climbed into the ambulance. In light of what you presented, if local protocol dictates the use of a spine board, then a "standing takedown" would be my technique of choice, otherwise, a collar and supine positioning on the cot would have reduced spinal motion. As I said before, "climbing" into an ambulance I disagree with. 

  The only absolute indication I can think of is if the scene was unsafe to such an extent that it was the most expedious way to remove the patient from the hazards, but that seems very unlikely.

  Mike 

Ben Reynolds <aneurysm_42 at yahoo.com> wrote:
  When, if ever is it acceptable for a patient involved
in an MVA to be made to walk from the car into the
back of the ambulance to be boarded and collared? Use
the following example from which to springboard your
answer:

21 year old restrained female head on collision with a
stationary vehicle. Airbags deploy. Patient has a
large cut on her head but is out and walking around. 

Ben Reynolds, PA-C
Pittsburgh, PA

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Question for the prehospital experts