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Fri Aug 17 06:45:32 BST 2007

Anyone else on this list ever seen the patient who "didn't seem to need" 
immobilization, comes into the ER, is turned, x-rayed, etc., only to make 
one false move and ends up paralyzed? I have. Twice in my career. One was a 
9 year old girl hit by a car, walked at the scene, and the other was a 48 
year old man who had been drinking and fell down some stairs. Both ended up 
C4-5 and C5-6 quads. I can also recall one instance where we accidentally 
found a C-spine fracture on a MVA victim and C-spined after the fact. He did 
well, but in a halo for six months.
Rebecca
----- Original Message ----- 
From: "Bob Waddell II" <bobwaddell at bresnan.net>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Thursday, August 16, 2007 8:50 PM
Subject: RE: Question for the prehospital experts


> The greater question is, "what is the ethical considerations for spinal
> immobilization?"  More and more data showing that we in the US over
> immobilize without medial benefit to the patient.  One only has to look
> at the X-game "Boarder" with the WELL documented vertical fall from 45
> ft without any spinal injury.  He did have other injuries that were
> treated upon admission to the hospital.
>
> All or nothing?  A protocol with historical roots that refuses to
> acknowledge evidence based advancements?  There are times I truly
> believe (tongue in cheek) that in the days of Sheriff Matt Dillon they
> used coffin lids as a way to carry the shot bad guys up stairs to Doc's
> office.   If they lived they came off the coffin lid and went to jail.
> If they died they were carried down to the stable, the died guy and lid
> were quick flipped over and nailed down to the coffin.  At some point in
> time a really smart medical person saw all this and decided that the
> coffin lids was actual a spinal protective device and history tells the
> rest!
>
> Where is the care of the patient in the protocol?
>
> Take care,
> Bob
>
>
> bobwaddell at bresnan.net
>
> 307 920 2020
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ben Reynolds
> Sent: Thursday, August 16, 2007 8:00 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: Question for the prehospital experts
>
> 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