List Archives

Fri Aug 17 15:55:41 BST 2007

It must be that time of year again to get all squinchy over spinal
immobilization.  It's like the flu.  Just have to suffer through it
every year or so.

The link to MEMS protocols is as follows.  The spine algorithm is on
page 69 of the .pdf:

http://www.maine.gov/dps/ems/docs/2005%20Protocols.pdf

Long and short of it, the protocol articulates and ratifies conventional
wisdom.  As such, it helps chiefly to prevent the unnecessary and/or
arbitrary immobilization of nonpatients.  It's not a bad algorithm, and
clearly well-intentioned; but you'd be hard pressed to see how it's much
of an improvement on otherwise expected prehospital practice.

As for getting rid of the backboard, we've been around and around and
around and around and around and around and around and around and around
and around and around and around and around on it, with the same
predictable result:  Prehospital care will abandon spine immobilization
at precisely the same time it abandons any other immobilization of
suspected fractures.  Even if you believe otherwise, the hope of an
evidentiary basis for eliminating spinal immobilization is NIL.  Nobody
but a handful of bold trauma junkies are gonna consent for the
experimental group.  Get over it, and learn to use spinal immobilization
properly: as a SHORT-TERM, PREHOSPITAL TRANSPORT device.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bob Waddell II
Sent: Friday, August 17, 2007 12:42 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: getting rid of the backboard

Contact the Maine EMS office.  They adopted a spinal clearance protocol
a number of years ago.

Take care, 

Bob 

Robert K. Waddell II 
Vice President - 
Emergency Preparedness and Response 
"The Sacco Triage Methodology" 
ThinkSharp, Inc 

Wyoming Office: 
1302 East 5th Avenue 
Cheyenne, Wyoming 82001 
(307) 920 - 2020 cell 

bwaddell at sharpthinkers.com 
or bobwaddell at bresnan.net 
www.sharpthinkers.com 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
Sent: Thursday, August 16, 2007 10:19 PM
To: Trauma &amp, Critical Care mailing list
Subject: getting rid of the backboard

I have tried many different arguements I have yet to be able to actually
convince EMS providers or medical directors to drop mandatory spinal
immoboilization. Has anyone else been able to? If you have, how did you
go about it?

  Mike

Bob Waddell II <bobwaddell at bresnan.net> wrote:
  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 &, 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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getting rid of the backboard