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Tue May 12 16:28:24 BST 2009

I just reviewed the links.  Whoa.

Again let me emphasize that I do not encourage long-boarding anything
that crashes or falls; but screening and long-boarding are two very
different discussions.  As a fellow who has been hip-deep in blunt
trauma for more than a quarter of a century... well, whoa.

If nothing else, we're talking about a process that appears to celebrate
a 1% missed injury rate specific to SPINAL INJURY.  Where I come from,
that'd have to be close to a case every couple of years -- and I come
from the boonies.  Before you write your nursing protocol, I suggest you
run the numbers past your Loss Prevention people.

Moreover, as I review the Canadian Rule, it literally catches my breath:
you rule the patient IN for high-risk mechanism (and/or peripheral
neurologic symptoms); then encourage ACTIVE RANGE OF MOTION if he
"ambulated at any time at scene;" then apparently forego immobilization
in a patient -- WITH NECK PAIN -- if he can rotate 45 degrees (and, one
assumes, hasn't developed true sensorimotor deficits by the time you're
done).

Give me an hour and I'll find twenty patients in the last ten years of
our registry who could probably have passed this algorithm in spite of
significant spinal fractures.  At least half of them will be
level-surface falls.  

The only way this makes any sense at all is if the Canadian Rule is
invoked AFTER the NEXUS criteria have been satisfied (sensible, but by
no means obvious).  If so, we're back to ruling out bystanders.  If not,
it's abjectly unsafe.  

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Rick Tappan
Sent: Tuesday, May 12, 2009 9:13 AM
To: 'Trauma and Critical Care mailing list'
Subject: RE: C-Spine Clearance by ED Triage Nurses

Pret, you are describing mechanisms which would not qualify for field
clearance. If the distracting injury is significant enough, c-spine
immobilization must be considered. As all clinical judgment is paramount
as
well as experience see following articles

http://publicsafety.com/article/article.jsp?id=2221&siteSection=8

http://www.surgicalcriticalcare.net/Guidelines/cervical%20spine%20cleara
nce.
pdf

http://www.maine.gov/dps/ems/documents/spinal_assessment_book.pdf

RT

Rick Tappan
703 726-3734
rtappan at gwu.edu
"Who Dares, Wins"
-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Pret Bjorn
Sent: Monday, May 11, 2009 9:52 PM
To: 'Trauma and Critical Care mailing list'
Subject: RE: C-Spine Clearance by ED Triage Nurses

If these are the same criteria used in Maine (USA), they chiefly serve
to
keep bystanders from being immobilized against their will.

Too often, MECHANISM ALONE IS A DISTRACTING INJURY.  It's easy to
minimize
or ignore a sore neck or back when you've just almost died, or almost
killed
someone else, or actually killed someone else, or have no insurance, or
just
totalled dad's car.

I'm all for getting them off the board; but spine clearance can wait for
a
clinician and some judicious imaging.

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 jennymurphy61 at bigpond.com
Sent: Monday, May 11, 2009 7:19 PM
To: Trauma List
Subject: C-Spine Clearance by ED Triage Nurses

What is the group's opinion of C-spine clearance by Emergency Department
triage nurses using the Nexus Low-Risk Criteria or Canadian C-Spine
Rule.
Has this been a successful initative in some hospitals ?

Jenny.
CN. Emergency Department
Base Hospital. Bundaberg.
Queensland. Australia.
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C-Spine Clearance by ED Triage Nurses