C-Spine Stabilization research

[ExplorerShane]

I don't know how it popped into my head last night, but I really started thinking about stabilization for C-spine. I started wondering how often, during an MVA, a person suffers from an injury to the spine? Obviously it differs by the impart point and where you were exactly in the car, but for how often a patient is backboarded, is it necessary? Also, when we backboard a patient, does it provide the best stabilization possible under the circumstances? I just was curious of the research being done.

[spenac]

Actually there have been many studys. From what I remember many seem to point that backboards and c-collars are used way to often and may be even causing harm. Many paramedic services now have protocols that allow for deciding against use of back boards and c-collars.

It seems that some of the research was posted here so a search may provide you the answer.

[Richard B the EMT]

I keep hearing research is supposed to be being done.

Until it is, despite the protests of that doctor in the Peninsula Hospital ED for following existing protocols by long back board immobilization, and I'm told by the NY State DoH to do whatever new protocol, I'm going to do what is required of me.

[spenac]

Here are some discussions about Selective Spinal Immobilization or c-spine clearing as some call it.

http://www.emtcity.com/phpBB2/viewtopic.ph...cspine+clearing

http://www.emtcity.com/phpBB2/viewtopic.ph...cspine+clearing

[firedoc5]

This has been an issue for years, especially back when BTLS was first being established on a national level. It was agreed on, at the time, that what has been protocol nationwide with c-collar (rigid), full spine board, head immobilizers, were the appropriate way to go. Slowly there has been some improvements with new designs of the same equiptment. KED onto a full spine board has been optimal. Some medics may have improved the procedures to accomplish these tasks.

But to answer the question, yes, it is essential. Rather be safe than sorry. Many times there has been those who were in a lot of pain, which sometimes increased when placed on a board or had a collar applied, but it then that when x-rayed or examined would have unstable and/or multiple fx. What if you did not package them the right way? One movement, one jar, and wham...who knows what the consequences could be. I think I've had more pats on the back from proper packaging or handling of potential spinal injuries than anything else. So you can't go wrong with proper spinal immobilization.

[akroeze]

So you can't go wrong with proper spinal immobilization.

Yeah, I mean there is nothing wrong with a pressure sore that takes months or in some cases years to heal because they were on a board that they didn't need to be. Nothing wrong with that at all.

[mobey]

I dunno... I have a problem with all this pressure sore talk. I have heard all the mumbo jumbo about sores after 2 hours, and I am sure that holds true for little old ladies. But for the average adolesent/adult I have had very different experience.

I worked for a very remote service with a transport time of about 2.5 hours down some terrible roads (max speed 80-90km/hr). My patients would be on a board for around 3 hours by the time we got a room and god knows how long after we left them.

Ya they were definatly in discomfort/pain, but i never heard complaints of sores.

I always wondered... would it be that detrimental to put like a 1/4 inch of foam on top of the board?

[spenac]

I dunno... I have a problem with all this pressure sore talk. I have heard all the mumbo jumbo about sores after 2 hours, and I am sure that holds true for little old ladies. But for the average adolesent/adult I have had very different experience.

I worked for a very remote service with a transport time of about 2.5 hours down some terrible roads (max speed 80-90km/hr). My patients would be on a board for around 3 hours by the time we got a room and god knows how long after we left them.

Ya they were definatly in discomfort/pain, but i never heard complaints of sores.

I always wondered... would it be that detrimental to put like a 1/4 inch of foam on top of the board?

They actually sell a pad that sticks on. I have also seen an air pad that you inflate after placing patient so it supports all areas.

[akroeze]

I have heard (not actually done yet though) that if you inflate a BP cuff in the small of the back it can provide some relief

[spenac]

I have heard (not actually done yet though) that if you inflate a BP cuff in the small of the back it can provide some relief

Should work. Are you going to take it out before taking patient into the hospital? Service might get mad at you if every time you backboard they have to order new BP cuff.

I always try and slide a towel in the small of the back, behind the knees, and anyplace else I see daylight. Not the best but it at least gives some support on the long ride to the hospital at what is now my part time job.