C-Spine Stabilization research

[spenac]

Here is some info on some products.

http://www.rescuepad.com/

http://www.buyemp.com/product/1051701.html

http://www.patentstorm.us/patents/6848134-description.html

[firedoc5]

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.

Hopefully they can be tended to before a pressure sore can develope. But yes, if there is a spinal injury that can cause paralysis or even death, a pressure sore is the least of their worries. I laid on a board with collar for about an hour one time and there was a place on the back of my head, a sharp pressure point, that was to the point of being torturous. But I knew if it was going to keep something more important immobilized then it was worth it. I know someone with the general public may not understand that but I always stressed to them the importance of being kept still. But something as simple as an ABD pad placed there can relieve that without compromising movement. Many times I'd done that, or even using a small towel or wash cloth. And I always explained to someone while being packaged that it will be uncomfortable but it it's going to prevent further complications then they need to just be patient and hold on. Hopefully it won't be a long experience.

I do love the new padded head immobilzers. We use to use the old rolled up towels formed into a horse shoe with sand bags. (showing my age and when I started). We didn't have all the new Ferno equiptment. And even when it first came out a lot of services couldn't afford it at first.

[akroeze]

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.

Isn't it along the same lines as leaving the board/collar/straps with the patient?

[spenac]

Isn't it along the same lines as leaving the board/collar/straps with the patient?

No one besides another ambulance wants your boards etc and if you have your name on them they are easy to spot. But every nurse would snatch that BP cuff in a minute. Even with your name on it it would disappear.

[firedoc5]

No one besides another ambulance wants your boards etc and if you have your name on them they are easy to spot. But every nurse would snatch that BP cuff in a minute. Even with your name on it it would disappear.

No kidding!

[akroeze]

Fair enough

Then it is easy enough to deflate and remove it at the ER. Especially when you have a long transport it is worth it.

[Richard B the EMT]

Clarification, please...?

Is a "pressure sore" the same as a "bed sore"? I'm presuming different wording for the same problem, which we all know happens some times.

Also, anyone please, how long does it normally take for either of them to form? The longest I recall having observed a patient I had left at an ED being left on the board until being "cleared" by either exam or x-ray is at tops, 2 hours, so, have I inadvetently caused them a pressure/bed sore?

[akroeze]

Clarification, please...?

Is a "pressure sore" the same as a "bed sore"? I'm presuming different wording for the same problem, which we all know happens some times.

Also, anyone please, how long does it normally take for either of them to form? The longest I recall having observed a patient I had left at an ED being left on the board until being "cleared" by either exam or x-ray is at tops, 2 hours, so, have I inadvetently caused them a pressure/bed sore?

I don't have the source with me, but I remember reading somewhere that they can form in rare cases as quickly as 30 minutes but tend to be in the several hours or more range. Problem is we can't predict 100% who will be the quick ones.

[Freaknuggetz_chick]

if there is concern about pressure sores etc, a bit of padding ( a blanket folded in half on the board is my fave ) is easy and quick. or maybe your service buys the boards with the pads built in etc.

however, the real concern should be our strapping techiniques to ensure that immobilization is obtained. i love spider straps (hated them in school, but have learned to appreciate them as they have more contact points, even though they make take a little longer to place).

i read an article in a JEMS magazine awhile back... alot of what we're taught is x on the chest, x on the hips, across the legs if needed. but that still allows for significant movement on the board. it was suggested that we x across the chest, another across the chest, same for hips, and 2 more across the legs. if we're going through the effort, and the pt is going through the discomfort, then shouldnt we try to immobilize as much as possible?

responses??

[Doczilla]

A pressure ulcer and a bedsore are the same thing. It is thought to take about 2.5-3 hours to form a stage 1 pressure ulcer in a normal person, far less in someone who already has thin skin (elderly) or some amount of skin breakdown (bedridden or dependent, laying in the same place for a long time, etc.). Once that skin breakdown takes hold, it doesn't take much to continue it, and the pressure from the bed can go to work on the area after damage is done by the backboard.

I've been on this soapbox before: we adhere strongly in EMS to a doctrine of spinal immobilization without evidence to support it. Most EMS providers I've run into don't seem to understand that standard treatment of spinal fractures, including c-spine fractures, is laying flat on the bed (with c-collar if it's a c-spine) until a brace is obtained, halo is applied, or fusion is performed. Long backboards have no role in spinal fracture treatment. I believe that securing the patient well to the gurney during transport with straps and no board will provide equivalent spinal immobilization to a LBB with a whole lot more comfort. The LBB should be reserved for getting the patient out of the car/house/grinder and to the gurney, particularly with long transport times.

I think the discomfort caused by spinal immobilization is not a benign thing, and that we need to give our patients better care than a great big pile of suck-it-up. I have had numerous patients who got spinal x-rays based on spinal pain and tenderness, which evaporated after they were off the board for a while, and was caused solely by the board.

Here we are implementing a protocol where medics transfer the patient to the ER gurney and immediately remove them from the backboard, leaving them in the c-collar laying flat on the bed before being seen by the physician. It is not c-spine clearance (in fact, most of these patients will ultimately undergo c-spine imaging), but goes far to improve their comfort. This also takes some of the pressure off (ha ha) us to interrupt our resuscitation of someone to take someone else off the backboard. This has met unanimous approval from the regional physicians advisory board as well as EMS providers who have been consulted. This does not apply to patients with neuro deficits or who cannot follow instructions, who must be seen immediately on arrival by the physician anyway.

'zilla