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C-collar without a backboard?


DwayneEMTP

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a c-collar is useless without a spine board or a KED, whoever uses a collar and doesnt immobilize the spine should go back to basic school. i cant believe that there is even a difference of opinion on this matter. a collar without a board is like an IV needle without the line.

Papa:

Firstly have you ever heard of I.O. or PICC line....you have spiked a response, don't be so dogmatic, this is how we learn ( the evidence based medicine provided by the OZ is dinkcome sp.?) the vast differences and broad spectrum of situations that we may encounter "demand" that professionals to constantly review treatment. Hey I can remember when CPR was 15:2....last week, sorry different thread.

Frankly the jumping to conclusions made on the initiation of this thread could be a touch of controversial to start with....as I look for my level 3a body armour. lol.

It is entirely within reason to stabilize a C-spine and "entire spine" with a Ferno contoured pads, headblocks or many other ajuncts, these can and will do the job just as well. There is numerous studies that indicate we may be "complicating patent care" with stress ilieus, compromising airway and complicating the picture in restless patients that may require additional pharmo intervention just to keep them from fighting the accepted treatment that being a hard board.

An "outside the box" approach I have seen just lately and I submit for your review.... please check out the Oregon Spinal system, by SKEDCO it has been approved by your very own military.

There is NO chin Strap....WHAT OUTRAGEOUS NONSENSE!

Yes a Strap that fits over the nose, the rational being that the Mandible is not as secure placement as the the Maxilla further..... all of EMS medical training priority is AIRWAY # 1, correct? so then why would we strap a jaw closed?

Also could it be that the paranoia of lawsuits is dictating the care and not common sense?

Sorry don't have a the link's; but try these documents as they are an interesting perspective. If you cant locate them with a search contact PM an I will shoot the attachments in full.

The New England Journal of Medicine

VALIDITY OF A SET OF CLINICAL CRITERIA TO RULE OUT INJURY

TO THE CERVICAL SPINE IN PATIENTS WITH BLUNT TRAUMA.

or JAMA, Oct 17, 2001. Vol 286 No 15

CANADIAN C-SPINE RULE for RADIOGRAPHY in the ALERT STABLE TRAUMA PATIENT.

More than one way to immobilize a ROO/ CAT / WALLABY

ps what the hell is a wallaby anyway, can you eat them?

Cheer Mates.

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True .. cervical collars are usually used.... but. truthfully most are a piece of crap... If there is something better, then we need to investigate and read. Shame EMS does not conduct more studies and maybe we could invent better equipment.

I have been in the field long enough, to know there are some patients that you have to improvise and actually have a better immobilization than the traditional cervical collars.

I would like to see the strap device... I have not seen the pad yet.. that sound interesting.

Be safe,

R/R 911

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I'm seeing some very interesting comments here. "Way back" in the old days when we did mostly load and go, it was quite common to see a patient on a board with NO collar and vice-versa. They just weren't teaching proper c-spine immobilization back then. Now that's basically unheard of!

However, I work as a first responder in my part of the county. I'm an EMT, and will be a paramedic when I repeat the NR exam!

A few months ago I responded on an oilfield accident where a worker was hit in the head with a 6" plastic pipe. Knocked him down, and he was out for a minute or two. When I drove up another worker was holding him to keep him still, but wasn't immobilizing the neck. I could hear the ambulance coming, so I applied traction to the neck and had to keep the guy still. When the medics got there, they put on a collar and put him on the backboard. I looked around and said, "Where are your spider straps?" The medic said..."OH, we don't use those things.....they're too much trouble. We'll strap him down when we get him in the rig." I was apalled. This was a large metropolitan Fire/EMS with no spider (or other) visible straps! The department where I worked during my most recent EMT (I've been certified as an EMT since 1974!) re-cert and in going through paramedic training, spider straps were pre-attached to the backboard. No question about it!

For those of you who would like a look at how ambulances were operated in the '60s and '70s, my friend Steve Loftin in More,OK, has a video that runs about an hour and a half with a lot of ambulance footage taken by a news cameraman between 1962 and 1972 in Corpus Christi. He has these videos on VHS and CD for about $30. There's a lot of footage showing the old stationwagon ambulances, full size and short-wheel-based, coaches, suburbans and early hightops. These are 16mm films converted to high quality video and in full color, but no sound. Contact Steve Loftin at: steveloftin@sbcglobal.net for further information and orders.

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True .. cervical collars are usually used.... but. truthfully most are a piece of crap... If there is something better, then we need to investigate and read. Shame EMS does not conduct more studies and maybe we could invent better equipment.

I have been in the field long enough, to know there are some patients that you have to improvise and actually have a better immobilization than the traditional cervical collars.

I would like to see the strap device... I have not seen the pad yet.. that sound interesting.

Be safe,

R/R 911

Ridryder: Clearly I don't work in EMS? LMFAO!

I wish some days it were true, its hard to be patient with those that get tunneled.

I am trying to be good, oh that's better the Versed is starting to be therapeutic ahhhh.

Well thanks for the support Rid, research based medicine does validate ones position and you are so correct, it is a shame that more EMS in the field studies are not undertaken, it makes ALL the difference between Professionals and Technicians.

If one goes to www.skedco.com request the video to be sent to your home address. The best part its FREE! The production lacks some glitz and polish but the Officer that does the presentation is VERY Experienced, the Sked application for vertical lifting to a fling wing and Swift water rescue is stellar. I believe that International Rescue 3 out of California had some involvement with the rapid deployment model.

Improvise Persevere Overcome.

squinting

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Being active as a provider nearly 30 years.. I have seen things come and go. True cervical collars are definitely lacking... let's not throw them out with the bath water, but if there is something better.. let's study and trial it.

Most of you do not remember short spine boards.. although, they worked when properly applied ( that is the clue) .. but a real pain in the anus. Hence, someone invented something better and easier.. (the KED)..they were uncomfortable, sloppy with straps across the chest, etc... Oh, I remember the doomsday prediction with it as well. ..Short spine board is the only way !... hmm when was the last time you seen one ?...

I like to see real trials in a controlled setting first (to prevent potential injuries) then maybe field afterward. Hey. If it works & better .. then I am all for it !

Be safe,

R/R 911

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My service has both short spine boards and KEDS on our trucks... We don't use the short boards very often. I personally like the KED and feel that if properly applied, the work great during stable extrications. There was another thread about c-collars recently, and I think most will agree that they are not perfect and sometimes a bit of creativity is needed to secure the spine.

As for a pt getting a collar without a board... only if pt refuses... If you can't think of a scenario where you could get a collar on someone before refusing the board, I submit this experience:

My very 1st MCI on a I95 in Eliot, Maine (right on the border on NH). We got sent to a bunch of cars that piled up. The car we were triaged to had very minor injuries. Mother, Father, 2 children in car. Mother got her head bounced off the steering wheel, complaining of mild neck pain. Manual stabilization in the car, Mom's tolerating it well. Put long board under her butt, spin her onto board. Little child calls out for mommy. Mommy can't see child because her face in pointing straight to the heavens. Mommy freaks out. Mommy becomes irate, wants nothing else in this world than to be able to look at her kid while she's in the ambulance. We explain that we need to get her on the long board and secured or she could possible have some irreversible c-spine damage. Mommy says she doesn't care. Mommy VOLUNTEERS to fill out any form that we need in order to stay off the board and in a sitting position. What can we do? Sign here please. Hold her head and try to get her not to move (wasn't happening). Who were we to force mom to not be able to see her kid? It went against all of our training, but we had little choice.

Weird things happen, we can't afford to live by absolutes in this field. Each situation has different obstacles, and different solutions. It's our job to come up with those solutions within the framework of our training and protocols.... and sometimes we are not allowed to solve. So be it.

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See the title of my post that is my opinion of a LSB. Show mw one qualified study that shows that a LSB prevents further injury in any type of spinal injury.

so much of what we do has no science behind it, including c-spining unless there is deformity, or existing neuroligical deficits. Have you ever heard of anyone not being c-spined and later collapsing because of a spinal injury? Only if ther is a bleed or a clot that is forming in the spine and a board and collar will not prevent that.

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Well said, medik8. I think even if they're dazed a bit they can understand that you're only trying to protect them. I may borrow that line! :)

Does anyone have any "best practice" out there for padding under the patient or handling a cold board? The surface of the board is a bit slippery for a blanket. On a cold night it's like putting someone on a block of ice. We picked up an elderly lady from a nursing home, ground level fall but she said her back hurt so we immobilized her. I felt terrible for her, she looked so uncomfortable. Any suggestions?

The absolute "best" technique currently available is to use one of the new semi-disposable vacuum splints (Fasplint by Hartwell uses the most supple material) as a combination spineboard pad / head immobilizer. The large (leg splint) is the best for an adult; the splint is tapered and long enough to reach from the head to the hips. Hold the splint, wide end at the top, draped on the board as you log roll the pt. on. The beads in the splint fill in the voids between the patient and board conforming perfectly to the pts body contours. Form your head immobilizer with the wide end at the top, apply vacuum with a pump or suction unit :) to lock beads in place, tape across the eyebrows to secure, and strap down. This system has many benefits:

1. Faster than head blocks and padding

2. Unitizes the entire spine rather than placing the head in a vice with the body sliding around the board.

3. Spinal "bouncing" eliminated during transport as contoured fit fully supports spine.

3. Patient on board can be tipped sideways to clear an airway with virtually no spinal movement.

4. Patient comfort vastly improved as weight is evenly distributed...can be on spineboard for long periods safely.

5. These splints are inexpensive and can be reused making them cheaper than disposable head blocks.

A variation for getting the pt. onto the pad is to vacuum the splint out so that it is flat and rigid, slide the pt onto the thus padded board, let the air back into the splint allowing the beads to flow, then shape, vacuum and secure as above. This works well for auto extrications and other similar situations; just be sure to brush any glass etc. away before dragging the pt. across the splint.

Hope this helps.

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