Spinals @ MX

[OzMedic]

Ozmedic- If I followed the way you have described to immobilize a patient, would this stand up in court if something were to happen?

Timmy, First of all what do you think that I am telling you to do/not to do that you are doing now? and second, what do you mean by "something were to happen"?

I would never advise anybody to go against the specific training and medical direction that they work under for a start. To do so is foolhardy and contrary to your contract of employment. What I do promote is research and questioning of how we all do things. If we do think we have found a better way then there are always internal mechanisms for change. All I am promoting is my opinion based on the research and training and experience that I have been exposed to, which could very well be dead wrong! However as with most things medical you will very rarely find a dead wrong or right way. As you have seen my opinion on this issue is probably in the minority and I can honestly say that if something comes up on this board to change my opinion then I will follow it through within my organisation as I have done in the past and give credit where it is due. The question you ask is kind of irrelevant and but if you are worried about this issue then be more specific and I will try to answer you as best I can.

[Dustdevil]

As you have seen my opinion on this issue is probably in the minority...

I sure hope not.

I like to think we have a little more intelligent and enlightened crowd here than the average fire department.

[OzMedic]

I still have not found the CT studies that I first refered to, however the following are still relavent to the subject.

Spinal boards or vacuum mattresses for immobilisation

http://www.tripdatabase.com/spider.html?itemid=138620

Comparison of a long spinal board and vacuum mattress for spinal immobilisation M D Luscombe and J L Williams Emerg. Med. J. 2003;20;476-478 doi:10.1136/emj.20.5.476

http://emj.bmj.com/cgi/reprint/20/5/476.pdf

Effects of Prehospital Spinal Immobilization: A Systematic Review of Randomized Trials on Healthy Subjects

http://pdm.medicine.wisc.edu/20-1%20PDFs/Kwan.pdf

This study demonstrates the problem of movement of the body when the head is strapped rigid.

Spine. 1999 Sep 1;24(17):1839-44. The efficacy of head immobilization techniques during simulated vehicle motion.

Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR.

STUDY DESIGN: Laboratory experiment. OBJECTIVE: To compare the efficacy of different head immobilization techniques during motion simulating ambulance transport. BACKGROUND: A significant number of neurologic injuries associated with cervical spine fractures arise or are aggravated during emergency extrication or patient transport. Previous studies have not addressed the effect of head immobilization on the passive motion that could occur across the neck during transport. METHODS: Three different head-immobilization methods were compared in six healthy young adults by using a computer-controlled moving platform to simulate the swaying and jarring movements that can occur during ambulance transport. In all tests, the trunk was secured by means of a commonly used "criss-cross" strapping technique. Efficacy of head immobilization was evaluated using measures of head motion and neck rotation. RESULTS: None of the three immobilization techniques was successful in eliminating head motion or neck rotation. Movement of the trunk contributed substantially to the lateral bending that occurred across the neck. A new product involving the placement of wedges underneath the head provided some small, but statistically significant improvements in fixation of the head to the fracture board; however, there was no improvement in terms of the relative motion occurring across the neck. CONCLUSIONS: Somewhat improved fixation of the head to the fracture board can be achieved by placing wedges under the head; however, the benefits of any fixation method, in terms of cervical spine immobilization, are likely to be limited unless the motion of the trunk is also controlled effectively. Future research and development should address techniques to better control head and trunk motion.