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using the spine board too much
There is one case yesterday night we responded (Aug. 27 '09 PST) as a first responder firefighters to an MVA involving two SUV's about 25 meters from our station. On scene, including our fire chief who happens to be a senior EMT in our group done a head to toe examination, the vitals are very good, no visible cuts and we found out that she already walked from the front seat of the car to the back and lie on her back to rest. The only chief complaint is - her bump on her forehead. While our chief is doing the head to toe, the lady keeps on calling and texting her cellphone. Then the neighboring township ambulance and rescue units arrives. They insisted to put the lady on the spineboard and package her. But we said NO, because she doesn't have a spinal injury. We ask if they got the chair but instead they put her on a gurney. The patient was transported to the nearby hospital.
In our experience with this neighboring township unit, we noticed on previous incidents. Like another example we responded to a motorcycle accident when the motorcycle lost control because of the wet and too much debris on the road because after the heavy rain. The two male riding the bike slide out and sustain some abrasion to the legs, and arms and some abrasion wounds at the face. When we got there, the two are already walking around and looking to his personal items lost on the road. The other guy is already walking and conferring with the traffic cop. And we ask the two to sit down and to have better look. Then the neighboring ambulance team arrives and to our surprise they put the two at the spineboard and package them up. Despite telling them the situation. We were not able to object because they have the resources and felt we kindaof bullied.
But the last night incident as I mentioned already. We said NO and this time their supervisor is with them and told him right away.
So the question is... Do you need to put her on the spine board. I've heard some units put patients on the spine board because the rationale is "precautionary."
Another question, other than we learned from first responder, EMT courses. Is this depends on their departmental SOP that they put patients in a spineboard when they are in doubt and the nature of the incident is MVA's or trauma.
any thoughts?
Thanks,
Mike
In our experience with this neighboring township unit, we noticed on previous incidents. Like another example we responded to a motorcycle accident when the motorcycle lost control because of the wet and too much debris on the road because after the heavy rain. The two male riding the bike slide out and sustain some abrasion to the legs, and arms and some abrasion wounds at the face. When we got there, the two are already walking around and looking to his personal items lost on the road. The other guy is already walking and conferring with the traffic cop. And we ask the two to sit down and to have better look. Then the neighboring ambulance team arrives and to our surprise they put the two at the spineboard and package them up. Despite telling them the situation. We were not able to object because they have the resources and felt we kindaof bullied.
But the last night incident as I mentioned already. We said NO and this time their supervisor is with them and told him right away.
So the question is... Do you need to put her on the spine board. I've heard some units put patients on the spine board because the rationale is "precautionary."
Another question, other than we learned from first responder, EMT courses. Is this depends on their departmental SOP that they put patients in a spineboard when they are in doubt and the nature of the incident is MVA's or trauma.
any thoughts?
Thanks,
Mike
Replies are closed for this discussion.
Replies to This Discussion
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Permalink Reply by lutan1 on
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There's no such thing as over use of the spine board.
To Ben and others that suggest that the use of spine board can contribute to further complicaitons, I'd go on a limb and suggest that the techniques being used are not up to date with the latest techniques.
There is some very good research (3 published and 1 university thesis on board comfort) on the correct packaging and techniques, including padding of the patient, which resolves all issues of comfort. Sadly most orgainsations ignore these studies. (3 of which are available to read here http://www.neann.com/Board%20Comfort.htm )
I was a contributing author to a book titled, "A Photographic Guide To Prehospital Spinal Care" and I've asked Anthony the author to weigh in on this discussion. I'd suggest that what he doesn't know about prehospital spinal care is not worth knowing. Page 209 of the manual talks about these studies and the outcomes.
You can download and read the 240 page manual for free at http://emergencytechnologies.com.au/psm.htm -
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TO those that beleive you have a "spinal clearance protocol", I'd suggest that the terminology is incorrect and possibly leading to a false sense of security in the field.
The protocol is actually a "Selective Spinal Immobilisation" protocol where you select patients to immobilised and don't immobilise patients who don't meet the criteria.
Spinal clearance can only be performed by a Doctor using techniques/equipment such as X-Ray and CT.
While it may be semantics, it is important that people understand the difference beyween the two terms. -
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Permalink Reply by 260fire134 on
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you can not use to much c-spine precotion, plus if you dont you yet fired and or sued, always treat as if the pt was your grandma or your kid. and if thay refuse get that waver, and try your best to get them to go get checked out somehow ,somewhere.
plus your pt had a head wound in the EMT-b class or even first responder thay say any wound form the chest/sholdes up gets a back bord. -
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Permalink Reply by Brian Dumser on
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It'll be the one time you don't use it that will bite you in the a$$. Always err on the side of caution.
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Permalink Reply by Michael Vito on
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Thanks for the post Lutan1.
260fire134 and Guys, don't get us wrong. If we do employ spinal immobilization. We do the fullest and attention to detail and move it carefully. Like make sure the straps are secured, voids should have pads etc. Unlike the neighboring ambulance unit in question. Their packaging is sloppy and they didn't have a head block too. As I said before, we are in the place that there is no national EMS system in place. Their ambulance unit is manned by a nurses conveniently so called "paramedic" and led by their team leader with just a first responder level background only. The only the plus side is that they have the resources.
and again, thanks for the post. -
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RALPH ! before you post something.... read carefully the replies and why it come to that. Can't you read!
We got the message ALREADY ..... again,..... again.....again.... I thought this case was rested.
Again, I would like acknowledge like I've mentioned for the good contribution of their experience. Thank you all ! -
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