Re: Standard of Care

[Guest guest]

MOI plays a role in your " educated " treatment as well as your

protocol. How many of us have seen an old impala with minimum

damage with a fatal injuries to the occupants. However, a new impala

with severe damage with no injuries.

It is my belief that we treat the same. I do know that we are faced

with less than obvious gross trauma, however, ever heard of the boy

who cried wolf?

I do think there will come a time where EMS in general can rule out

injuires, but until the order for the " portable, deluxe, turbo

modelx-ray machine " comes in..

[Guest guest]

Since the original subject line of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

-- Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized

2. Anyone under the influence of drugs or alcohol

3. Anyone who has an injury that would be distracting from a c-spine injury

(major long bone fractures).

4. Anyone under the age of ten and over the age of 65

5. Anyone who is unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

Good idea Troy. I few thoughts that apply to this entire thread.

Is it spinal immobilization or spinal motion restriction? We never truly

'immobilize' a patient.

Also, 'c-spine' is not what we are trying to protect. We are trying to protect

the C, the T, and the L-spine as well.

Both of these terms 'spinal motion restriction' and 'c-spine precautions' should

leave our vocabulary as they can be trouble makers in court.

White, L.P.

Assistant Professor

Emergency Medical Services

Tarrant County College

828 Harwood Road

Hurst, TX 76054-3299

shawn.white@...

(cell)

(office)

Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized

2. Anyone under the influence of drugs or alcohol

3. Anyone who has an injury that would be distracting from a c-spine injury

(major long bone fractures).

4. Anyone under the age of ten and over the age of 65

5. Anyone who is unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

Troy Irvine

Firefighter/Tactical Paramedic

Port Arthur Fire Department

Standard of Care

>

>

> >

> > so today in medic school the instructor brought up what i thought was

a

> > good point.

> >

> > as things are now, if we are called to a MVC that is minor, very

little or

> > no damage at all, and one passanger complains of insurance pain, so we

> > package them fully to CYA, if their back didnt hurt, it will by the

time

> > they have gotten to the hospital, had X-rays and are cleared to be

> > released from being packaged. as it is now, that is the standard of

care,

> > you put a medic on the stand in court and he/she will say yeah, id do

> > that.

> >

> > well, if we all collectively decide to NOT package the people from

these

> > minor accidents, then we cannot be sued because it is not outside of

the

> > standard of care.

> >

> > obviously significant MOIs should be packaged, but im talking about

the BS

> > calls where all it is is an insurance convention.

> >

> > what are ya'lls thoughts?

> >

> >

> >

> >

[Guest guest]

This is an approach that I agree with. We wouldn't splint an

arm is there were no signs or symptoms of injury, so why do

we think we should splint a back when there are no signs or

symptoms of injury?

Maxine Pate

hire-Pattison EMS

---- Original message ----

>Date: Wed, 16 Feb 2005 17:07:00 -0600 (Central Standard Time)

>

>Subject: Re: Standard of Care

>To:

>

> Since the original subject line of this thread was

> " Standard of Care " this

> raises an interesting question. Gene, Dr. B,

> others?? When the Maine

> protocol was developed back in the 80', i believe,

> the standard of care was

> to immobilize all possible c-spine injuries based on

> mechanism of injury.

> Thus, a protocol was needed to deviate from the

> standard of care. Is this

> the standard of care anymore, to immobilize anyone

> who may not need it in

> any way, shape or form just in case. Or is the

> standard of care now

> selective immobilization and not requiring a

> protocol to perform this, just

> like we don't need a protocol to NOT intubate

> someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

[Guest guest]

This is an approach that I agree with. We wouldn't splint an

arm is there were no signs or symptoms of injury, so why do

we think we should splint a back when there are no signs or

symptoms of injury?

Maxine Pate

hire-Pattison EMS

---- Original message ----

>Date: Wed, 16 Feb 2005 17:07:00 -0600 (Central Standard Time)

>

>Subject: Re: Standard of Care

>To:

>

> Since the original subject line of this thread was

> " Standard of Care " this

> raises an interesting question. Gene, Dr. B,

> others?? When the Maine

> protocol was developed back in the 80', i believe,

> the standard of care was

> to immobilize all possible c-spine injuries based on

> mechanism of injury.

> Thus, a protocol was needed to deviate from the

> standard of care. Is this

> the standard of care anymore, to immobilize anyone

> who may not need it in

> any way, shape or form just in case. Or is the

> standard of care now

> selective immobilization and not requiring a

> protocol to perform this, just

> like we don't need a protocol to NOT intubate

> someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

[Guest guest]

This is an approach that I agree with. We wouldn't splint an

arm is there were no signs or symptoms of injury, so why do

we think we should splint a back when there are no signs or

symptoms of injury?

Maxine Pate

hire-Pattison EMS

---- Original message ----

>Date: Wed, 16 Feb 2005 17:07:00 -0600 (Central Standard Time)

>

>Subject: Re: Standard of Care

>To:

>

> Since the original subject line of this thread was

> " Standard of Care " this

> raises an interesting question. Gene, Dr. B,

> others?? When the Maine

> protocol was developed back in the 80', i believe,

> the standard of care was

> to immobilize all possible c-spine injuries based on

> mechanism of injury.

> Thus, a protocol was needed to deviate from the

> standard of care. Is this

> the standard of care anymore, to immobilize anyone

> who may not need it in

> any way, shape or form just in case. Or is the

> standard of care now

> selective immobilization and not requiring a

> protocol to perform this, just

> like we don't need a protocol to NOT intubate

> someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

[Guest guest]

I believe that current standards are selective immobilization based upon more

than MOI. Current pain management studies, together with the study that

shows that folks typically lie on the spine board for more than an hour, point

away from unnecessary immobilization. There are medical consequences, such as

pressure injury, from prolonged immobilization.

I think the Maine protocols are a better solution. I have an algorhythm

chart that I would be happy for you to look at if you'd like.

GG

>

> Since the original subject line of this thread was " Standard of Care "   this

> raises an interesting question.  Gene, Dr. B, others??  When the Maine

> protocol was developed back in the 80', i believe, the standard of care was

> to immobilize all possible c-spine injuries based on mechanism of injury.

> Thus, a protocol was needed to deviate from the standard of care.  Is this

> the standard of care anymore, to immobilize anyone who may not need it in

> any way, shape or form just in case.  Or is the standard of care now

> selective immobilization and not requiring a protocol to perform this, just

> like we don't need a protocol to NOT intubate someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

> -- Fw: Standard of Care

>

> I am currently working on a protocol that I am not calling a c-spine

> clearance protocol, but selective immobilization. There is a criteria to

> establish who is immobilized and who isn't:

> 1. Anyone complaining of pain in that area is automaticly immobilized

> 2. Anyone under the influence of drugs or alcohol

> 3. Anyone who has an injury that would be distracting from a c-spine injury

> (major long bone fractures).

> 4. Anyone under the age of ten and over the age of 65

> 5. Anyone who is unconscious

>

> Of course the medic in charge has the final say so, and the first thing  the

> protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

> criteria like this, you don't have to immobilize someone who say, has some

> cuts from broken glass, or who is complaining of knee pain and wants to be

> transported.

>

>

>

>

[Guest guest]

I believe that current standards are selective immobilization based upon more

than MOI. Current pain management studies, together with the study that

shows that folks typically lie on the spine board for more than an hour, point

away from unnecessary immobilization. There are medical consequences, such as

pressure injury, from prolonged immobilization.

I think the Maine protocols are a better solution. I have an algorhythm

chart that I would be happy for you to look at if you'd like.

GG

>

> Since the original subject line of this thread was " Standard of Care "   this

> raises an interesting question.  Gene, Dr. B, others??  When the Maine

> protocol was developed back in the 80', i believe, the standard of care was

> to immobilize all possible c-spine injuries based on mechanism of injury.

> Thus, a protocol was needed to deviate from the standard of care.  Is this

> the standard of care anymore, to immobilize anyone who may not need it in

> any way, shape or form just in case.  Or is the standard of care now

> selective immobilization and not requiring a protocol to perform this, just

> like we don't need a protocol to NOT intubate someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

> -- Fw: Standard of Care

>

> I am currently working on a protocol that I am not calling a c-spine

> clearance protocol, but selective immobilization. There is a criteria to

> establish who is immobilized and who isn't:

> 1. Anyone complaining of pain in that area is automaticly immobilized

> 2. Anyone under the influence of drugs or alcohol

> 3. Anyone who has an injury that would be distracting from a c-spine injury

> (major long bone fractures).

> 4. Anyone under the age of ten and over the age of 65

> 5. Anyone who is unconscious

>

> Of course the medic in charge has the final say so, and the first thing  the

> protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

> criteria like this, you don't have to immobilize someone who say, has some

> cuts from broken glass, or who is complaining of knee pain and wants to be

> transported.

>

>

>

>

[Guest guest]

I believe that current standards are selective immobilization based upon more

than MOI. Current pain management studies, together with the study that

shows that folks typically lie on the spine board for more than an hour, point

away from unnecessary immobilization. There are medical consequences, such as

pressure injury, from prolonged immobilization.

I think the Maine protocols are a better solution. I have an algorhythm

chart that I would be happy for you to look at if you'd like.

GG

>

> Since the original subject line of this thread was " Standard of Care "   this

> raises an interesting question.  Gene, Dr. B, others??  When the Maine

> protocol was developed back in the 80', i believe, the standard of care was

> to immobilize all possible c-spine injuries based on mechanism of injury.

> Thus, a protocol was needed to deviate from the standard of care.  Is this

> the standard of care anymore, to immobilize anyone who may not need it in

> any way, shape or form just in case.  Or is the standard of care now

> selective immobilization and not requiring a protocol to perform this, just

> like we don't need a protocol to NOT intubate someone breathing and with a

> patent airway.

>

> Chambers, AAS, LP

>

> -- Fw: Standard of Care

>

> I am currently working on a protocol that I am not calling a c-spine

> clearance protocol, but selective immobilization. There is a criteria to

> establish who is immobilized and who isn't:

> 1. Anyone complaining of pain in that area is automaticly immobilized

> 2. Anyone under the influence of drugs or alcohol

> 3. Anyone who has an injury that would be distracting from a c-spine injury

> (major long bone fractures).

> 4. Anyone under the age of ten and over the age of 65

> 5. Anyone who is unconscious

>

> Of course the medic in charge has the final say so, and the first thing  the

> protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

> criteria like this, you don't have to immobilize someone who say, has some

> cuts from broken glass, or who is complaining of knee pain and wants to be

> transported.

>

>

>

>

[Guest guest]

Here in West Texas, PEMSS to be exact, we have a similar protocal that sets

forth criteria for just such instances. Basically a few simple questions are

asked and depending on the answer to those questions will determine level of

c-spine immobilization. Example: Neck Pain, Back Pain, Loss of Conciousness,

ect. If patient answers no to any and all questions, we can opt to not

immobilize. If the patient answers yes to one of the questions, we always err

on the side of caution.

Chambers wrote:Since the original subject line

of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

-- Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized

2. Anyone under the influence of drugs or alcohol

3. Anyone who has an injury that would be distracting from a c-spine injury

(major long bone fractures).

4. Anyone under the age of ten and over the age of 65

5. Anyone who is unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

Here in West Texas, PEMSS to be exact, we have a similar protocal that sets

forth criteria for just such instances. Basically a few simple questions are

asked and depending on the answer to those questions will determine level of

c-spine immobilization. Example: Neck Pain, Back Pain, Loss of Conciousness,

ect. If patient answers no to any and all questions, we can opt to not

immobilize. If the patient answers yes to one of the questions, we always err

on the side of caution.

Chambers wrote:Since the original subject line

of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

-- Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized

2. Anyone under the influence of drugs or alcohol

3. Anyone who has an injury that would be distracting from a c-spine injury

(major long bone fractures).

4. Anyone under the age of ten and over the age of 65

5. Anyone who is unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

Here in West Texas, PEMSS to be exact, we have a similar protocal that sets

forth criteria for just such instances. Basically a few simple questions are

asked and depending on the answer to those questions will determine level of

c-spine immobilization. Example: Neck Pain, Back Pain, Loss of Conciousness,

ect. If patient answers no to any and all questions, we can opt to not

immobilize. If the patient answers yes to one of the questions, we always err

on the side of caution.

Chambers wrote:Since the original subject line

of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

-- Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized

2. Anyone under the influence of drugs or alcohol

3. Anyone who has an injury that would be distracting from a c-spine injury

(major long bone fractures).

4. Anyone under the age of ten and over the age of 65

5. Anyone who is unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

Patients staying on a backboard for an extended period of time is usually blamed

on the prehospital providers in most discussions on this issue.

If patients are on the board for an extended period of time isn't this a

hospital problem and not a prehospital problem.

ajl

Fw: Standard of Care

>

> I am currently working on a protocol that I am not calling a c-spine

> clearance protocol, but selective immobilization. There is a criteria to

> establish who is immobilized and who isn't:

> 1. Anyone complaining of pain in that area is automaticly immobilized

> 2. Anyone under the influence of drugs or alcohol

> 3. Anyone who has an injury that would be distracting from a c-spine injury

> (major long bone fractures).

> 4. Anyone under the age of ten and over the age of 65

> 5. Anyone who is unconscious

>

> Of course the medic in charge has the final say so, and the first thing  the

> protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

> criteria like this, you don't have to immobilize someone who say, has some

> cuts from broken glass, or who is complaining of knee pain and wants to be

> transported.

>

>

>

>

[Guest guest]

Patients staying on a backboard for an extended period of time is usually blamed

on the prehospital providers in most discussions on this issue.

If patients are on the board for an extended period of time isn't this a

hospital problem and not a prehospital problem.

ajl

Fw: Standard of Care

>

> I am currently working on a protocol that I am not calling a c-spine

> clearance protocol, but selective immobilization. There is a criteria to

> establish who is immobilized and who isn't:

> 1. Anyone complaining of pain in that area is automaticly immobilized

> 2. Anyone under the influence of drugs or alcohol

> 3. Anyone who has an injury that would be distracting from a c-spine injury

> (major long bone fractures).

> 4. Anyone under the age of ten and over the age of 65

> 5. Anyone who is unconscious

>

> Of course the medic in charge has the final say so, and the first thing  the

> protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

> criteria like this, you don't have to immobilize someone who say, has some

> cuts from broken glass, or who is complaining of knee pain and wants to be

> transported.

>

>

>

>

[Guest guest]

hire-Pattison EMS says:

>

> We wouldn't splint an arm is there were no signs or symptoms of

> injury, so why do we think we should splint a back when there are

> no signs or symptoms of injury?

Two reasons:

1. Because I have seen asymptomatic/non-complaining c-spinal fractures. I

have not ever seen an asymptomatic/non-complaining arm fracture.

2. Because the blood sucking lawyers sue over not taking such precautions.

I have not ever seen a blood sucking lawyer sue over the discomfort of a

long board.

Neither of the above situations are likely to ever change, therefore, this

entire discussion is little more than academic.

Rob

[Guest guest]

hire-Pattison EMS says:

>

> We wouldn't splint an arm is there were no signs or symptoms of

> injury, so why do we think we should splint a back when there are

> no signs or symptoms of injury?

Two reasons:

1. Because I have seen asymptomatic/non-complaining c-spinal fractures. I

have not ever seen an asymptomatic/non-complaining arm fracture.

2. Because the blood sucking lawyers sue over not taking such precautions.

I have not ever seen a blood sucking lawyer sue over the discomfort of a

long board.

Neither of the above situations are likely to ever change, therefore, this

entire discussion is little more than academic.

Rob

[Guest guest]

> And Rob, the standard is CHANGING. Read the literature, please.

I read it. It's crap. It's an excuse for laziness. It's like a union

voting for a strike because, " they can't fire us all if we all do it! " Yet

it is being embraced by the academic elite with the same zeal that CISM was.

And I suspect it will turn out to be as valid as CISM was too.

And it will result in unnecessary morbidity and mortality.

And as someone else rightfully stated, injuries from prolonged

immobilization (for lack of a better term) is the problem of the hospital,

not

the medic.

Rob

[Guest guest]

> And Rob, the standard is CHANGING. Read the literature, please.

I read it. It's crap. It's an excuse for laziness. It's like a union

voting for a strike because, " they can't fire us all if we all do it! " Yet

it is being embraced by the academic elite with the same zeal that CISM was.

And I suspect it will turn out to be as valid as CISM was too.

And it will result in unnecessary morbidity and mortality.

And as someone else rightfully stated, injuries from prolonged

immobilization (for lack of a better term) is the problem of the hospital,

not

the medic.

Rob

[Guest guest]

<I read it. It's crap. It's an excuse for laziness. It's like a

<union voting for a strike because, " they can't fire us all if we

<all do it! " Yet it is being embraced by the academic elite with

<the same zeal that CISM was.

<And as someone else rightfully stated, injuries from prolonged

<immobilization (for lack of a better term) is the problem of the

<hospital, not the medic.

<Rob>

In today's world there are numerous people who " believe in

themselves " . I believe self confidence to be a good thing, in

moderation, but there are some, Rob, who push far beyond the limits,

creating a " God of Self " . I believe your last statement reflects

your total lack of responsibility.

Brent.......

[Guest guest]

The standard of care in the 1970s and early 80s (and continuously in other

modern countries) was to apply spinal immobilization only when a spinal

injury was suspected. When the EMT curriculum was " dumbed down " in the

1980s, curriculum planners determined that it was easier to train all EMTs

to backboard everybody instead of teaching them which to

backboard--definitely a step back for EMS. Maine EMS, based on multiple

data, and then the NEXUS study showed that EMTs can safely apply a simple

protocol and only apply the backboard to those likely to have an injury. It

is safe, scientific, has had few, if any adverse effects, and can be learned

by all. It is in PHTLS, BTLS, our new textbooks--hence it is a standard of

care. Rob is suffering from another case of craniorectal inversion.

BEB

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized 2.

Anyone under the influence of drugs or alcohol 3. Anyone who has an injury

that would be distracting from a c-spine injury (major long bone fractures).

4. Anyone under the age of ten and over the age of 65 5. Anyone who is

unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

The standard of care in the 1970s and early 80s (and continuously in other

modern countries) was to apply spinal immobilization only when a spinal

injury was suspected. When the EMT curriculum was " dumbed down " in the

1980s, curriculum planners determined that it was easier to train all EMTs

to backboard everybody instead of teaching them which to

backboard--definitely a step back for EMS. Maine EMS, based on multiple

data, and then the NEXUS study showed that EMTs can safely apply a simple

protocol and only apply the backboard to those likely to have an injury. It

is safe, scientific, has had few, if any adverse effects, and can be learned

by all. It is in PHTLS, BTLS, our new textbooks--hence it is a standard of

care. Rob is suffering from another case of craniorectal inversion.

BEB

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized 2.

Anyone under the influence of drugs or alcohol 3. Anyone who has an injury

that would be distracting from a c-spine injury (major long bone fractures).

4. Anyone under the age of ten and over the age of 65 5. Anyone who is

unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

The standard of care in the 1970s and early 80s (and continuously in other

modern countries) was to apply spinal immobilization only when a spinal

injury was suspected. When the EMT curriculum was " dumbed down " in the

1980s, curriculum planners determined that it was easier to train all EMTs

to backboard everybody instead of teaching them which to

backboard--definitely a step back for EMS. Maine EMS, based on multiple

data, and then the NEXUS study showed that EMTs can safely apply a simple

protocol and only apply the backboard to those likely to have an injury. It

is safe, scientific, has had few, if any adverse effects, and can be learned

by all. It is in PHTLS, BTLS, our new textbooks--hence it is a standard of

care. Rob is suffering from another case of craniorectal inversion.

BEB

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Fw: Standard of Care

I am currently working on a protocol that I am not calling a c-spine

clearance protocol, but selective immobilization. There is a criteria to

establish who is immobilized and who isn't:

1. Anyone complaining of pain in that area is automaticly immobilized 2.

Anyone under the influence of drugs or alcohol 3. Anyone who has an injury

that would be distracting from a c-spine injury (major long bone fractures).

4. Anyone under the age of ten and over the age of 65 5. Anyone who is

unconscious

Of course the medic in charge has the final say so, and the first thing the

protocol states is " If you have any doubt at all, IMMOBILIZE!! " With

criteria like this, you don't have to immobilize someone who say, has some

cuts from broken glass, or who is complaining of knee pain and wants to be

transported.

[Guest guest]

Well, I'm getting closer to an answer. Dr. Bledsoe says selective spinal

restriction IS the standard of care. So, since this is a basic,

non-invasive procedure and decision process does that mean that a protocol

is NOT required? Is it simply a matter of training and policy?

Chambers, LP, AAS

-- Re: Standard of Care

Since the original subject line of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

[Guest guest]

Well, I'm getting closer to an answer. Dr. Bledsoe says selective spinal

restriction IS the standard of care. So, since this is a basic,

non-invasive procedure and decision process does that mean that a protocol

is NOT required? Is it simply a matter of training and policy?

Chambers, LP, AAS

-- Re: Standard of Care

Since the original subject line of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP

[Guest guest]

Well, I'm getting closer to an answer. Dr. Bledsoe says selective spinal

restriction IS the standard of care. So, since this is a basic,

non-invasive procedure and decision process does that mean that a protocol

is NOT required? Is it simply a matter of training and policy?

Chambers, LP, AAS

-- Re: Standard of Care

Since the original subject line of this thread was " Standard of Care " this

raises an interesting question. Gene, Dr. B, others?? When the Maine

protocol was developed back in the 80', i believe, the standard of care was

to immobilize all possible c-spine injuries based on mechanism of injury.

Thus, a protocol was needed to deviate from the standard of care. Is this

the standard of care anymore, to immobilize anyone who may not need it in

any way, shape or form just in case. Or is the standard of care now

selective immobilization and not requiring a protocol to perform this, just

like we don't need a protocol to NOT intubate someone breathing and with a

patent airway.

Chambers, AAS, LP