Re: Spinal Immobilization Question

[Guest guest]

The practice is mindlessly stupid.

GG

>

>

>

>

> I have observed several times lately EMS responders manually stabilizing

> an ambulatory?trauma pt's. c-spine, applying a c-collar and then walking

> them to a stretcher and having them sit down on a backboard.? The pt. then

> lies down and is secured to the board. My personal opinion is that if I am

> going to place a pt on a board from a standing position I would do just that

> and not risk further manipulation of the spine by having them walk, sit

> down, raise their legs, turn around and lay down.? Is my thought process

> outdated?? I would appreciate any comments.? Thanks-

>

> Sam

>

>

[Guest guest]

I think that this is an excellent example of either not understanding the

principles of spinal motion restriction (SMR)?or of going through the motions of

following the protocols.

To me, if SMR is warranted, I'm going to do a standing takedown if the patient

is standing.? If SMR is not warranted, I'm hoping I'm someplace where the medics

are given the protocols, tools, and training to appropriately assess the need

for c-spine precautions.

-Wes Ogilvie

Spinal Immobilization Question

I have observed several times lately EMS responders manually stabilizing an

ambulatory?trauma pt's. c-spine, applying a c-collar and then walking them to a

stretcher and having them sit down on a backboard.? The pt. then lies down and

is secured to the board. My personal opinion is that if I am going to place a pt

on a board from a standing position I would do just that and not risk further

manipulation of the spine by having them walk, sit down, raise their legs, turn

around and lay down.? Is my thought process outdated?? I would appreciate any

comments.? Thanks-

Sam

[Guest guest]

Wes you silly idealist.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> I think that this is an excellent example of either not

> understanding the principles of spinal motion restriction (SMR)?or

> of going through the motions of following the protocols.

>

> To me, if SMR is warranted, I'm going to do a standing takedown if

> the patient is standing.? If SMR is not warranted, I'm hoping I'm

> someplace where the medics are given the protocols, tools, and

> training to appropriately assess the need for c-spine precautions.

>

> -Wes Ogilvie

>

>

> Spinal Immobilization Question

>

>

>

>

>

>

>

>

>

> I have observed several times lately EMS responders manually

> stabilizing an ambulatory?trauma pt's. c-spine, applying a c-collar

> and then walking them to a stretcher and having them sit down on a

> backboard.? The pt. then lies down and is secured to the board. My

> personal opinion is that if I am going to place a pt on a board from

> a standing position I would do just that and not risk further

> manipulation of the spine by having them walk, sit down, raise their

> legs, turn around and lay down.? Is my thought process outdated?? I

> would appreciate any comments.? Thanks-

>

> Sam

>

>

[Guest guest]

That is pretty much my thoughts as well Wes.? I would love to see their run

reports and how they are?documented.

Sam

Spinal Immobilization Question

I have observed several times lately EMS responders manually stabilizing an

ambulatory?trauma pt's. c-spine, applying a c-collar and then walking them to a

stretcher and having them sit down on a backboard.? The pt. then lies down and

is secured to the board. My personal opinion is that if I am going to place a pt

on a board from a standing position I would do just that and not risk further

manipulation of the spine by having them walk, sit down, raise their legs, turn

around and lay down.? Is my thought process outdated?? I would appreciate any

comments.? Thanks-

Sam

[Guest guest]

Your opinion is the correct one.

If you're think immobilization is prudent and necessary, then

immobilize. Do it correctly, without shortcuts.

If you *don't* consider immobilization necessary, then why are you doing

it, and half-assed at that?

Paragal911@... wrote:

>

>

>

> I have observed several times lately EMS responders manually

> stabilizing an ambulatory?trauma pt's. c-spine, applying a c-collar

> and then walking them to a stretcher and having them sit down on a

> backboard.? The pt. then lies down and is secured to the board. My

> personal opinion is that if I am going to place a pt on a board from a

> standing position I would do just that and not risk further

> manipulation of the spine by having them walk, sit down, raise their

> legs, turn around and lay down.? Is my thought process outdated?? I

> would appreciate any comments.? Thanks-

>

> Sam

>

>

[Guest guest]

Those run reports match up perfectly to any video shot of the scene as

sure as the reports from the OHP match up to the video of thar highway

incident.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> That is pretty much my thoughts as well Wes.? I would love to see

> their run reports and how they are?documented.

>

> Sam

>

>

> Spinal Immobilization Question

>

>

>

>

>

>

>

>

>

> I have observed several times lately EMS responders manually

> stabilizing an

> ambulatory?trauma pt's. c-spine, applying a c-collar and then

> walking them to a

> stretcher and having them sit down on a backboard.? The pt. then

> lies down and

> is secured to the board. My personal opinion is that if I am going

> to place a pt

> on a board from a standing position I would do just that and not

> risk further

> manipulation of the spine by having them walk, sit down, raise their

> legs, turn

> around and lay down.? Is my thought process outdated?? I would

> appreciate any

> comments.? Thanks-

>

> Sam

>

>

[Guest guest]

This has been done for obviously quite some time. I have noticed it for at least

5  to 10 years.  The medics doing such need to be retrained or be given an

explanation as to the ramification of their actions. If you are believing a

person to have suffered a spinal injury walking them is the last thing to do. If

they are standing do a standing backboard procedure. The legal ramifications can

be quite sobering if that action is persued.  Think " Negligent Behavior " .  

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

This has been done for obviously quite some time. I have noticed it for at least

5  to 10 years.  The medics doing such need to be retrained or be given an

explanation as to the ramification of their actions. If you are believing a

person to have suffered a spinal injury walking them is the last thing to do. If

they are standing do a standing backboard procedure. The legal ramifications can

be quite sobering if that action is persued.  Think " Negligent Behavior " .  

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

This has been done for obviously quite some time. I have noticed it for at least

5  to 10 years.  The medics doing such need to be retrained or be given an

explanation as to the ramification of their actions. If you are believing a

person to have suffered a spinal injury walking them is the last thing to do. If

they are standing do a standing backboard procedure. The legal ramifications can

be quite sobering if that action is persued.  Think " Negligent Behavior " .  

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

I have seen it off and on in past years as well, however it seems to be more

prevalent now?in?several 911?services.? I don't know if it comes more from poor

training or laziness.? Possibly both?? I do however know I would not want to be

the one in court attempting to justify my actions or the EMS/Medical Director

who also may at some point become invovled.?

Sam

Re: Spinal Immobilization Question

This has been done for obviously quite some time. I have noticed it for at least

5? to 10 years.? The medics doing such need to be retrained or be given an

explanation as to the ramification of their actions. If you are believing a

person to have suffered a spinal injury walking them is the last thing to do. If

they are standing do a standing backboard procedure. The legal ramifications can

be quite sobering if that action is persued.? Think " Negligent Behavior " .??

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

I have seen it off and on in past years as well, however it seems to be more

prevalent now?in?several 911?services.? I don't know if it comes more from poor

training or laziness.? Possibly both?? I do however know I would not want to be

the one in court attempting to justify my actions or the EMS/Medical Director

who also may at some point become invovled.?

Sam

Re: Spinal Immobilization Question

This has been done for obviously quite some time. I have noticed it for at least

5? to 10 years.? The medics doing such need to be retrained or be given an

explanation as to the ramification of their actions. If you are believing a

person to have suffered a spinal injury walking them is the last thing to do. If

they are standing do a standing backboard procedure. The legal ramifications can

be quite sobering if that action is persued.? Think " Negligent Behavior " .??

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

My first thought is Laziness. There is no way to justify your actions when you

know that is not the way you are trained.

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

My first thought is Laziness. There is no way to justify your actions when you

know that is not the way you are trained.

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

My first thought is Laziness. There is no way to justify your actions when you

know that is not the way you are trained.

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

I agree it's a CYA thing, but it's really not doing anything to " CYA "

because it doesn't follow any known acceptable procedure. And if it did, it

still, as you aptly say, it doesn't do anybody any good.

Field clearance protocols are in use all over the place and they work. So

far as I can tell there have been no lawsuits as a result of a botched

field clearance.

Let's design a " Don't board me " bracelet and sell it. You can design it

since you're an accomplished artist, and we'll get rich.

Gene

>

>

>

> In no way am I saying that the practice of walking them to the board is

> okay - don't believe that - but what happens to lead to these things, OTHER

> than laziness, is (1) EMS burnout, (2) the realization that SMR is doing no

> good on patients ambulating easily (and who have great LOCs), and (3) that

> they only need to do it because of CYA reasons. I too had trouble initially

> believing there was any reason to place someone on a hard wooden (or

> plastic) board when they were obviously not spinal-injured (or if

minimally...In

> no way am I saying that the practice of walking them to the board is okay

> - don't believe that - but what happens to lead to these things, OTHER than

> laziness, is (1) EMS burnout, (2) the realization that SMR is doing no

> good on patients ambulating easily (and who have great LOCs), and (3) that

> they only need to

>

> We're still in the dark ages with this aspect of care but unfortunately no

> better answer exists. We board people many, many times because it's the

> " legal " thing to do or for appearances. Even the patient who may have a

> " cracked " a vertebra in his/her neck but walks with 0 difficulty, turns their

> head with 0 difficulty, and has no pain is not going to benefit from that

> board. A collar, possibly, yes. But not the board. It simply covers the

> rear-end of the crew and makes for a way to get them into the truck. If I am

the

> patient in a wreck who wants to go to the hospital but knows the board is

> not needed - I'm refusing it. And it cannot be forced on me.

>

> For the crew it should be " if one has to do a job, do it right " . For the

> patient often...doing the job right is literally a pain in the neck.

>

> Don, Tyler

>

> >>> " Danny " 6/16/2009 12:03 PM >>>

> My first thought is Laziness. There is no way to justify your actions when

> you know that is not the way you are trained.

>

> Danny L.

> Owner/NREMT-

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

It's hard to change habits and harder to change ideas that have been

institutionalized for decades, although without any medical basis.

How many things do we do " just because we've always done it this way? "

There's a whole list that we could come up with, and it has already been the

subject of debate on here and other lists numerous times.

Don, you remember when we used to believe that defibrillation wouldn't work

until we corrected acidosis, so we drove up on the cardiac arrest scene and

pushed two amps of bicarb. We also stopped CPR top feel for spontaneous

pulses often, and so forth. You also remember when we intubated, then

bagged the patient as fast as the bag would refill, and we rolled it up in a

ball

to squeeze the last little bit of those 1800 milliliters out of it,

effectively placing the last nails into the coffins of our patients. Then we

turned people loose with NTG and told them to give MONA for chest pain, and they

knew nothing about right sided MIs and the dangers of NTG in them. Many

still don't know anything about that and are not being taught.

Spine boarding is another one of those myths. Like so many things we do,

it makes us feel good, gives us a false sense of security, and lets us think

the lawyers aren't onto us.

Unfortunately they are. They're well aware of these things, some of them

moreso than lots of medics. Now they're looking at pain management issues,

pressure sore issues, and so forth, along with stuff like airway issues

(still the No. 1 cause of lawsuits against medics after MVC) .

Lawyers know, for example, that the Texas Supreme Court has held that the

ACLS Guidelines are admissible evidence of standard of care and can be

introduced into evidence without expert testimony. (Bush v. Columbia Las

Colinas, a case I worked on). How many medical directors and medics are aware

of that?

We'll get there on spinal issues eventually. But there will always be

other issues. Best check your amiodarone and vasopressin supplies.

Gene

>

>

>

> We have one as well...naturally patterned after Maine's (everyone's pretty

> much is I think) but very few uses of it. We would expect it to be used a

> little bit more but maybe it's a good thing it's not. Best to err on the

> side of caution.

> Don

>

> >>> " Grayson " Grayson902@...> 6/16/2009 3:46 PM >>>

> Don, the entire state of Maine has a spinal clearance algorithm, and

> they don't even use MOI as a determining factor any more. They've had it

> for close to ten years.

>

> Yet, I'm not seeing news reports of the avalanche of personal injury

> lawsuits coming out of Maine.

>

> It would seem that fear of lawsuits isn't even a valid reason for

> resistance to implementing spinal clearance algorithms.

>

> Don Elbert wrote:

> >

> >

> > In no way am I saying that the practice of walking them to the board

> > is okay - don't believe that - but what happens to lead to these

> > things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> > that SMR is doing no good on patients ambulating easily (and who have

> > great LOCs), and (3) that they only need to do it because of CYA

> > reasons. I too had trouble initially believing there was any reason to

> > place someone on a hard wooden (or plastic) board when they were

> > obviously not spinal-injured (or if minimally... obviously not spinal-

> > going to help) when they're walking around with great motion with each

> > limb, great motion of their head/neck, had no pain but yet wanted to

> > go. Then the realization that " oh...it's a legal thing " or " I don't

> > want the ED staff to give me a hard time " occurs. Not that there's a

> > clinical reason.

> >

> > We're still in the dark ages with this aspect of care but

> > unfortunately no better answer exists. We board people many, many

> > times because it's the " legal " thing to do or for appearances. Even

> > the patient who may have a " cracked " a vertebra in his/her neck but

> > walks with 0 difficulty, turns their head with 0 difficulty, and has

> > no pain is not going to benefit from that board. A collar, possibly,

> > yes. But not the board. It simply covers the rear-end of the crew and

> > makes for a way to get them into the truck. If I am the patient in a

> > wreck who wants to go to the hospital but knows the board is not

> > needed - I'm refusing it. And it cannot be forced on me.

> >

> > For the crew it should be " if one has to do a job, do it right " . For

> > the patient often...doing the job right is literally a pain in the neck.

> >

> > Don, Tyler

> >

> > >>> " Danny "

> > 6/16/2009 12:03 PM >>>

> > My first thought is Laziness. There is no way to justify your actions

> > when you know that is not the way you are trained.

> >

> > Danny L.

> > Owner/NREMT-

> > PETSAR INC.

> > (Panhandle Emergency Training Services And Response)

> >

> >

[Guest guest]

In no way am I saying that the practice of walking them to the board is okay -

don't believe that - but what happens to lead to these things, OTHER than

laziness, is (1) EMS burnout, (2) the realization that SMR is doing no good on

patients ambulating easily (and who have great LOCs), and (3) that they only

need to do it because of CYA reasons. I too had trouble initially believing

there was any reason to place someone on a hard wooden (or plastic) board when

they were obviously not spinal-injured (or if minimally...that the board wasn't

going to help) when they're walking around with great motion with each limb,

great motion of their head/neck, had no pain but yet wanted to go. Then the

realization that " oh...it's a legal thing " or " I don't want the ED staff to give

me a hard time " occurs. Not that there's a clinical reason.

We're still in the dark ages with this aspect of care but unfortunately no

better answer exists. We board people many, many times because it's the " legal "

thing to do or for appearances. Even the patient who may have a " cracked " a

vertebra in his/her neck but walks with 0 difficulty, turns their head with 0

difficulty, and has no pain is not going to benefit from that board. A collar,

possibly, yes. But not the board. It simply covers the rear-end of the crew and

makes for a way to get them into the truck. If I am the patient in a wreck who

wants to go to the hospital but knows the board is not needed - I'm refusing it.

And it cannot be forced on me.

For the crew it should be " if one has to do a job, do it right " . For the patient

often...doing the job right is literally a pain in the neck.

Don, Tyler

>>> " Danny " petsardlj@...> 6/16/2009 12:03 PM >>>

My first thought is Laziness. There is no way to justify your actions when you

know that is not the way you are trained.

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

Don, the entire state of Maine has a spinal clearance algorithm, and

they don't even use MOI as a determining factor any more. They've had it

for close to ten years.

Yet, I'm not seeing news reports of the avalanche of personal injury

lawsuits coming out of Maine.

It would seem that fear of lawsuits isn't even a valid reason for

resistance to implementing spinal clearance algorithms.

Don Elbert wrote:

>

>

> In no way am I saying that the practice of walking them to the board

> is okay - don't believe that - but what happens to lead to these

> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> that SMR is doing no good on patients ambulating easily (and who have

> great LOCs), and (3) that they only need to do it because of CYA

> reasons. I too had trouble initially believing there was any reason to

> place someone on a hard wooden (or plastic) board when they were

> obviously not spinal-injured (or if minimally...that the board wasn't

> going to help) when they're walking around with great motion with each

> limb, great motion of their head/neck, had no pain but yet wanted to

> go. Then the realization that " oh...it's a legal thing " or " I don't

> want the ED staff to give me a hard time " occurs. Not that there's a

> clinical reason.

>

> We're still in the dark ages with this aspect of care but

> unfortunately no better answer exists. We board people many, many

> times because it's the " legal " thing to do or for appearances. Even

> the patient who may have a " cracked " a vertebra in his/her neck but

> walks with 0 difficulty, turns their head with 0 difficulty, and has

> no pain is not going to benefit from that board. A collar, possibly,

> yes. But not the board. It simply covers the rear-end of the crew and

> makes for a way to get them into the truck. If I am the patient in a

> wreck who wants to go to the hospital but knows the board is not

> needed - I'm refusing it. And it cannot be forced on me.

>

> For the crew it should be " if one has to do a job, do it right " . For

> the patient often...doing the job right is literally a pain in the neck.

>

> Don, Tyler

>

> >>> " Danny " petsardlj@...

> > 6/16/2009 12:03 PM >>>

> My first thought is Laziness. There is no way to justify your actions

> when you know that is not the way you are trained.

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

Don, the entire state of Maine has a spinal clearance algorithm, and

they don't even use MOI as a determining factor any more. They've had it

for close to ten years.

Yet, I'm not seeing news reports of the avalanche of personal injury

lawsuits coming out of Maine.

It would seem that fear of lawsuits isn't even a valid reason for

resistance to implementing spinal clearance algorithms.

Don Elbert wrote:

>

>

> In no way am I saying that the practice of walking them to the board

> is okay - don't believe that - but what happens to lead to these

> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> that SMR is doing no good on patients ambulating easily (and who have

> great LOCs), and (3) that they only need to do it because of CYA

> reasons. I too had trouble initially believing there was any reason to

> place someone on a hard wooden (or plastic) board when they were

> obviously not spinal-injured (or if minimally...that the board wasn't

> going to help) when they're walking around with great motion with each

> limb, great motion of their head/neck, had no pain but yet wanted to

> go. Then the realization that " oh...it's a legal thing " or " I don't

> want the ED staff to give me a hard time " occurs. Not that there's a

> clinical reason.

>

> We're still in the dark ages with this aspect of care but

> unfortunately no better answer exists. We board people many, many

> times because it's the " legal " thing to do or for appearances. Even

> the patient who may have a " cracked " a vertebra in his/her neck but

> walks with 0 difficulty, turns their head with 0 difficulty, and has

> no pain is not going to benefit from that board. A collar, possibly,

> yes. But not the board. It simply covers the rear-end of the crew and

> makes for a way to get them into the truck. If I am the patient in a

> wreck who wants to go to the hospital but knows the board is not

> needed - I'm refusing it. And it cannot be forced on me.

>

> For the crew it should be " if one has to do a job, do it right " . For

> the patient often...doing the job right is literally a pain in the neck.

>

> Don, Tyler

>

> >>> " Danny " petsardlj@...

> > 6/16/2009 12:03 PM >>>

> My first thought is Laziness. There is no way to justify your actions

> when you know that is not the way you are trained.

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

Also, I'd note that the current PHTLS text includes criteria for spinal

clearance.

-Wes Ogilvie

Re: Spinal Immobilization Question

Don, the entire state of Maine has a spinal clearance algorithm, and

they don't even use MOI as a determining factor any more. They've had it

for close to ten years.

Yet, I'm not seeing news reports of the avalanche of personal injury

lawsuits coming out of Maine.

It would seem that fear of lawsuits isn't even a valid reason for

resistance to implementing spinal clearance algorithms.

Don Elbert wrote:

>

>

> In no way am I saying that the practice of walking them to the board

> is okay - don't believe that - but what happens to lead to these

> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> that SMR is doing no good on patients ambulating easily (and who have

> great LOCs), and (3) that they only need to do it because of CYA

> reasons. I too had trouble initially believing there was any reason to

> place someone on a hard wooden (or plastic) board when they were

> obviously not spinal-injured (or if minimally...that the board wasn't

> going to help) when they're walking around with great motion with each

> limb, great motion of their head/neck, had no pain but yet wanted to

> go. Then the realization that " oh...it's a legal thing " or " I don't

> want the ED staff to give me a hard time " occurs. Not that there's a

> clinical reason.

>

> We're still in the dark ages with this aspect of care but

> unfortunately no better answer exists. We board people many, many

> times because it's the " legal " thing to do or for appearances. Even

> the patient who may have a " cracked " a vertebra in his/her neck but

> walks with 0 difficulty, turns their head with 0 difficulty, and has

> no pain is not going to benefit from that board. A collar, possibly,

> yes. But not the board. It simply covers the rear-end of the crew and

> makes for a way to get them into the truck. If I am the patient in a

> wreck who wants to go to the hospital but knows the board is not

> needed - I'm refusing it. And it cannot be forced on me.

>

> For the crew it should be " if one has to do a job, do it right " . For

> the patient often...doing the job right is literally a pain in the neck.

>

> Don, Tyler

>

> >>> " Danny " petsardlj@...

> > 6/16/2009 12:03 PM >>>

> My first thought is Laziness. There is no way to justify your actions

> when you know that is not the way you are trained.

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

We have one as well...naturally patterned after Maine's (everyone's pretty much

is I think) but very few uses of it. We would expect it to be used a little bit

more but maybe it's a good thing it's not. Best to err on the side of caution.

Don

>>> " Grayson " Grayson902@...> 6/16/2009 3:46 PM >>>

Don, the entire state of Maine has a spinal clearance algorithm, and

they don't even use MOI as a determining factor any more. They've had it

for close to ten years.

Yet, I'm not seeing news reports of the avalanche of personal injury

lawsuits coming out of Maine.

It would seem that fear of lawsuits isn't even a valid reason for

resistance to implementing spinal clearance algorithms.

Don Elbert wrote:

>

>

> In no way am I saying that the practice of walking them to the board

> is okay - don't believe that - but what happens to lead to these

> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> that SMR is doing no good on patients ambulating easily (and who have

> great LOCs), and (3) that they only need to do it because of CYA

> reasons. I too had trouble initially believing there was any reason to

> place someone on a hard wooden (or plastic) board when they were

> obviously not spinal-injured (or if minimally...that the board wasn't

> going to help) when they're walking around with great motion with each

> limb, great motion of their head/neck, had no pain but yet wanted to

> go. Then the realization that " oh...it's a legal thing " or " I don't

> want the ED staff to give me a hard time " occurs. Not that there's a

> clinical reason.

>

> We're still in the dark ages with this aspect of care but

> unfortunately no better answer exists. We board people many, many

> times because it's the " legal " thing to do or for appearances. Even

> the patient who may have a " cracked " a vertebra in his/her neck but

> walks with 0 difficulty, turns their head with 0 difficulty, and has

> no pain is not going to benefit from that board. A collar, possibly,

> yes. But not the board. It simply covers the rear-end of the crew and

> makes for a way to get them into the truck. If I am the patient in a

> wreck who wants to go to the hospital but knows the board is not

> needed - I'm refusing it. And it cannot be forced on me.

>

> For the crew it should be " if one has to do a job, do it right " . For

> the patient often...doing the job right is literally a pain in the neck.

>

> Don, Tyler

>

> >>> " Danny " petsardlj@...

> > 6/16/2009 12:03 PM >>>

> My first thought is Laziness. There is no way to justify your actions

> when you know that is not the way you are trained.

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

You're also a smart and experienced enough medic to know that erring on

the side of caution presumes that the spinal immobilization is a benign

treatment, ie no harm done if the patient turns out not to have a fracture.

But what if it *isn't* benign?

What about respiratory decompensation? Increased pain? Increases in ICP?

Pressure sores on the occiput, sacrum and heels?

You know, it takes only 30 minutes on that board for your 85 squared

(years, pounds) granny to develop a Stage 1 pressure sore, and it is a

lot easier to keep the sore from occurring in the first place than it is

to halt its progression once started.

The University of Malaya/University of New Mexico C-spine study had a

relatively small sample size, but the study was otherwise

well-constructed and the patient groups well-matched. The

non-immobilized Malaya patients had markedly better neurological

outcomes than the professionally immobilized New Mexico patients. This

at the very least warrants further study, and raises the question that

perhaps spinal immobilization does more harm than good, even for

patients with spinal injuries.

I think the lack of utilization of the clearance protocol at ETMC is

probably for the same reasons as it is at Acadian: unwarranted fear of

lawsuits and sheer organizational inertia.

Don Elbert wrote:

>

>

> We have one as well...naturally patterned after Maine's (everyone's

> pretty much is I think) but very few uses of it. We would expect it to

> be used a little bit more but maybe it's a good thing it's not. Best

> to err on the side of caution.

> Don

>

> >>> " Grayson " Grayson902@... >

> 6/16/2009 3:46 PM >>>

> Don, the entire state of Maine has a spinal clearance algorithm, and

> they don't even use MOI as a determining factor any more. They've had it

> for close to ten years.

>

> Yet, I'm not seeing news reports of the avalanche of personal injury

> lawsuits coming out of Maine.

>

> It would seem that fear of lawsuits isn't even a valid reason for

> resistance to implementing spinal clearance algorithms.

>

> Don Elbert wrote:

> >

> >

> > In no way am I saying that the practice of walking them to the board

> > is okay - don't believe that - but what happens to lead to these

> > things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> > that SMR is doing no good on patients ambulating easily (and who have

> > great LOCs), and (3) that they only need to do it because of CYA

> > reasons. I too had trouble initially believing there was any reason to

> > place someone on a hard wooden (or plastic) board when they were

> > obviously not spinal-injured (or if minimally...that the board wasn't

> > going to help) when they're walking around with great motion with each

> > limb, great motion of their head/neck, had no pain but yet wanted to

> > go. Then the realization that " oh...it's a legal thing " or " I don't

> > want the ED staff to give me a hard time " occurs. Not that there's a

> > clinical reason.

> >

> > We're still in the dark ages with this aspect of care but

> > unfortunately no better answer exists. We board people many, many

> > times because it's the " legal " thing to do or for appearances. Even

> > the patient who may have a " cracked " a vertebra in his/her neck but

> > walks with 0 difficulty, turns their head with 0 difficulty, and has

> > no pain is not going to benefit from that board. A collar, possibly,

> > yes. But not the board. It simply covers the rear-end of the crew and

> > makes for a way to get them into the truck. If I am the patient in a

> > wreck who wants to go to the hospital but knows the board is not

> > needed - I'm refusing it. And it cannot be forced on me.

> >

> > For the crew it should be " if one has to do a job, do it right " . For

> > the patient often...doing the job right is literally a pain in the neck.

> >

> > Don, Tyler

> >

> > >>> " Danny " petsardlj@...

>

> > > 6/16/2009 12:03 PM >>>

> > My first thought is Laziness. There is no way to justify your actions

> > when you know that is not the way you are trained.

> >

> > Danny L.

> > Owner/NREMT-P

> > PETSAR INC.

> > (Panhandle Emergency Training Services And Response)

> >

> >

[Guest guest]

Don with respect that last sentence is half the problem.

The evidence tells us we board and collar way too much.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> We have one as well...naturally patterned after Maine's (everyone's

> pretty much is I think) but very few uses of it. We would expect it

> to be used a little bit more but maybe it's a good thing it's not.

> Best to err on the side of caution.

> Don

>

>

>>>> " Grayson " Grayson902@...> 6/16/2009 3:46 PM >>>

> Don, the entire state of Maine has a spinal clearance algorithm, and

> they don't even use MOI as a determining factor any more. They've

> had it

> for close to ten years.

>

> Yet, I'm not seeing news reports of the avalanche of personal injury

> lawsuits coming out of Maine.

>

> It would seem that fear of lawsuits isn't even a valid reason for

> resistance to implementing spinal clearance algorithms.

>

> Don Elbert wrote:

>>

>>

>> In no way am I saying that the practice of walking them to the board

>> is okay - don't believe that - but what happens to lead to these

>> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

>> that SMR is doing no good on patients ambulating easily (and who have

>> great LOCs), and (3) that they only need to do it because of CYA

>> reasons. I too had trouble initially believing there was any reason

>> to

>> place someone on a hard wooden (or plastic) board when they were

>> obviously not spinal-injured (or if minimally...that the board wasn't

>> going to help) when they're walking around with great motion with

>> each

>> limb, great motion of their head/neck, had no pain but yet wanted to

>> go. Then the realization that " oh...it's a legal thing " or " I don't

>> want the ED staff to give me a hard time " occurs. Not that there's a

>> clinical reason.

>>

>> We're still in the dark ages with this aspect of care but

>> unfortunately no better answer exists. We board people many, many

>> times because it's the " legal " thing to do or for appearances. Even

>> the patient who may have a " cracked " a vertebra in his/her neck but

>> walks with 0 difficulty, turns their head with 0 difficulty, and has

>> no pain is not going to benefit from that board. A collar, possibly,

>> yes. But not the board. It simply covers the rear-end of the crew and

>> makes for a way to get them into the truck. If I am the patient in a

>> wreck who wants to go to the hospital but knows the board is not

>> needed - I'm refusing it. And it cannot be forced on me.

>>

>> For the crew it should be " if one has to do a job, do it right " . For

>> the patient often...doing the job right is literally a pain in the

>> neck.

>>

>> Don, Tyler

>>

>>>>> " Danny " petsardlj@...

>> > 6/16/2009 12:03 PM >>>

>> My first thought is Laziness. There is no way to justify your actions

>> when you know that is not the way you are trained.

>>

>> Danny L.

>> Owner/NREMT-P

>> PETSAR INC.

>> (Panhandle Emergency Training Services And Response)

>>

>>

[Guest guest]

Gene I think President Obama just reference cardiac protocols as being

something like less than 60% evidenced based just yesterday on his

speach to the AMA in Chicago.

I'm working from memory as my PC is in the shop. I have the text of

the speach on it.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> It's hard to change habits and harder to change ideas that have been

> institutionalized for decades, although without any medical basis.

>

> How many things do we do " just because we've always done it this way? "

> There's a whole list that we could come up with, and it has already

> been the

> subject of debate on here and other lists numerous times.

>

> Don, you remember when we used to believe that defibrillation

> wouldn't work

> until we corrected acidosis, so we drove up on the cardiac arrest

> scene and

> pushed two amps of bicarb. We also stopped CPR top feel for

> spontaneous

> pulses often, and so forth. You also remember when we intubated,

> then

> bagged the patient as fast as the bag would refill, and we rolled it

> up in a ball

> to squeeze the last little bit of those 1800 milliliters out of it,

> effectively placing the last nails into the coffins of our

> patients. Then we

> turned people loose with NTG and told them to give MONA for chest

> pain, and they

> knew nothing about right sided MIs and the dangers of NTG in them.

> Many

> still don't know anything about that and are not being taught.

>

> Spine boarding is another one of those myths. Like so many things

> we do,

> it makes us feel good, gives us a false sense of security, and lets

> us think

> the lawyers aren't onto us.

>

> Unfortunately they are. They're well aware of these things, some

> of them

> moreso than lots of medics. Now they're looking at pain management

> issues,

> pressure sore issues, and so forth, along with stuff like airway

> issues

> (still the No. 1 cause of lawsuits against medics after MVC) .

>

> Lawyers know, for example, that the Texas Supreme Court has held

> that the

> ACLS Guidelines are admissible evidence of standard of care and can be

> introduced into evidence without expert testimony. (Bush v.

> Columbia Las

> Colinas, a case I worked on). How many medical directors and

> medics are aware

> of that?

>

> We'll get there on spinal issues eventually. But there will always

> be

> other issues. Best check your amiodarone and vasopressin supplies.

>

> Gene

>

>

>

>

>

>>

>>

>>

>> We have one as well...naturally patterned after Maine's (everyone's

>> pretty

>> much is I think) but very few uses of it. We would expect it to be

>> used a

>> little bit more but maybe it's a good thing it's not. Best to err

>> on the

>> side of caution.

>> Don

>>

>>>>> " Grayson " Grayson902@...> 6/16/2009 3:46 PM >>>

>> Don, the entire state of Maine has a spinal clearance algorithm, and

>> they don't even use MOI as a determining factor any more. They've

>> had it

>> for close to ten years.

>>

>> Yet, I'm not seeing news reports of the avalanche of personal injury

>> lawsuits coming out of Maine.

>>

>> It would seem that fear of lawsuits isn't even a valid reason for

>> resistance to implementing spinal clearance algorithms.

>>

>> Don Elbert wrote:

>>>

>>>

>>> In no way am I saying that the practice of walking them to the board

>>> is okay - don't believe that - but what happens to lead to these

>>> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

>>> that SMR is doing no good on patients ambulating easily (and who

>>> have

>>> great LOCs), and (3) that they only need to do it because of CYA

>>> reasons. I too had trouble initially believing there was any

>>> reason to

>>> place someone on a hard wooden (or plastic) board when they were

>>> obviously not spinal-injured (or if minimally... obviously not

>>> spinal-

>>> going to help) when they're walking around with great motion with

>>> each

>>> limb, great motion of their head/neck, had no pain but yet wanted to

>>> go. Then the realization that " oh...it's a legal thing " or " I don't

>>> want the ED staff to give me a hard time " occurs. Not that there's a

>>> clinical reason.

>>>

>>> We're still in the dark ages with this aspect of care but

>>> unfortunately no better answer exists. We board people many, many

>>> times because it's the " legal " thing to do or for appearances. Even

>>> the patient who may have a " cracked " a vertebra in his/her neck but

>>> walks with 0 difficulty, turns their head with 0 difficulty, and has

>>> no pain is not going to benefit from that board. A collar, possibly,

>>> yes. But not the board. It simply covers the rear-end of the crew

>>> and

>>> makes for a way to get them into the truck. If I am the patient in a

>>> wreck who wants to go to the hospital but knows the board is not

>>> needed - I'm refusing it. And it cannot be forced on me.

>>>

>>> For the crew it should be " if one has to do a job, do it right " . For

>>> the patient often...doing the job right is literally a pain in the

>>> neck.

>>>

>>> Don, Tyler

>>>

>>>>>> " Danny "

>> > 6/16/2009 12:03 PM >>>

>>> My first thought is Laziness. There is no way to justify your

>>> actions

>>> when you know that is not the way you are trained.

>>>

>>> Danny L.

>>> Owner/NREMT-

>>> PETSAR INC.

>>> (Panhandle Emergency Training Services And Response)

>>>

>>>

[Guest guest]

WOW! I didn't see or hear that, but I'll be watching and listening.

I agree that a lot of medicine is less than evidence based. But that's

oversimplification.

The question is: What is standard of care?

At least the Texas Supreme Court has held that the ACLS Guidelines are, per

se, standard of care for emergency cardiac care.

That trumps the AMA, Obama, ACEP, and any individual doc IN TEXAS. Not

elsewhere. A decision of the Texas Supremes is not binding on anybody but

Texas courts, but it is in Texas. It can be " persuasive precedent " in other

jurisdictions.

Bottom line: Know the literature, know the practices, and do what's best

for your patient and be able to prove it.

GG

>

>

>

> Gene I think President Obama just reference cardiac protocols as being

> something like less than 60% evidenced based just yesterday on his

> speech to the AMA in Chicago.

>

> I'm working from memory as my PC is in the shop. I have the text of

> the speech on it.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/ FF/

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

> > It's hard to change habits and harder to change ideas that have been

> > institutionalized for decades, although without any medical basis.

> >

> > How many things do we do " just because we've always done it this way? "

> > There's a whole list that we could come up with, and it has already

> > been the

> > subject of debate on here and other lists numerous times.

> >

> > Don, you remember when we used to believe that defibrillation

> > wouldn't work

> > until we corrected acidosis, so we drove up on the cardiac arrest

> > scene and

> > pushed two amps of bicarb. We also stopped CPR top feel for

> > spontaneous

> > pulses often, and so forth. You also remember when we intubated,

> > then

> > bagged the patient as fast as the bag would refill, and we rolled it

> > up in a ball

> > to squeeze the last little bit of those 1800 milliliters out of it,

> > effectively placing the last nails into the coffins of our

> > patients. Then we

> > turned people loose with NTG and told them to give MONA for chest

> > pain, and they

> > knew nothing about right sided MIs and the dangers of NTG in them.

> > Many

> > still don't know anything about that and are not being taught.

> >

> > Spine boarding is another one of those myths. Like so many things

> > we do,

> > it makes us feel good, gives us a false sense of security, and lets

> > us think

> > the lawyers aren't onto us.

> >

> > Unfortunately they are. They're well aware of these things, some

> > of them

> > moreso than lots of medics. Now they're looking at pain management

> > issues,

> > pressure sore issues, and so forth, along with stuff like airway

> > issues

> > (still the No. 1 cause of lawsuits against medics after MVC) .

> >

> > Lawyers know, for example, that the Texas Supreme Court has held

> > that the

> > ACLS Guidelines are admissible evidence of standard of care and can be

> > introduced into evidence without expert testimony. (Bush v.

> > Columbia Las

> > Colinas, a case I worked on). How many medical directors and

> > medics are aware

> > of that?

> >

> > We'll get there on spinal issues eventually. But there will always

> > be

> > other issues. Best check your amiodarone and vasopressin supplies.

> >

> > Gene

> >

> >

> >

> >

> >

> >>

> >>

> >>

> >> We have one as well...naturally patterned after Maine's (everyone's

> >> pretty

> >> much is I think) but very few uses of it. We would expect it to be

> >> used a

> >> little bit more but maybe it's a good thing it's not. Best to err

> >> on the

> >> side of caution.

> >> Don

> >>

> >>>>> " Grayson " Grayson902@...> 6/16/2009 3:46 PM >>>

> >> Don, the entire state of Maine has a spinal clearance algorithm, and

> >> they don't even use MOI as a determining factor any more. They've

> >> had it

> >> for close to ten years.

> >>

> >> Yet, I'm not seeing news reports of the avalanche of personal injury

> >> lawsuits coming out of Maine.

> >>

> >> It would seem that fear of lawsuits isn't even a valid reason for

> >> resistance to implementing spinal clearance algorithms.

> >>

> >> Don Elbert wrote:

> >>>

> >>>

> >>> In no way am I saying that the practice of walking them to the board

> >>> is okay - don't believe that - but what happens to lead to these

> >>> things, OTHER than laziness, is (1) EMS burnout, (2) the realization

> >>> that SMR is doing no good on patients ambulating easily (and who

> >>> have

> >>> great LOCs), and (3) that they only need to do it because of CYA

> >>> reasons. I too had trouble initially believing there was any

> >>> reason to

> >>> place someone on a hard wooden (or plastic) board when they were

> >>> obviously not spinal-injured (or if minimally... obviously not

> >>> spinal-

> >>> going to help) when they're walking around with great motion with

> >>> each

> >>> limb, great motion of their head/neck, had no pain but yet wanted to

> >>> go. Then the realization that " oh...it's a legal thing " or " I don't

> >>> want the ED staff to give me a hard time " occurs. Not that there's a

> >>> clinical reason.

> >>>

> >>> We're still in the dark ages with this aspect of care but

> >>> unfortunately no better answer exists. We board people many, many

> >>> times because it's the " legal " thing to do or for appearances. Even

> >>> the patient who may have a " cracked " a vertebra in his/her neck but

> >>> walks with 0 difficulty, turns their head with 0 difficulty, and has

> >>> no pain is not going to benefit from that board. A collar, possibly,

> >>> yes. But not the board. It simply covers the rear-end of the crew

> >>> and

> >>> makes for a way to get them into the truck. If I am the patient in a

> >>> wreck who wants to go to the hospital but knows the board is not

> >>> needed - I'm refusing it. And it cannot be forced on me.

> >>>

> >>> For the crew it should be " if one has to do a job, do it right " . For

> >>> the patient often...doing the job right is literally a pain in the

> >>> neck.

> >>>

> >>> Don, Tyler

> >>>

> >>>>>> " Danny "

>>> > 6/16/2009 12:03 PM >>>

> >>> My first thought is Laziness. There is no way to justify your

> >>> actions

> >>> when you know that is not the way you are trained.

> >>>

> >>> Danny L.

> >>> Owner/NREMT-

> >>> PETSAR INC.

> >>> (Panhandle Emergency Training Services And Response)

> >>>

> >>>