Re: Spinal Immobilization Question

[Guest guest]

Please do.

GG

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[Guest guest]

Gene I will send you Obama's speach.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> 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)

>>>>>

>>>>>

[Guest guest]

PERFECT!

>>> wegandy1938@...> 6/16/2009 4:58 PM >>>

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]

>>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.<<

I'd just call it crews being careful with patients.

>>> " Grayson " Grayson902@...> 6/16/2009 5:40 PM >>>

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]

Sure we do. No doubt about it...we're just cruel people! And it IS certainly

cruel.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

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]

THANK YOU! Someone other than I is bringing up this creep in how we care for

patients. We have been doing clinical clearances based on NEXUS criteria since

the early 1990's in the ED. It is not a difficult skill and has been proven in

the pre-hospital arena.

I get more grief from medics (from ECA to LP) who refuse to read and adjust

their practices based on peer reviewed literature, especially when it is older

than their cert cards!

I have been trying to get this implemented in my services. I include that the

medic may always board if they are uncomfortable with a particular patient, so

they usually default to boarding everyone to keep FROs and police happy.

Perhaps we should add to every EMS curriculum a period of full spinal

immobilization of 20-30 minutes for EVERY EMS student.

>

> 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.

>

[Guest guest]

As pointed out the evidence suggests it's more than cruel.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> Sure we do. No doubt about it...we're just cruel people! And it IS

> certainly cruel.

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

> 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]

What's the future answer if anyone can predict it? Nothing will happen to change

this in my lifetime I'm sure. What's the next generation of EMS crews going to

see in regard to this issue?

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

As pointed out the evidence suggests it's more than cruel.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> Sure we do. No doubt about it...we're just cruel people! And it IS

> certainly cruel.

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

> 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]

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

I'll buy one! In fact, I'll buy some to give as Christmas gifts!

Maxine Pate

---- Original message ----

>Date: Tue, 16 Jun 2009 17:58:50 EDT

>From: wegandy1938@...

>Subject: Re: Spinal Immobilization Question

>To: texasems-l

>

>

> 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

>

[Guest guest]

Gene's idea is great.....

>>> mbpate mbpate@...> 6/17/2009 10:07 AM >>>

I'll buy one! In fact, I'll buy some to give as Christmas gifts!

Maxine Pate

---- Original message ----

>Date: Tue, 16 Jun 2009 17:58:50 EDT

>From: wegandy1938@...

>Subject: Re: Spinal Immobilization Question

>To: texasems-l

>

>

> 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

>

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disclosure under applicable law. If you are

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that the dissemination, distribution or copying

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===========================================================

[Guest guest]

If you're a patient in Maine who gets boarded...it's still a miserable

thing...nothing changed about that.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 10:06 AM >>>

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

I misunderstood your comment Don.

You are correct but even that is arguable if we look to our European

Brothers as they in many cases use vacuum splints while I understand

they too are uncomfortable I am told less so but that's pure anecdote,

but then most of EMS is as well

--

Lou Molino, Sr.

FF/NREMT-B/FSI/EMSI

From the road some where

(Cell Phone)

Re: Spinal Immobilization Question

If you're a patient in Maine who gets boarded...it's still a miserable

thing...nothing changed about that.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 10:06 AM >>>

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

Maybe we all need to carry our own inflatable mattresses with us just in case.

And then insist upon their use if we fall, get in an MVC, etc. We trialed some

mattresses here and have some left over...I think I'll put one or two in my

truck. And maybe each EMS organization can offer a simple refusal/option form

whereas a patient can decide and then release the crew from liability for

failing to perform SMR.

I can hear the EMS crew member ask: " Sir/Mam...can we interest you in being

placed onto a very hard flat board which will cause you misery, possibly some

nasty sores, drive you around in a truck that rides like a wagon, and see you

beg us to remove you from in just a matter of a few minutes? " " And if you think

you were hurting now, just wait... " " Or you can sign here. "

We'll talk about this forever and may not see any real changes......how many

lawyers do we have per capita now?

>>> " Louis N. Molino, Sr. " lnmolino@...> 6/17/2009 10:20 AM >>>

I misunderstood your comment Don.

You are correct but even that is arguable if we look to our European

Brothers as they in many cases use vacuum splints while I understand

they too are uncomfortable I am told less so but that's pure anecdote,

but then most of EMS is as well

--

Lou Molino, Sr.

FF/NREMT-B/FSI/EMSI

From the road some where

(Cell Phone)

Re: Spinal Immobilization Question

If you're a patient in Maine who gets boarded...it's still a miserable

thing...nothing changed about that.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 10:06 AM >>>

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

Maybe we all need to carry our own inflatable mattresses with us just in case.

And then insist upon their use if we fall, get in an MVC, etc. We trialed some

mattresses here and have some left over...I think I'll put one or two in my

truck. And maybe each EMS organization can offer a simple refusal/option form

whereas a patient can decide and then release the crew from liability for

failing to perform SMR.

I can hear the EMS crew member ask: " Sir/Mam...can we interest you in being

placed onto a very hard flat board which will cause you misery, possibly some

nasty sores, drive you around in a truck that rides like a wagon, and see you

beg us to remove you from in just a matter of a few minutes? " " And if you think

you were hurting now, just wait... " " Or you can sign here. "

We'll talk about this forever and may not see any real changes......how many

lawyers do we have per capita now?

>>> " Louis N. Molino, Sr. " lnmolino@...> 6/17/2009 10:20 AM >>>

I misunderstood your comment Don.

You are correct but even that is arguable if we look to our European

Brothers as they in many cases use vacuum splints while I understand

they too are uncomfortable I am told less so but that's pure anecdote,

but then most of EMS is as well

--

Lou Molino, Sr.

FF/NREMT-B/FSI/EMSI

From the road some where

(Cell Phone)

Re: Spinal Immobilization Question

If you're a patient in Maine who gets boarded...it's still a miserable

thing...nothing changed about that.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 10:06 AM >>>

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

Maybe we all need to carry our own inflatable mattresses with us just in case.

And then insist upon their use if we fall, get in an MVC, etc. We trialed some

mattresses here and have some left over...I think I'll put one or two in my

truck. And maybe each EMS organization can offer a simple refusal/option form

whereas a patient can decide and then release the crew from liability for

failing to perform SMR.

I can hear the EMS crew member ask: " Sir/Mam...can we interest you in being

placed onto a very hard flat board which will cause you misery, possibly some

nasty sores, drive you around in a truck that rides like a wagon, and see you

beg us to remove you from in just a matter of a few minutes? " " And if you think

you were hurting now, just wait... " " Or you can sign here. "

We'll talk about this forever and may not see any real changes......how many

lawyers do we have per capita now?

>>> " Louis N. Molino, Sr. " lnmolino@...> 6/17/2009 10:20 AM >>>

I misunderstood your comment Don.

You are correct but even that is arguable if we look to our European

Brothers as they in many cases use vacuum splints while I understand

they too are uncomfortable I am told less so but that's pure anecdote,

but then most of EMS is as well

--

Lou Molino, Sr.

FF/NREMT-B/FSI/EMSI

From the road some where

(Cell Phone)

Re: Spinal Immobilization Question

If you're a patient in Maine who gets boarded...it's still a miserable

thing...nothing changed about that.

>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 10:06 AM >>>

It's changed in Maine? Are the a better EMS System?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typo's

(Cell)

LNMolino@...

> What's the future answer if anyone can predict it? Nothing will

> happen to change this in my lifetime I'm sure. What's the next

> generation of EMS crews going to see in regard to this issue?

>

>

>

>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/17/2009 9:20 AM >>>

> As pointed out the evidence suggests it's more than cruel.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

>> Sure we do. No doubt about it...we're just cruel people! And it IS

>> certainly cruel.

>>

>>

>>>>> " LouIs N. Molino, Sr. " lnmolino@...> 6/16/2009 6:17 PM >>>

>> 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]

>From: wegandy1938@...

> Let's design a " Don't board me " bracelet and sell it!

Genius! Last year it was, " Don't tase me, Bro! " After the Oklahoma incident,

it's " Don't choke me, Bro! " The new battle cry shall be, " Don't board me, Bro! "

[Guest guest]

I love it........we'll go to all of the conferences and sell millions.

>>> " rob.davis@... " rob.davis@...> 6/17/2009

11:25 AM >>>

>From: wegandy1938@...

> Let's design a " Don't board me " bracelet and sell it!

Genius! Last year it was, " Don't tase me, Bro! " After the Oklahoma incident,

it's " Don't choke me, Bro! " The new battle cry shall be, " Don't board me, Bro! "

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[Guest guest]

I love it........we'll go to all of the conferences and sell millions.

>>> " rob.davis@... " rob.davis@...> 6/17/2009

11:25 AM >>>

>From: wegandy1938@...

> Let's design a " Don't board me " bracelet and sell it!

Genius! Last year it was, " Don't tase me, Bro! " After the Oklahoma incident,

it's " Don't choke me, Bro! " The new battle cry shall be, " Don't board me, Bro! "

===========================================================

This message is confidential, intended only

for the named recipient(s) and may contain

information that is privileged or exempt from

disclosure under applicable law. If you are

not the intended recipient(s), you are notified

that the dissemination, distribution or copying

of this message is strictly prohibited. If you

received this message in error, or are not the

named recipient(s), please notify the sender

and delete this e-mail from your computer.

ETMC has implemented secure messaging for

certain types of messages. For more information

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[Guest guest]

I love it........we'll go to all of the conferences and sell millions.

>>> " rob.davis@... " rob.davis@...> 6/17/2009

11:25 AM >>>

>From: wegandy1938@...

> Let's design a " Don't board me " bracelet and sell it!

Genius! Last year it was, " Don't tase me, Bro! " After the Oklahoma incident,

it's " Don't choke me, Bro! " The new battle cry shall be, " Don't board me, Bro! "

===========================================================

This message is confidential, intended only

for the named recipient(s) and may contain

information that is privileged or exempt from

disclosure under applicable law. If you are

not the intended recipient(s), you are notified

that the dissemination, distribution or copying

of this message is strictly prohibited. If you

received this message in error, or are not the

named recipient(s), please notify the sender

and delete this e-mail from your computer.

ETMC has implemented secure messaging for

certain types of messages. For more information

about our secure messaging system, go to:

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Thank you.

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