New Spinal immobilization Protocall?

[notch138 7]

I have a question regarding spinal immobilization protocol, I am hearing that now it is up to the care giver (EMT or medic) to decide if the PT need to have spinal immobilization based upon MOI and pts pain. If this is the case can someone give me some in site as to why they did this?

[xfirefighter484x 234]

I have a question regarding spinal immobilization protocall, I am hearing that now it is up to the care giver (EMT or medic) to decide if the PT need to have spinal immobilization based apon MOI and pts pain. If this is the case can someone give me some insite as to why they did this?

http://www.health.state.ny.us/nysdoh/ems/spinal/

This protocol has been out for several months.

[Goose 188]

Essentially, the state is allowing you to forge spinal immobilization under vary narrow circumstances. Mechanism is only part of the picture, you're going to have to take into account the type of patient you are dealing with, and information obtained from your patient interview and physical exam.

[Guest alsfirefighter]

To further what Goose added...another reason is the fact that 95% of people who are immobilized generally don't need it. The state finally gave providers a common sense approach (I still feel its entirely too narrow in comparison to some other states) to what a patient actually needs instead of a cookie cutter approach. Boards also can cause injury and in busy ED's people can lay on them for a significant amount of time.

[ckroll 101]

There have been several retrospective studies done on patient outcome with and without spinal immobilization. The gist is that there has been no evidence that spinal immobilization improves outcome and some evidence that patients do better without it. If generalized spinal immobilization were a 'treatment' it would be banned by the FDA as useless, possibly dangerous.

This is what led the state of Maine to introduce a spinal immobilization protocol in 1994. Several approaches to selective spinal immobilization have been examined across the country as demonstration projects and these have been successful. The best use of spinal immobilization protocols is not as a mechanism to rule OUT immobilizing, but to rule it IN. If the practitioner looks for reasons to use a backboard... neck pain, back pain, head injury, distracting injuries, numbness, tingling, altered mental status with mechanism, and in spite of best efforts cannot find a good reason to use a backboard, then in all likelihood there is no injury that will benefit from immobilization. Like any skill, ruling out immobilization has to be learned, practiced and applied properly.

[Guest paramedico987]

In addition to the simple fact that most patients don't actually require immobilization there are ASTRONOMICAL cost associated with immobilizing all those people for nothing. On the EMS end, we're paying for all sorts of extra collars, blocks, straps, boards that wear out sooner, workers' compensation claims related to more unnecessary lifting, additional resources required at a scene to manage additional supine patients [from MVAs].

On the hospital side, there are needless radiographs and CT scans, a supine patient taking up a valuable bed when they could be seated in a wheelchair, additional waste which must be discarded [collars, blocks, etc].

I know these all seem trivial, but the costs add up. And these days we can't afford to be wasteful in medicine. If it doesn't help and potentially hurts a patients outcome, then its cost is not justified, no matter how little.

[WAS967 97]

Take yourself, as a totally fine individual, and lay on a longboard (don't call them spine boards - they aren't) and see how long it is before it becomes uncomfortable. I bet it's not more than 5-10 minutes. Now take someone who has pain in their back for whatever reason and imagine subjecting them to the same "treatment".

I personally think the standard of care for people the truly need spinal immobilization should be the full body vacuum splints. But we won't see those in most places because they are too expensive.

http://www.mdimicrotek.com/prod_ems-immobilevac.htm

(The above link used solely as an example and in no means imply endorsement of said product).

Edited September 7, 2009 by WAS967