C Spine Clearance Protocol

[Guest alsfirefighter]

I've been sitting wondering what kind of topic can I get going that maybe we can drum up some convo on this stagnant board. And this is one that comes to mind. I personally feel that we are long overdue for a C spine clearance protocol in the Westchester area. Lets hear what you think. Obviously you can tell I am all for a protocol that uses common sense and good physical assessment skills for the clearance of C spine. In fact most of you probably do it on a not so official level and some of us have been doing it with the blessing of our medical directors on the Q-T. Let me forwarn some of my fellow EMS'ers. I am not a "we don't have an xray machine" friendly Paramedic. I don't believe in that quote, as well as the word "expedite" "CYA" and "litigation."

[N1Medic 69]

good physical assessment skills for the clearance of C spine. ....."litgation."

How do you suggest this is done? It would probaly take one person to screw it up for the rest of us.

I do like the idea, as many times it's not neccasary to imobolize someone,and can even make things worse, but the care I feel is very inconsistent around these parts to do something like this. And would people start to get lazy and abuse this protocol. I think so. Wasn't there a pilot program somewhere in the county a few years back?

[Guest DG795]

Empress ran a C-Spine clearance pilot a couple years ago, However I dont know if this was an Empress, County or State initiative. To be honest, the details of this program are escaping me, but in my opinion the protocols and worksheets for it didnt shed any different light or new info/procedures then what is already done through common sense. It was nearly impossible to find a PT that would successfully make it through all the requirements to avoid the longboard. It probably ended up causing more immobilzations! lol....(A little humor, I dont actually know the final stats/results)....anyway, as many things do, the clearance ended, and to the best of my knowledge, nothing has come of the study yet.

[x635 4,066]

I remember that program, it think it was actually a study. I worked there when it started around '98......I dont know what type of program it was, all I remember right now is John Wood and Dr. Derobertis teaching the class at St. Joes, and the paperwork that went along with a clearance. I didnt get the final results of the study, but I remember some in-progress results as backboarding going up, as DG said. I will see if I can find the training and paperwork on this study when I finally get unpacked.

[Guest ksneubec]

I think I remember reading that Maine implemented a prehospital C-spine clearance protocol, primarily due to the long transport times across the state. Maybe JEMS a few years ago?

I think in general it is a good idea, but in-hospital the steps are pretty tough to clear someone sans x-rays as it is. I would imagine it would be tough to meet the presumably more stringent criteria for pre-hospital clearance.

[Guest alsfirefighter]

Great input so far, I only hope some more comes in. First Maine has a C-spine clearance protocol, and in my opinion the protocol itself the way its written is extremely stringent and almost reduces any possibility of mistake....if....the protocol is followed. Secondly, any Paramedic that comes out of school that can't physically assess a cervical spine, either shouldn't be a medic or more over their school should be investigated. X-rays are not always used to rule out cervical spine injury right away. Most doctors perform a physical assessment of the cervical vertabrae, looking for deformities, "stepping stones," pain (huge, huge indicator of a poss. neck fracture is pain on palpation to a boney process) and MOI consideration, and the collar comes off. Common sense and sound judgement along with good clinical decision making make the provider not the black ink on a book labelled "protocols."

[WAS967 97]

I believe what DG said is true. In several areas where C-Spine clearance studies have been done, immobilization cases actualy INCREASED. At the same time, the greatest cure for a XRay that shows a C-Spine Fracture, is to have the XRay reread by a radiologist. It's amazing how many ED docs mistake a normal Xray for a fracture.

[Oswegowind 17]

actually in regards to the Empress program, those of us that were qualified to do such maneuvers such as clearance are still able to do so per Dr. Derobertis. He infact wants those learned of such practice to conduct this on a regular basis. The sheets were for a study and now I use them as an addendum to my ACR when utilizing such techniques.

[WAS967 97]

I hope you have so called "addendums" to your NYS BLS protocols in writing. All it takes is for one person to suffer some kind of "injury" from your clearance to sue, and have a nonwritten protocol suddenly become "I never said that". Be warned. I know Dr. DeRobertis is very proEMS and into doing new things, but unless you have a protocol in writting, I'd be VERY sceptical to taking any orders verbally unless you called each time to get MC approval.

[Oswegowind 17]

I don't know, but we have been doing it for the past 5 years or so and I know that we have a protocol in our ops. proc. and apparently it will be in the REMAC per Nicky.