"How do you feel about how we treat cevical spine injuries today"?
I believe we overdo it. I've been in countless
argumentsdiscussions about various settings and scenerios. I've personally had a victim of a collision deny any pain or discomfort. She refused all treatment, ambulatory without any deficit, turn her head to answer a question and drop dead on the spot. We all know about the "Prudentialitis" victims when the MOI (mechanism of injury) didn't knock the dirt off the bumper complain of "severe" neck pain. The 80 year old who slid out of their wheelchair to the floor who denies injury, but the nursing home wants them transported.
In the majority of cases, we immobilize not to protect the c-spine, but rather to protect our own ass. We try to justify it by citing the MOI. MOI IS an important consideration we should use to formulate the type of treatment, but it should not dictate. Trauma guidelines state one should transport all patients in the same vehicle, to a trauma center if there was a fatality in that vehicle. The problem with that rational is the one who died, failed to wear their seat belt and "french kissed" the windshield, while the other passengers were properly restrained and suffered minor injuries.
I skimmed through your attachment, and a few things jumped out at me.
Our study employed healthy volunteers in a controlled setting.... Mean age was 23.2 What about the elderly patient with osteoporosis, who is already shaped like a question mark? What about facial trauma especially to the maxilla, zygoma, and orbits? Anyone who has been in this profession more than a couple of weeks, has had these types of patients, and knows the device mentioned in this study is not going to be any better than the others, in these type of situations,
The subject was coached to maintain an upright back position to prevent rounding and anterior flexion of the shoulders. Can we affect the results of any study any more than by coaching the subject?
Now, being open minded and in all fairness, the xcollar by design probably does a little better job on normal non-deformity patients than those compared, but I would stop short of calling it impressive. Different, yes. Would I use them? Probably.
I do not now nor will I advocate using a c collar by itself without manual stabilization even in an MCI setting. One does not put a collar on a patient and leave them. What if we were allowed to think instead of saying "the manual says this"? What if we were taught to clear the c spine of "walking wounded" or where the MOI does not equate to actual injuries or symptoms? But as I stated earlier, we must watch our 6 because, the one time we don't will be the exception to the rule, and will come back on us.
There are a few other ways we can improve immobiliation. We do not need to be immoblizing all patients flat supine. Many patient groups would benefit from being immoblized on their side (not flat with the board tilted). Try placing someone on their side some time on a board, and then add extra padding (pillows and blankets) along the extra voids and spaces. Pregnant women, those with osteoporosis, and those with impaled objects, are all much more comfortable on their side than being layed flat or on a tilted board.
Also place PADDING on the longboard beneath the patient. A few blankets on the rigid board can make any transport more enjoyable.
Todd, you raise some valid points and ask some good questions. I agree 100% that we have performed cervical spine immobilization the same way without asking outselves why or how we can improve it. I agree with your description of the neutral position, however I disagree it must be performed in the supine position. The same can be accomplished with the patient on their side. This however is a moot point at the moment and a great discussion for later on.
Your original question was do we properly care for cervical spine injuries. I think our agreement here is no we currently do not routinely provide the best care we are capable of providing. This is yes, a function of cervical collars being treated as immobilization tools rather than the movement-reduction tools they were intended to be.
I question the DOT's statement that 25% of spine injuries are EMS induced. I have never seen one scientific study to support this, and if this were the case then patients would not be removed from longboards immediately upon ED arrival.
I agree with you that we need to be doing a better job with this skill. I am open to any equipment that truly improves immobilization as long as it is used as a whole with other immobilization tools (longboard). My initial fear is that some providers will use this product as an excuse to not place patients on a backboard and only apply the cervical splint. This would be a huge detriment to patients.
I would even be interested in the links to the web sites you mention. As a sales rep for XCollar you must have this information readily available. And please don't take our skepticism the wrong way. It is just that EMS has a long history of accepting new ideas and flashy products and putting them into practice without questioning the science.I am glad to see the tide changing.
What links are you looking for?
Michael Fraley said:I would even be interested in the links to the web sites you mention. As a sales rep for XCollar you must have this information readily available. And please don't take our skepticism the wrong way. It is just that EMS has a long history of accepting new ideas and flashy products and putting them into practice without questioning the science.I am glad to see the tide changing.