Spinal immobilization and austere/wilderness medicine

Devildoc

Devildoc

Verified Military
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Durham, NC
A friend of mine is a bigwig with the Wilderness Medicine Society, they have put forth the official position that pretty much shreds the notion of cervical/spinal immobilization in austere/wilderness settings. This is trickling down to many 911 EMS agencies. Seth is a very forward-thinking, progressive, pro-EMS/pro-military medicine EM physician.

https://www.wemjournal.org/article/...xPd70nn8tzbwyBp3CE1EIKZZ7f5lb8ewo88iGxR97Czdw
 
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In PA, the spinal immobilization protocol is pretty much out. We do, however place rigid collars on any altered mental, drunk, language barrier, distracting injury, old person but they are secured, if tolerated in supine position on stretcher mattress.

Long board only used for multi systems trauma or moving/transfer. Last, shit, 25 ish years (5 years in Army as medic), near 20 out here, we boarded everybody and they hated it, caused pain, resp. distress and so on, so, I'm glad protocols have caught up.
 
I wouldn’t say clinical clearance of the C-spine is new, but there are still agencies who cling to LSBs, MAST, 10^3 LPM O2 for everyone, pasta water, MSO4 for chest pain, etc.

To a degree, it’s lowest common denominator medicine for protocol monkeys.

#ebmgang
 
policemedic said:
I wouldn’t say clinical clearance of the C-spine is new, but there are still agencies who cling to LSBs, MAST, 10^3 LPM O2 for everyone, pasta water, MSO4 for chest pain, etc.

To a degree, it’s lowest common denominator medicine for protocol monkeys.

#ebmgang
Click to expand...

He and I were talking about how in the face of literature and clinical evidence even hospitals will say, "nah, I think the way we've always done it works fine". We both concluded you can lead the horse to the water yadda yadda yadda....
 
Blindly following protocol, or willfully ignoring protocol are equally dangerous. In extrication situations, rules may need to be bent and common sense needs to take over in order to preserve life and limb - I'm not going to waste time with a short board if there is a high likelihood of car fire even if the pt presents with C, T, L or S trauma.... stabilize to the best of my ability as the situation/time allows, and get that pt to a safe location for treatment. There are other factors, decerebrate or decorticate pts being at the fore of my thoughts (med guys/gals will understand that).

Good article, lots of food for thought.
 
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