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Immobalizing Ihop Trauma's


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#1 medic303

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Posted 14 June 2013 - 12:09 PM

Does anyone know of any studies or policies regarding when you should or should not immobalize an IHOP trauma patient. Most of the time we get to a sending facility the pt is already off of the LBB but may not have been completely "clinically cleared" or may not have had the CT or plain series read. Is it better for the pt to roll them back on to a LBB and then roll them off again at the receiving or just slide them onto the a/c litter and off again at the receiving. Are their any studies that clearly indicate which is better for the pt.

Thanks,

Eric
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#2 Jwade

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Posted 14 June 2013 - 03:10 PM

Does anyone know of any studies or policies regarding when you should or should not immobalize an IHOP trauma patient. Most of the time we get to a sending facility the pt is already off of the LBB but may not have been completely "clinically cleared" or may not have had the CT or plain series read. Is it better for the pt to roll them back on to a LBB and then roll them off again at the receiving or just slide them onto the a/c litter and off again at the receiving. Are their any studies that clearly indicate which is better for the pt.

Thanks,

Eric



Here you go......

Long Spine Boards are an extrication device and should only be used as such IMO.....Plenty of research to show they do more harm than good.

I think it is an old, outdated practice and should be done away with in most cases....

Here is an excellent article to read with supporting literature:

Supporting Literature Link

1. Hauswald M, Ong G, Tandberg D, et al. Out-of-hospital spinal immobilization: Its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214–219.

2. Baez AA, Schiebel N. Evidence-based emergency medicine/systematic review abstract. Is routine spinal immobilization an effective intervention for trauma patients? Ann Emerg Med. 2006;47(1):110–112.

3. Kwan I, Bunn F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20(1):47–53.

4. Barkana Y, Stein M, Scope A, et al. Prehospital stabilization of the cervical spine for penetrating injuries of the neck: Is it necessary? Injury. 2000;31(5):305–309.

5. Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: More harm than good? J Trauma. 2010;68(1):115–120; discussion 120–121.

6. Brown JB, Bankey PE, Sangosanya AT, et al. Prehospital spinal immobilization does not appear to be beneficial and may complicate care following gunshot injury to the torso. J Trauma. 2009;67(4):774–778.

7. Smith JP, Bodai BI, Hill AS, et al. Prehospital stabilization of critically injured patients: A failed concept. J Trauma. 1985;25(1):65–70.

8. Seamon MJ, Fisher CA, Gaughan J, et al. Prehospital procedures before emergency department thoracotomy: ‘Scoop and run’ saves lives. J Trauma. 2007;63(1):113–120.

9. Chan D, Goldberg R, Tascone A, et al. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med. 1994;23(1):48–51.

10. Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46(2):123–131.

11. Kwan I, Burns F. Spinal immobilization for trauma patients (Cochrane Review). Cochrane Review; 2009; 11 http://summaries.coc...for-trauma-....

12. McHugh TP, Taylor JP. Unnecessary out-of-hospital use of full spinal immobilization. Acad Emerg Med. 1998;5(3):278–280.

13. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999;3(4):347–352.

14. Kaups KL, Davis JW. Patients with gunshot wounds to the head do not require cervical spine immobilization and evaluation. J Trauma. 1998;44(5):865–867.

15. Hauswald M. A re-conceptualisation of acute spinal care. Emerg Med J. Sept. 8, 2012. [Epub ahead of print].

16. Centers for Disease Control and Prevention (Sept. 6, 2012). Guidelines for Field Triage of Injured Patients. 2011; Retrieved from www.cdc.gov/Fieldtriage. Accessed Sept. 24, 2012, 2012.

17. Worsing R. Basic Rescue and Emergency Care. First Edition. Ed: American Academy of Orthopaedic Surgeons, Park Ridge, IL; 1990; 253 .

18. Goth P. Spine Injury, Clinical Criteria for Assessment and Management. Augusta, ME: Medical Care Development Publishing; 1994.

19. Morrissey J. Field Guide of Wilderness Medicine and Rescue. Third Edition Ed: Wilderness Medical Associates, Portland, ME; 2000; 30-33.

20. Stuke LE, Pons PT, Guy JS, et al. Prehospital spine immobilization for penetrating trauma: Review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma. 2011;71(3):763–769; discussion 769–770.

21. Berg RA, Hemphill R, Abella BS, et al. Part 5: Adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S685–S705.

22. March JA, Ausband SC, Brown LH. Changes in physical examination caused by use of spinal immobilization. Prehosp Emerg Care. 2002;6(4):421–424.

23. Kennedy FR, Gonzalez P, Beitler A, et al. Incidence of cervical spine injury in patients with gunshot wounds to the head. South Med J. 1994;87(6):621–623.

24. Chong CL, Ware DN, Harris JH, Jr. Is cervical spine imaging indicated in gunshot wounds to the cranium? J Trauma. 1998;44(3):501–502.

25. Arishita GI, Vayer JS, Bellamy RF. Cervical spine immobilization of penetrating neck wounds in a hostile environment. J Trauma. 1989;29(3):332–337.

26. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27(9):647–649.

27. Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17(2):135–137.

28. Ben-Galim P, Dreiangel N, Mattox KL, et al. Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010;69(2):447–450.

29. Cordell WH, Hollingsworth JC, Olinger ML, et al. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26(1):31–36.

30. Luscombe MD, Williams JL. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J. 2003;20(5):476–478.

31. Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care. 1999;3(1):1–6.

32. Domeier RM, Evans RW, Swor RA, et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehosp Emerg Care. 1999;3(4):332–337.

33. Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med. 2001;37(6):609–615.

34. Barry TB, McNamara RM. Clinical decision rules and cervical spine injury in an elderly patient: a word of caution. J Emerg Med. 2005;29(4):433–436.

35. Burton JH, Dunn MG, Harmon NR, et al. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006;61(1):161–167.
36. Shafer JS, Naunheim RS. Cervical spine motion during extrication: a pilot study. West J Emerg Med. 2009;10(2):74–78.
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John Wade MBA, CCEMT-P, FP-C, RN

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#3 onearmwonder

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Posted 14 June 2013 - 04:22 PM

Check out the NEXUS and Canadian c-spine rules... They can give you a good guideance. In my opinion you should just place a c-collar on them. Pad the voids, bend the knees with padding underneath if they permit. Try not to move them too much. Treat pain and make them comfortable. Tell the recieving hospital what happened and why you did what you did. Emphasize that you did want to cause anymore patient harm and discomfort by rolling them and reboarding them. Be professional if they give you lip and then give them the direct phone number to your medical director. Again be nice and take the higher road. Just my opinion...

Matt
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#4 DltaMedic

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Posted 14 June 2013 - 04:22 PM

http://degreesofclar...G BACKBOARD.pdf
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#5 medic4cqb

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Posted 16 June 2013 - 01:57 PM

This is a great topic that does deserve more attention, especially on the pre hospital level as LBB-ing all trauma and suspected trauma patients is still taught. As John mentioned, it is an old practice that has never really been proven to be beneficial for other than transferring. If you've ever been transported boarded and collared, you'd know exactly what this all boils down to. Patients are being subjected hours of mistreatment in most busy receiving facilities as they wait for a physician to either clinically clear them or radiologically authorize them be taken of the board. Pressure ulcers are real and can evolve rather quickly in you frail, medically compromised patients. So the longer they are subjected to being immobilized on a LBB, the more trouble you're asking for.

My question, is with there already being research in place, why haven't our practices changed yet? I'll be honest with you, if my patient was walking around at the scene and MOI and IOS isn't high... you can walk to my stretcher and I'll secure you there...
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Steve A., RN, CCRN, EMT-P

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#6 yourAVERAGEmedic

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Posted 18 June 2013 - 02:59 AM

We have a protocol to not reimmobilize the patient on trauma transports unless there is neurological deficit. I'm happy to share this protocol with anyone. It's driven based on the afore mentioned Data. We do use cervical collars for transport
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Kevin Collopy, BA, FP-C, CCEMT-P, NREMT-P, CMTE