[TraumaNurseRN]

TNCC...take the course!

[ZippyGBR]

Originally Posted by TraumaNurseRN

TNCC...take the course!

and what exacxtly is that meant to mean ...

even as a TNCC provider i don't see how that particular continuning education course justifies any of the dogma spouted in this thread vs current clinical practice guidelines and the evidence base, TNCC provider status is small part of being an effective practitioner in Emergency care settings ( whether in hospital or out, Nurse , Paramedic or both )

PHTLS for instance in practice scenarios sometimes throws up a patient who needs a none time critical extrication just to make sure you know those skills, or even a patient who doesn't actually need interventions beyond the primary and secondary surveys and a bit of basic first aid...

[ZippyGBR]

just to add fuel to the fire - an article comparing the canadian C spine rules and NEXUS

https://content.nejm.org/cgi/reprint/349/26/2510.pdf

[Medic15251]

no-one on this thread has been able to sustain an arguement for why someone should remain on a Long Extrication Board after extricationnd primary transfer

I'm not sure about your "crazy" UK long extrication board, but here in the states where we do things logically, they remain on a long back board because it helps to keep them immobilized until they are cleared by a physician.

I agree with TraumaNurse.

[TraumaNurseRN]

Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK*

P. S. Jones 1 , J. Wadley 2 and M. Healy 3 1 Specialist Registrar, Department of Anaesthesia, The Royal London Hospital, Whitechapel, London E1 1BB, UK
2 Consultant Neurosurgeon, Department of Neurosurgery, The Royal London Hospital, Whitechapel, London E1 1BB, UK 3 Consultant Intensivist, Intensive Care Unit, The Royal London Hospital, Whitechapel, London E1 1BB, UK
Correspondence to P. S. Jones
E-mail: <i><font color="#336699">psjones@doc....uk</font></i>

*This work was presented as an abstract at the International Trauma and Critical Care Symposium (TraumaCare 2003), Dallas, TX, USA, 15 May 2003.


Copyright 2004 Blackwell Publishing Ltd

KEYWORDS
Spinal injuries • Diagnostic imaging • Unconsciousness

Summary


A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion–extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries.

[ZippyGBR]

Originally Posted by Medic15251

I'm not sure about your "crazy" UK long extrication board, but here in the states where we do things logically, they remain on a long back board because it helps to keep them immobilized until they are cleared by a physician.

I agree with TraumaNurse.

so you advocate causing harm to patients ?

the prevalence of significant bony injury in patients who are assessed for neck injuries is very small ( <2 % in the comparison of the CCR and NEXus quoted above) , the likelihood of skin damage due to porolonged immobilisation on a Long Extrication Board is 100% .

where applicable the CCR is very specific for finding significant and none significant bony injuries to the C spine

i've yet to see any evidence presented that prolonged immobilisation on extrication device which as a 100% rate of causing harm to patients if misused is either appropriate or justified.

[TraumaNurseRN]

Originally Posted by Medic15251

I'm not sure about your "crazy" UK long extrication board, but here in the states where we do things logically, they remain on a long back board because it helps to keep them immobilized until they are cleared by a physician.

I agree with TraumaNurse.

Sure, I agree the backboard is uncomfortable.....but to say the risk of a pressure sore vs spinal cord injury is I guess where this RN and many others shake our heads with the arguement. We follow our protocols, plain and simple. If I were in a trauma, I would want to be immobilized and the discontinuation of that immobilization determined by a Licensed Physician (EMD/Trauma Surgeon) based on their assessment and completed studies to determine extent of injury. (Which is what we do)

[ZippyGBR]

once again

YOU HAVE NOT PROVIDED ANY EVIDENCE TO SUPPORT THE STATEMENT that "a patient Must remain on a long extrication board until after Imaging, and only a physician has the skills to assessment whether immobilsation is required"

the CCR proves that for a fairly sizeable subset of patients the C-spine can be cleared without imaging , other posters in the thread have stated that they reoutinely remove patients from the long extrication board during the intial assessment process.

the clinical guidelines in use in a variety of settings allow for either or both of Selective Immobilisation and/or Clinical Clearance of the C spine by any suitably trained health professional ...

YOU HAVE NOT PROVIDED ANY EVIDENCE TO SUPPORT THE ASSERTION
that if the patient remains on the long extrication board they have better Spinal immobilisation than if they are taken off the board during initial assessment

YOU HAVE ADVOCATED A COURSE OF ACTION THAT WILL (not might)CAUSE YOUR PATIENT HARM.

aside from the issues that the vast majority of prehopsital providers in the USA are not adequately educated and that this education does not bear comparision with other places in the civilised world ( have a read of some of the stuff Brian Bledose has written)

[Silverdragon102]

Closing for staff review

[Silverdragon102]

Thread reopened.

Can we please try to stay on topic and make contributing posts and remember that things will be done differently depending on hospital protocols