I posted this question in another thread about a nurse getting an MVC patient who had not been immobilized on a back board for transport to her ER, but I wanted to move it to it's own thread so I can get my question answered without hijacking that other post:
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Ok, I've looked through my TNCC book and my Emergency Nursing book, because I just hate to ask this question and risk looking like a total MORON! I've been in ER for a year now and SHOULD KNOW the answer to this question...but I've actually asked it of several people at work, and gotten different answers! (and the books just say HOW to immobilize using the backboard, not why).
So here goes: is the purpose of the backboard to immobilize the spine for transport only, or the entire time they're in the ER, until their spine is cleared via xray or CT?
I've had docs immediately take the pt off the backboard, based on their conversation and physical assessment, although they were pending results of xrays/CTs. I've had other docs insist that the pt stay on the backboard until the L-spine film is taken (but not read, just xrays have been shot) because the board helps get a better picture. But once the xray's been taken, they'll have the pt off the board, before the xrays have been read. And then I've got another doc who won't let us take the pt off the board until all films have been read and their spine has been cleared (could be an hour or two in the minor MVCs!).
We also have been told that one of the very important issues in the traumas is getting the pt off the board as quickly as possibly, because of the issue of skin breakdown.
So...what's the purpose of the board IN THE ER?
Oh, by the way, until their spine is cleared via xrays/CT, we do keep them lying flat, with the c-collar on, we log roll them off if we're taking them off the board, etc. But we very often put the pt on a soft bed before any xray/ct results have come back.
Specializes in Spinal Cord injuries, Emergency+EMS.
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...
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.
clearing the cervical spine in unconscious adult trauma patients: a survey of practice in specialist centres in the uk[color=#336699]*
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
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.
Specializes in Spinal Cord injuries, Emergency+EMS.
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 (
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.
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)
Specializes in Spinal Cord injuries, Emergency+EMS.
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)
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
At least any medic in the states that has half a brain knows that immobilizing to a lbb is a higher priority than potentially causing a bed sore.
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
Sure we have. Have your "civilized" medics that you supposedly supervise immobilize you to a lbb with a c collar and head blocks. Next observe your range of motion.
Now compare this to you laying on a mattress with no straps or head blocks. It's common sense. You have way more motion. All it would take is for someone to come in the room and the pt forget he is supposed to lay still and raises to greet them then boom, spinal injury or boom, previous spinal injury now much worse.
so you advocate causing harm to patients ?
No I advocate keeping the pt immobilized until either a doc clears them or the pt refuses medical treatment (specifically being immobilized to a lbb). At the end of the day I would much rather potentially cause a bed sore as opposed to potentially causing someone to live in a wheelchair. We will all have to answer for our actions sometime. If you sleep well at night knowing you are practicing dangerous medicine more power too you, but as for me, I will practice caution and common sense.
At least any medic in the states that has half a brain knows that immobilizing to a lbb is a higher priority than potentially causing a bed sore.
Sure we have. Have your "civilized" medics that you supposedly supervise immobilize you to a lbb with a c collar and head blocks. Next observe your range of motion.
Now compare this to you laying on a mattress with no straps or head blocks. It's common sense. You have way more motion. All it would take is for someone to come in the room and the pt forget he is supposed to lay still and raises to greet them then boom, spinal injury or boom, previous spinal injury now much worse.
No I advocate keeping the pt immobilized until either a doc clears them or the pt refuses medical treatment (specifically being immobilized to a lbb). At the end of the day I would much rather potentially cause a bed sore as opposed to potentially causing someone to live in a wheelchair. We will all have to answer for our actions sometime. If you sleep well at night knowing you are practicing dangerous medicine more power too you, but as for me, I will practice caution and common sense.
Well, I understand your argument from an anecdotal stand point; however, the reverse is true and in the literature. People who spend time on backboards become uncomfortable. Uncomfortable people tend to develop anxiety, restlessness, and move around. Immobilized or not, an uncomfortable person is going to move and potentially exacerbate the situation.
Again, the crux of this discussion should be based around getting somebody off the board as soon a possible. I would hope we could all agree on this point. I simply cannot understand why we continue to argue. This seems such a simple concept?
This idea is not exclusive to Europeans. The following link is to an e-medicine article. The author is a neurosurgeon from the United States. Clearly, patients are going to be put on long spine boards by EMS providers; however, one of the goals should be to get the patient off of the board as soon as possible. I understand this may not occur in the pre-hospital environment; however, we should always strive to consider what will happen to our patient after they leave our care.
TraumaNurseRN
497 Posts
TNCC...take the course!