MVA, EMS didn't use a backboard!!

Nurses General Nursing

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One of my nursing students just told me that yesterday she was driving home after an exam and saw a body lying in the middle of the highway. She pulled over, blocking traffic with her pickup truck (I shuddered at the thought...so unsafe! but I just listened - it was done and she lived...). She ran to the body and discovered two other students from our school attending to a woman who had been hit by a car. They stayed with her, she was breathing, but unconscious with visible wounds to the head. They comforted the driver of the vehicle as well - she was incredibly upset. EMS arrived first (it took about 10 minutes - the student said, "It seemed like forever" - seems like a long response time to me for one of the larger cities in a southeastern state. Here's where I freak out. She said, "EMS didn't put her on a backboard or stabilize her head." I can't even grasp this. Can anyone explain this behavior? I'm sure I can find out who was on that particular run, but I want to hear from ya'll first. Maybe I'm wrong, but I always thought that stabilizing the head and neck were the number one priority in an unwitnessed accident/victim unconscious.

Wondering what you would do? Should I try to track them down and report them? This student said several months ago she had called EMS to attend to her husband who was having chest pains and they hadn't known how to do a blood pressure. I am not typically reactionary and try to see all sides of a story, and of course the student could have misunderstood in the stress of the situation.

Would love some input.

I’m not trying to be snarky, but how are you an instructor but not up to date on what is actually the most recent EBP.

This is what drives me nuts about nursing schools. It’s very outdated material being used and it’s basically worthless in the real world.

I don’t feel a bunch of inexperienced students should pull over and try to take on a fresh MVC accident scene. They know just a little to have too much confidence.

I also know nursing students love to embellish a little and love to criticize those in the field as it’s not how they are learning in nursing school. I can remember all those exclaiming but that’s not safe during my clinical days when we would have post conference.

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Specializes in OR, Nursing Professional Development.
5 minutes ago, LovingLife123 said:

I’m not trying to be snarky, but how are you an instructor but not up to date on what is actually the most recent EBP.

To be fair, pre-hospital is barely touched on and emergency nursing doesn't get a lot of attention either in nursing school. For me, emergency was a small blip during critical care classes/clinicals.

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14 hours ago, CKPM2RN said:

I'm still a paramedic as well as an RN and I have updated information on this subject that is taking a while to work through our interdisciplinary system.

Our EMS medical director, a board-certified Emergency Department physician with a focused interest in pre-hospital emergency medicine, has banned the use of long back board immobilization and we only use the back board as an extrication adjunct for patients. Study after study has shown that motion actually increases on these boards thereby exacerbating any potential injury to the spine. We are instructed to utilize c-collars only if the patient is symptomatic, i.e. neck pain, tingling in extremities, etc.

Here is a Clinical Review of the matter:

https://www.mdedge.com/emergencymedicine/article/107718/trauma/changing-standard-care-spinal-immobilization

I think this is a perfect teaching opportunity for the students. I'd say go ahead and give them this information, and then talk to them about how they are going to see varying practices. Some of which they won't agree with, but are not necessarily wrong. Teach them to always be curious and ask questions, but to do so in a humble way, as they may have no clue what they are talking about. This was a perfect example.

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Specializes in Oncology, Home Health, Patient Safety.
49 minutes ago, Orion81RN said:

I think this is a perfect teaching opportunity for the students. I'd say go ahead and give them this information, and then talk to them about how they are going to see varying practices. Some of which they won't agree with, but are not necessarily wrong. Teach them to always be curious and ask questions, but to do so in a humble way, as they may have no clue what they are talking about. This was a perfect example.

Yes, and the importance of thinking hard about what you post on social media - I wish I hadn't mentioned the part about reporting in my original post - I was just so surprised. It never occurred to me how it would be perceived! I am learning every day, every SINGLE day. I always share that with my students! You can't know everything, you can't stay up to date on everything, so when you aren't sure, reach out for learning opportunities. Thanks so much for your kind words.

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Specializes in CEN, Firefighter/Paramedic.
On 9/26/2019 at 5:30 PM, SafetyNurse1968 said:

Should we continue to hold the head still/ immobile until EMS arrive? Sounds like the issue is injury during transport?

You can if it makes them feel better, but in the same studies that have shown backboards to be not only unhelpful but potentially harmful, they’ve found c-spine immobilization to be voodoo also.

Think about the anatomy of the spine.. does holding someone’s neck straight and in the anatomical position actually immobilize the spine? Then of course there’s the dramatic amount of forced movement onto a backboard which blows the immobilization to heck, when it’s easier and safer for the patient to have them help in getting to the cot in a way that’s least painful to them.

The final nail in the coffin is that there’s just no meaningful evidence that demonstrates this theory of an incomplete spinal cord fracture that was maintained through full spinal immobilization..

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For someone who states seeing all sides of the scenario you sure seem to accept everything this student states as gospel from EMS not knowing how to do a BP to c-collar on a 'body' in the road. 'Tis possible person iin road had fixed/dilated pupils even with someone breathing and we only have her word on 'EMS not knowing how to do a BP...unless she is wonder-nurse she'll encounter everything from "son did get ANYTHING for pain in days!" to Mom did not have a BM in a week!" on her watch...

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Specializes in Oncology, Home Health, Patient Safety.
14 hours ago, FiremedicMike said:

You can if it makes them feel better, but in the same studies that have shown backboards to be not only unhelpful but potentially harmful, they’ve found c-spine immobilization to be voodoo also.

Think about the anatomy of the spine.. does holding someone’s neck straight and in the anatomical position actually immobilize the spine? Then of course there’s the dramatic amount of forced movement onto a backboard which blows the immobilization to heck, when it’s easier and safer for the patient to have them help in getting to the cot in a way that’s least painful to them.

The final nail in the coffin is that there’s just no meaningful evidence that demonstrates this theory of an incomplete spinal cord fracture that was maintained through full spinal immobilization..

This is fantastic information - thank you! I teach community health and digital and information literacy, so I don't have much reason to get updated on emergency medicine best practice. I wish I could stay up to date on everything!

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Specializes in CEN, Firefighter/Paramedic.
On 9/29/2019 at 9:00 PM, SafetyNurse1968 said:

This is fantastic information - thank you! I teach community health and digital and information literacy, so I don't have much reason to get updated on emergency medicine best practice. I wish I could stay up to date on everything!

It really first came on my radar back in EMT-basic school (a long long time ago) when we were learning "standing take-downs", where someone is walking around but it's decided "HUR DUR.. MUST BACKBOARD".. We had this whole process for holding c-spine, putting the backboard flush to their back and laying them and the backboard flat onto the ground. I remember thinking "this is the dumbest thing I've ever seen, they were just walking around!"

Anyhoo, when the backboarding was finally on it's way out the door as standard practice, I cheered a bit inside..

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This thread, like another recent thread, brings up the lack of first aid/emergency response training nurses get.

OP mentioned "She pulled over, blocking traffic with her pickup truck (I shuddered at the thought...so unsafe!"

Actually, an excellent choice- If she had been properly trained, this is exactly what she would do. Scene safety comes before Airway.

I wonder how many nurse would actually take an ERRN (Emergency Response for Registered Nurses) course if one existed.

I think an 8 hour course would go a long way in teaching RNs how to channel their knowledge in unfamiliar situations.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
47 minutes ago, FiremedicMike said:

It really first came on my radar back in EMT-basic school (a long long time ago) when we were learning "standing take-downs", where someone is walking around but it's decided "HUR DUR.. MUST BACKBOARD".. We had this whole process for holding c-spine, putting the backboard flush to their back and laying them and the backboard flat onto the ground. I remember thinking "this is the dumbest thing I've ever seen, they were just walking around!"

Yep, I did this as an EMT-B in 1999. So stupid!

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Specializes in Private Duty Pediatrics.
55 minutes ago, hherrn said:

This thread, like another recent thread, brings up the lack of first aid/emergency response training nurses get.

. . .

I wonder how many nurse would actually take an ERRN (Emergency Response for Registered Nurses) course if one existed.

I think an 8 hour course would go a long way in teaching RNs how to channel their knowledge in unfamiliar situations.

This is why I took an MFR (Medical First Responder) class. In some areas, my knowledge was much deeper than my classmates, and in other areas, I was such a newbie.

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Specializes in being a Credible Source.

I will point out that backboards can cause harm unto themselves and aren't appropriate for general use, particularly given that there's a dearth of evidence that they prevent morbidity and mortality.

Setting aside issues of skin breakdown, the very process of getting someone onto and off of a board can be problematic, especially in the field. ENA is now arguing against log-rolling trauma patients.

Often times, a scoop is a better device because it can require less patient manipulation.

And as others have said, I really wouldn't give much credence to the reports of nursing students - unless, that is, they were experienced pre-hospital providers.

♪♫ in my ♥

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