Wednesday, January 25, 2012

Spinal Immobilization: Nothing But Questions

If you haven't already read any of the various articles and blog posts about whether or not we should be immobilizing patients, or what research there is or is not, supporting such a thing, go read this article from EMS World.

I have a lot of thoughts on the subject, and many questions, but no answers.

It is clear to me that with elderly patients, who may have fallen from standing, or from a chair or bed, backboarding them may well do more harm than good.

It is clear to me that we have a lot of patients from MVAs who are unhurt, due to the improvement in car construction, safety belts and airbags, or just plain luck, who are backboarded due to "mechanism" but don't really need to be. It probably falls in the "neither harm nor good" category for most of them.

Where I'm not clear is this: patients who are injured, who have a mechanism that protocols say we should immobilize... what then? Does it really help?  If it doesn't, then what WOULD? What SHOULD we be doing? How can we help the people who NEED some sort of protection because of a spinal injury?

I have not had a patient who was demonstrably harmed from either being immobilized, or from not being immobilized, that I am aware of.  Still, I'm not satisfied that we're doing the best we can for them.

I'm intrigued by the full body sized vacuum splints. How does this change the effects of being backboarded? Is it safer?  How about those pads they make for backboards? Any real difference?

Mostly, I want to know when there WILL be actual research on all of this.
I confess, it scares me. It scares me that we might be causing harm to patients. That I have protocols I have to follow- but don't know what they are based on, if anything.

I know medics who sometimes choose, under certain situations, to override protocols, when they are sure that it is in the patient's best interest.  I am way too new at this to feel comfortable doing that, so I'm left in a very awkward position.

I got in this to help people.
I don't want to do things that harm anyone, and I want to know, for sure, or at least as sure as I can be,  that what I'm doing actually helps.
Is that too much to ask?

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