immobilzation

[coolmom9396]

if a person falls down stairs and they move approx 20-30 ft befoe u get there do you by law still have to immobilize them in the state of wv

[firefighterbeau]

I don't know what the laws say, but just to cover you ***, c-collar, and backboard them. you'll never get in trouble for taking to many precautions. its when you don't that gets you in trouble. I know of times that we have had people up walking around when we get on scene, we took c-spine precautions and later found that they had broken vertibra.

[Catch22]

I responded on a guy that dove into a creek, walked a mile to the house. When he got to the house, he laid down and hasn't moved below the waist since. As such, I would recommend spinal immobilization on any pt. with a potential spinal injury, no matter how much they've moved around.

[MalahatTwo7]

Like one of my instructors in the past said: "Do what you know, and know what you do." In other words, if you know the MOI was a fall or high speed impact, C-spine management is a requirement.

If it turns out that you did it and it wasn't needed, so much for the better - chalk it up to good practice. If it was required and you didn't do it...... well I hope your insurance premiums are paid up.

[DaSharkie]

Now as a clinician I see it a variety of ways.

Of course, if they move it doesn't mean squat. Is there a distracting injury? Is there a medication, drug, or EtOH on board? Was there a loss of consciousness?

Your scenario is a bit too vague for my liking though.

Board them if your gut tells you to, but exercise some sense and think about what is going on before you put someone on a board. Remember, skin breakdown can occur in 20 minutes in patients on a backboard. So now they have a decubitus ulcer on top of whatever injuries they may (or may not) have.

[Lewiston2FF]

Now as a clinician I see it a variety of ways.

Of course, if they move it doesn't mean squat. Is there a distracting injury? Is there a medication, drug, or EtOH on board? Was there a loss of consciousness?

Your scenario is a bit too vague for my liking though.

Board them if your gut tells you to, but exercise some sense and think about what is going on before you put someone on a board. Remember, skin breakdown can occur in 20 minutes in patients on a backboard. So now they have a decubitus ulcer on top of whatever injuries they may (or may not) have.

Thats a new one to me! Any reason why the breakdown is so quick on a backboard? I am not advocating backboarding with "reckless abandon". Besides the hospital is usually pretty good about balling up the spider straps and yanking the BB out from under them while we are still there. (But boy do they yell when they arent boarded) (Long story, too long to get into here)

[mcaldwell]

if a person falls down stairs and they move approx 20-30 ft befoe u get there do you by law still have to immobilize them in the state of wv

There is no "Law" regarding detailed treatment like that, but rather your department/service's protocols.

I also agree that the movement after the fall means squat, but I'm with Sharkie. Don't board with reckless abandon. You do what your training and protocols allow. That may or may not include ruling out the need for C-spine management.

[DaSharkie]

Thats a new one to me! Any reason why the breakdown is so quick on a backboard?

It is strictly from the pressure. Especially prominant in the elderly folks due to loss of fat pad and subcutaneous fat. This leads to more prominent bony ridges creating more pressure. Add to that dehydration and other issues and you get a mix for nastiness. Worst case is 20 mintues for the pressure sores to set in, but even in healthy folks it can take less than an hour to do so, and you figure you are on a board at the scene for 5 minutes or so before you are transported, then another 10 - 20 minutes for transport, another 10 minutes before you get moved to a gurney (if there is one) in the ED. Another 10 minutes before you get rolled off of a board if you get cleared.

Let alone an interfacility transport and you can add on a ton of time there too. Just something to keep in mind......

Besides the hospital is usually pretty good about balling up the spider straps and yanking the BB out from under them while we are still there. (But boy do they yell when they arent boarded) (Long story, too long to get into here)

A pet peeve of mine. It may not take long to clear them before removing a patient from the board, but you realy ought to clear 'em before the straps come off. Hopefully I will not turn into that type of person when I start working.

[LeuitEFDems]

A pet peeve of mine. It may not take long to clear them before removing a patient from the board, but you realy ought to clear 'em before the straps come off. Hopefully I will not turn into that type of person when I start working.

If you are, we'll let ya know
As for here...MOI, possibility of distracting injury/adrenaline rush ( the patient may not feel any pain for quite some time) and Massachusetts "liberal" protocols, this person would be boarded....

[sfdffemt17]

Protocol

In NH we have a protocol that would allow us to clear the c-spine in the filed. The pt must deny pain to the area, have no obvious deformity upon palpation, must not have any distracting injuries, be able to to move the head/neck in circles and back in forth with no demonstration of pain, and must be of sound mind, and not intoxicated.

Jon

[Lewiston2FF]

In NH we have a protocol that would allow us to clear the c-spine in the filed. The pt must ... and must be of sound mind, and not intoxicated.

Jon

That would rule out quite a few of our MVA patients right there!