Back Injury Basics
Apathy & Education
By Alan Perry
November 26, 2013
Spinal
immobilization is a basic EMS skill that every provider should be intimately familiar
with. The skill is part of most State EMT tests, as well as the National
Registry practical exam. Motor vehicle
accidents (MVA’s) are responsible for the majority of back and spinal cord
injuries[i].
MVA’s present unique challenges for
extrication of patients while maintaining some degree of immobilization to
protect the spine and spinal cord from further injury. Traumatic spinal cord
injuries occur at a rate of 12,000-20,000 per year[ii].
The efficacy of spinal immobilization is debated and currently being
investigated, some have even suggested that in the case of patient extractions
from MVA’s it would be better for the patient to remove themselves with only a
c-collar to prevent unnecessary spinal manipulation[iii].
Providers
must make several decisions when confronted with a MVA patient complaining of
back pain. First, consider the Urgency; is the patient’s condition critical?
Will they suffer additional harm if not removed and treated immediately, such
as for a major bleed? Are they in immediate danger from fire or drowning? If the answer is yes, then spinal
immobilization concerns become secondary and the patient must be removed in the
most expedient way possible until immediate life threats are resolved (if they
ever can be). Then choose your method; if the patient’s condition and
environment are stable then you have to decide what method is best, in most
places this will be determined for you by local protocol, in a few places it is
left to technician discretion. Most localities have the option of using a
regular long backboard (LBB) and short board or Kendrick style extrication
device (KED) as their primary tools.
We are taught
that with a stable patient and stable environment (the majority of MVA’s), that
the KED is the most effective way to remove a patient from an automobile that
has only minor damage[iv]. All too frequently this tool is left disheveled
in the back of the backboard compartment in favor of the more expedient and
less time consuming trauma roll onto a LBB. Why is this? I suspect a number of
factors are in play; education & training, expectations &
communication, laziness and complacency, leadership, and especially in the fire
service, culture. While the academic world debates the efficacy of the
procedure, it is important to note that the textbooks, protocols and
certification processes still define what our standard of care should be.
Can you tell
where I’m going with this? I’m not worried much about what a lawyer thinks
about my patient care because everything I do for my patients is based on what
is best for that patient and the current standard of care that I am expected to
provide. This includes routine use of a KED when indicated. Can you say the
same thing about your patient care? Where you even aware this might be a
problem? Think of it this way; do you want to be responsible for causing a
catastrophic spinal injury to a patient that otherwise might have walked home
from the hospital just to save some time or because you forgot how to use the
KED? When was the last time you trained with it? When was the last time you
suggested using it?
The KED is
but one tool of many that may be used to manage a back-injured patient. MVA’s
cause the most spinal injuries, and the KED is uniquely useful in removing
seated patients from automobiles which explains why it is the standard of care
for these patients. Many of the tools on the medic or engine are designed for a
specific purpose, the KED is no different. Take advantage of the tools you
have, your correct use of the KED could make a huge difference in your patients’
outcome.
Be Safe,
Alan
