My Baby Looks Hot Tonight: An Open Letter About Light Bondage and The NREMT

Dear NREMT,

I like you, I really do. I think you do some good stuff for EMS. But man, as a friend, I feel the time has come to speak up.  You have become like that friend we all have that is still hung up on that one girl that dumped him eighteen months ago.  He still thinks there is a chance; she has moved on and is now engaged to an investment banker named Brent that she met on Match.com. It’s over man, move on, stop looking at their Facebook photos of their vacation. 

The time has come to remove seated spinal immobilization testing from the EMT psychomotor exam.  There is no data to support the practice of seated spinal immobilization. Continuing to require it to be a skill EMTs are tested on is archaic and points to the NREMT ignoring evidence based medicine or having an interest in light bondage. If that is the case, you’re not alone, look at the popularity of Fifty Shades of Grey, it has sold over 125 million copies. No one is going to judge you. 

At this point most people in medicine have realized that the entire backboarding paradigm is flawed. Sure there are still a few back woods holdouts that are screaming about mechanism of injury and how we don’t have x-ray vision, but for the most part the world has simply moved on and stopped strapping a flexible curved spine to a hard piece of plastic. There is no epidemic of paralyzed patients because of a lack of backboarding.  We stopped backboarding and nothing bad happened.
What is the harm in leaving it on the test you might be asking?  An EMT class is at most 200 hours long, often much shorter. How many of those hours should be spent on components that are frankly bullshit but they have to be taught because of the test… even though no one uses them in the real world?

Hours spent teaching seated spinal immobilization could be used for many things that are more important in an EMT educational program.

Seated spinal immobilization is not an evidence based practice. The evidence of benefit for the practice of seated spinal immobilization is zero. There certainly is data showing that seated spinal immobilization does not immobilize the spine and causes more movement to the spine than allowing patients to self-extricate while wearing a cervical collar. [1-5]

A pilot study using motion capture technology found “Conventional extrication techniques record up to four times more cervical spine movement during extrication than controlled self-extrication.” [3]

While applying seated spinal immobilization to a patient with mutli-system trauma has no benefit it has a clear downside. It is a time consuming process and serves no purpose except to delay these patients from reaching emergency rooms, surgery, blood and blood products, etc.

Seated spinal immobilization is a practice that should be abandoned by EMS. Testing on seated spinal immobilization only instills competence in a dated and needless practice with no benefits. Seated spinal immobilization needs to be removed from the NREMT psychomotor test.

Honestly, I can’t imagine a cogent argument the NREMT could possibly form to defend this practice.

And remember, always use a safe word, 

Best Regards, 

BMB

 

Citations:

1. Shafer JS, Naunheim RS. Cervical spine motion during extrication: a pilotstudy. West J Emerg Med. 2009;10:74–8.146.

2. Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS. Cervical spine motion during extrication. J Emerg Med. 2013;44(1):122-7.

3. Dixon M, O’halloran J, Cummins NM. Biomechanical analysis of spinal immobilisation during prehospital extrication: a proof of concept study. Emerg Med J. 2014;31(9):745-9.

4. Dixon M, O’Halloran J, Hannigan A, Keenan S, Cummins NM.Confirmation of suboptimal protocols in spinal immobilisation?Emerg Med J. 2015;32:939–45

5. Cowley A, Hague A, Durge N. Cervical spine immobilization during extrication of the awake patient: a narrative review. Eur J Emerg Med. 2016;