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. 

my-baby

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;

Advertisements

3 thoughts on “My Baby Looks Hot Tonight: An Open Letter About Light Bondage and The NREMT

  1. On my Car in a remote town, we are driving nearly two hours to get a spinal MVA Patient to the Trauma Unit, the whole way my patients complain of excruciating pain from the class he’ll or spine board – I spend more time tucking in padding for comfort to relieve their pain then I do actually treating them. A collar and lay them on the cot would be soooo much better, but…. POLICY.
    Arghhhh!

    Like

    1. Here are a couple of resources to show to your medical director or supervisor… there is a dearth of evidence to support long boards for anything other than extrication (not transport) unless there are focal deficits, and even then the evidence isn’t strong. Here’s an excellent video lecture (with references) and another review of evidence to help support getting rid of the long board. My service has a fairly liberal C-Spine Clearance Protocol, age greater than 65, axial loading, high-speed MVC (100kph+), rollover, ejection, motorized recreational vehicle and bicycle / pedestrian struck or collision are considered high-risk mechanisms (low-risk mechanisms like simple rear-end / fender bender MVCs, Pt. ambulatory at any time or delayed onset of neck pain = no spinal protection, note protection is the term now instead of immobilization) If any of the following, spinal protection with a well fitted cervical collar and scoop stretcher to ambulance cot with 5 point restraint is applied: High risk mechanism as above plus age over 65 = protection, reliable historian and patient exam, numbness or tingling extremities, midline C-spine tenderness upon palpation all get spinal protection as discussed above. Low-risk mechanisms as above have their cervical range of motion checked and if no pain or neuro symptoms (distal numbness, pins and needles etc) then transport without protection. Patient stability also comes into this, SBP=90+ and RR 10-24/min must be intact, otherwise, spinal protection is applied. Patient’s are allowed to self-extricate where possible.

      EM Ottawa: “Spinal Immobilization: Everything you know is Wrong” https://www.youtube.com/watch?v=hyDwePwbaYQ

      The Evidence Against Backboards
      BY BRYAN E. BLEDSOE, DO, FACEP, FAAEM ON AUG 1, 2013:
      http://www.emsworld.com/article/10964204/prehospital-spinal-immobilization

      Where is the Evidence FOR Spinal Immobilization?
      http://roguemedic.com/2013/08/where-is-the-evidence-for-spinal-immobilization/

      Spinal Immobilization: How rigid do we need to be?
      George Lindbeck, MD, Virginia State EMS and Trauma Systems Medical Director https://www.nasemso.org/Councils/MedicalDirectors/documents/SpinalImmobilization-GeorgeLindbeck.pdf

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s