Archives for January 13, 2010

Spinal Immoblilzation a risk factor for death?


Emergency spine immobilization may do more harm than good, study says
January 11, 2010 | 3:57 pm
When emergency responders reach a gunshot or stabbing victim, they try to immobilize the spine to reduce the danger of paralysis upon movement of the victim. That effort, however, can have a fatal toll.

A study published in the Journal of Trauma has found that, among these types of trauma victims, those whose spines are held still are twice as likely to die as those whose spines aren’t immobilized.

Read the news article, but they’re talking only (apparently, I don’t get this journal) about penetrating trauma. Those discussing the article wonder if the reason for the increased mortality is “Stay and Play” vs “Load and Go”, the two basic precepts of transporting the ill and injured in prehospital medicine.

While I would agree a collar and backboard on a neurologically intact GSW patient is probably overkill, I suspect it’s a surrogate in this study for injury severity.

Anyone read JOT and want to help us out? I wonder if Injury Severity Scores were compared, in addition to transportation times.

And, my unrelated but sort-of related rant: we’re now getting, as policy, patients packaged for transportation like we’re going to sling them from helos and airdrop them into Afghanistan. Straps, zippers, tape, collars, etc. Very often applied to patients who were walking when EMS arrived on the scene. (I have given up asking EMS why, they just rote-repeat “Policy”), and have so far restrained from asking patients ‘why did you let someone strap you down like Hannibal Lecter’?)

Worrisome spinal tenderness, AMS, or an abnormal neuro exam? By all means. But a lot of it seems to be because they have a hammer, so every trauma patient is a nail…