MK>GS>mode of operation for years. In fact, I've seen CYA stuff that is
MK>GS>definitely harmful to patients. Unnecessary C-Spine immobilization
MK>GS>being only one of them.
MK>What do you classify as "unnecessary"?
Unnecessary C-Spine is done for your benefit, not the patient's. That 
is, there is no mechanism to support it, no distracting injury, no drugs 
or ETOH on board, or other factors that might mask an injury. You know, 
when a guy is in a MVA had his seat belt on, and his only complaint is 
ankle pain. That sort of thing. Or the person who tripped and is 
complaining of hip pain, didn't have LOC and has none of the above who 
gets C-Spined. 
MK>I have, on multiple occasions ordered patients to be backboard.
MK>Related to visible and assumed mech. of injury.  Only to have the
MK>medics remove the patient and walk them to the rig.
That's always a dicey decision, unless there is clear cut reason not to 
do it, but not having been there I can't say more. 
MK>How can Unnecessary C-spine immobil. be harmful?
At least two instances come to mind. 
First, in a study done at one of the medical schools, and I don't 
remember which one, young, healthy volunteers were immobilized on 
backboards to see what the effects would be. The original study was to 
be for 90 minutes to see what happened. None of the volunteers would 
tolerate more than 30 minutes. All of them had some complaint AFTER the 
experiment that they hadn't have before, such as neck pain, back pain, 
minor ulcerations at contact points with the board. Some of these 
complaints persisted for days after the experiment ended. Think about 
how many "mechanism" patients that you have boarded whose Chief 
Complaint upon arriving at the hospital was that they had been boarded. 
There is a growing school of thought that we should reconsider our knee 
jerk reaction to board everyone that has been in an MVA or any type of 
fall. 
Second, think of an elderly person who normally cannot tolerate lying 
flat due to CHF. You go to a call where they complain of hip pain after 
a fall and do the whole C-Spine routine. Many of them are not going to 
tolerate that too well. I've seen that a few times, and have always 
thought that we were doing more real harm than theoretical good. 
MK>The best part about the "undoing and walking" that I have seen was
MK>when, during an EMT refresher the instructor explained to us that you
MK>should do c-spine and backboard if even the thought was there....I
MK>asked him why he walked two teenagers from their car with double
MK>staring in the windshield.  He didn't seem to have an answer.
If someone stars a windshield, I consider that a sufficient mechanism, 
although I am not sure that there is a study showing any direct 
correlation. One lecture that I have attended had information showing 
that the "unknown" C-Spine injury is pretty much a myth. Usually, the 
damage is immediate, and irreversible. Even though everyone has a story 
about a person that walked around and had an undiscovered C-Spine 
injury, I have never seen documentation of such. There is always some 
sort of distracting injury or event, ETOH or drug, or some other reason 
why the person did not immediately feel neck pain. 
MK>Sometimes when you ask why they unhook someone you get the ol...look,
MK>I'm the PARAMEDIC and you are the EMT or First responder look....but
MK>that look goes away when they recognize you when they start giving
MK>report on a patient in the ED!!!  It gets replace with the
MK>Opppppppsssss...look!
There are a few times when I have removed collars, but they are very 
rare, and it has to be a very clear cut instance of the collar being put 
on for no reason. 
Gary
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