----- Original Message -----
From: "Biggin Chris (RTF) NHCT" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, September 10, 2002 9:14 PM
Subject: Re: Nurse initiated removal from spinal boards
> We're not as streamlined as we could be at North Tyneside as we would have
a
> dcotor present. What we would do though is pull a doctor at a very early
> stage to do exactly what you describe for all those advantages.
>
> Chris Biggin
>
> -----Original Message-----
> From: Adrian Boyle [mailto:[log in to unmask]]
> Sent: 06 September 2002 16:38
> To: [log in to unmask]
> Subject: Nurse initiated removal from spinal boards
>
>
> I am trying to reduce the amount of time our patients spend on spinal
> boards. One solution that has been put forward is that the paramedics and
> nurses logroll the patient off the board onto the couch as soon as the
> patient arrives (without the need for a doctor to be present) and then
> maintains immobilisation. The other advantage of this is that the two
> paramedics assist at arrival (and go away with their board) The triaging
> nurse only needs to request one other person to give them a hand with a
log
> roll.
> The present state is that a patient is left on the board by the triage
> nurse, the paramedics go off to their next job and the patient is not
taken
> off the board until the SHO comes to see them, often these people are
> medically fairly well and do not get high priorities so the wait can be
> considerable. It can also be a hassle getting a 'log roll posse' together.
> What is practice in other departments? can nurses and paramedics log roll
> patients off spinal boards without a doctor being present? If anyone has a
> formal (evidence based protocol or guideline) I would be very keen to have
a
> look at it.
> Adrian Boyle
>
I've watched this debate for a while and feel that it is maybe time for me
to throw by two pence into the ring ( thereby mixing my metaphors )
i think what Adrain suggests of the 'therapeutic' log roll vs. the
'diagnostic' log roll has value, especially from somethign which is seen as
a 'nursing' issue that of patient comfort and of pressure area care.
Firstly we have to consider what the purpose ofthe long board is - is it to
provide immobilisation until cleared / definite immobilisation is provided
( by whatever method, halo, traction, surgical procedures ...)
or is it to aid immobilisation in the extrication and transfer to definitive
care parts of the patient 'journey'
i would suggest that the second is closer to the truth as good
immobilisation can be obtained off the board, on an A+E trolley or similar -
after all several Ambulance services used to immobilise on the ambulance
trolley as they only carried scoop type stetchers as extrication aids .
we have to consider what we want to achieve about this issue if it is to
promote patient comfort and enable the crew to have their board back while
maintaining an appropriate level of immobilisation this is a desirable aim.
as for 'Can' of course you could teach primary school kids how to log roll ,
'should ' is the key question - and persoanlly even if the Nurse isn#t in a
position to clinically clear and /or request / interpret radiography there
are potential benefits to be seen
Martyn Hodson
[log in to unmask]
Registered Nurse
SJA Ambulance Attendant
writing for myself, views expressed are entirely my own,
and may not reflect those of my employer or St. John Ambulance , Nationally
or locally
-Duct tape is like the force, it has a light side and a dark side,
and it holds the universe together.
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