Adrian,

Taking this a step further, if a patient is cooperative and vaguely sensible
then why strap down their head at all?  Many of these patients I leave in
the collar but do not strap them down.  instead I explain to them what
injury they might have and ask them not to move their heads around.  If we
can trust them not to move their bodies can we not also trust them not to
move their heads?

Simon McCormick

P.S.  I've actually seen a number of patients who I have log rolled off the
spine board early in resus put back on them for transfer to another
hospital!


----- Original Message -----
From: Adrian Fogarty <[log in to unmask]>
To: <[log in to unmask]>
Sent: 13 September 2002 00:46
Subject: Re: Head only taped down in the ED


You're quite correct from a technical point of view Mike. But we're
pragmatic folk in the safe confines of our A&E departments. We figure that
if the patient is vaguely sensible and co-operative then their thoracolumbar
spine is immobilised by virtue of them lying quietly on the trolley, and
their c-spine is sorted out with strapping etc. It's only the intoxicated
and the downright psychotic ones that'll need their bodies strapped as well!
And if they're playing up that much after trauma then they usually need
scanned. Prehospital, you're moving them round a lot so you need belt n
braces, we're just babysitting them so the body strapping's not so crucial,
that's all.

Adrian Fogarty
  ----- Original Message -----
  From: Mike Bjarkoy
  To: [log in to unmask]
  Sent: Thursday, September 12, 2002 9:59 PM
  Subject: Head only taped down in the ED


  Starting a slightly different thread...

  One of my pet hates is the A&E/ED log rolling patients off of spinal
boards and then taping only the head/neck onto the trolley.

  While we try to minimise further damage to C-Spine in the Prehospital
arena it seems that there is an attitude that if we (the A&E/ED) tape the
'head only' to the trolley then the patients C-Spine is safe!

  I believe that the A&E/ED actually go out of their way. inadvertantly, to
potentially induce as much pressure on a suspect C-Spine as possible by
letting the heavy body move freely around, while the head which cannot move
thus inducing potential stress on the poor little ole' C-spine.

  Does this sound like bad practice only to me?

  Bottom line is -
  Is the C-spine cleared - YES, release all straps (including head)
  Is the C-Spine cleared - NO, leave the FULL body packaged

  Mike Bjarkoy
  Paramedic
  Sussex