> Its awkward for ambulance personnel. They don't get paid
> enough for clearing cervical spines if anyone states neck
> pain. SHOs do get paid enough ( especially come December) and
> if they are given adequate instruction they can clear these
> spines on arrival as the patient is got off the spinal board/
> scoop stretcher.
This is a bit insulting to the professionalism of ambulance personnel. The
issue is training and protocols, not pay, and I think there are few
ambulance crews who take the attitude that they will deliberately provide
suboptimal patient care unless they are paid more.
There are simple protocols in place for clearing cervical spines without
x-ray. These could easily by applied by ambulance personnel. This would make
the patient's journey to hospital considerably more comfortable. The
training issue is not a major one compared to such things as IV line
placement and drug administration and the benefits to patients greater than
for much of what paramedics do. The question to be addressed by those
involved in the ambulance service is why these protocols are not already in
place and when they will be introduced.
> Why bother if the patient has managed the feat that you
> describe, or is
> holding their head adequately like the air stewardess who I
> saw a couple
> of years ago. She gave herself a C5/6 unilateral facet
> dislocation when
> in the bath. Undeterred, she came in immaculately dressed with make-up
> as if she was off to work!
Not uncommon to see patients with cervical spine injuries walking in. The
C5/6 unifacet dislocation is a pretty common one and very stable (if you've
ever tried reducing one of these it takes a reasonable amount of force to do
even with muscles relaxed)- another important point on spinal injuries
though- not only are they fairly uncommon but a lot of them are stable.
I agree that there is an issue with risk/ benefit for 'spinal
immobilisation'. It is generally held to be a good thing. However there is
no clear evidence for its benefit even in patients with unstable spinal
injuries (I am prepared to be corrected on this one); it will clearly have
no benefit in the rest (the vast majority) and it had unquantified risk.
Scope here for further primary and secondary research and subsequent
evidence based challenge to the orthodoxy.
Matt Dunn
Warwick
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