I think Mike's point is one that should not be
dismissed lightly. If I may be so bold, Adrian, perhaps it is Mike who is being
pragmatic whilst your viewpoint is the "technically correct" one!
My limited experience has been enough to give me
the impression that immobilisation of the c-spine in the ED is often approached
with precisely not the pragmatic view that you describe.
Rather, overworked junior clinicians (nurses, paramedics, doctors) follow
the routine of taping from a protocol driven point of view - i.e. without the
knowledge or the time to make a reasoned decision. The result is:
a) taping is often inadequate - poorly
positioned, held on to the trolley by a few millimetres of tape on each side -
I've even seen it done with micropore!
b) the clinician may not consider the
potential for movement of the body, meaning that the uncooperative patients you
describe may be taped, and the cooperative ones may not have explained to them
the importance of lying still if ones suspect c-spine is immobilised at one end
only
Either taping should be done properly and with
regard to appropriateness, or not at all; and active measures have to be
taken to ensure this.
Chris
Dr C Kirke MRCSEd(A&E)
Research Officer
Clinical Information
Science Unit
University of Leeds
26 Clarendon Road
Leeds
LS2
9NZ
England
Tel. + 44 (0)113 2334961
Fax + 44 (0)113
2429078
email
[log in to unmask]
