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 can remove the need for x-ray and has a remarkable effect on the patients transit time through the department if this is their only "injury".
----- Original Message -----
Sent: 07 November 2002 23:46
Subject: Clearance of C spines
I find it worrying that cervical collars are beginning to creep back into treatment of RTA neck sprains. For what its worth I ran a review clinic for RTA patients some years ago in the bad old days of collars. Patients came back after only a few days stiff, immobile and miserable. It took long weeks of physio to improve things. After the evidence was published we abandoned collars for everybody, found we no longer saw the immobile miserable neck patients, such that I stopped the reviews as unnecessary.
The idea of simple discharge at triage with a written advice sheet sounds excellent, (if only we could do so consistently). Problems arise when patients go to the GP and mention the neck and get referred to physio even after only a few days pain. There are sometimes too many conflicting opinions that the patient can listen to.
Another problem I have is that my local ambulance crews are under instruction to put a stiffneck collar on all RTA patients if they mention neck pain, however slight and even if the patient is up and walking at the scene. Getting people out of them is difficult for juniors, just like getting people off transfer boards. Paramedics and their overcautious training have a lot to answer for.
I attach a copy of my patient instructions.
