I have been reading these threads with obvious interest, and the three seem
to be linked by the same medical/legal argument.
The decision to utilise the spinal long board is not always based on the
needs of the patient, but the protection of the ambulance crew. The
mechanisms involved in an RTA for example, may create an index of suspicion
even though the patient has walked at the scene, and is not overly keen to
be strapped to a board for transport. But based on the fact that 'absence
of neurological indicators does not rule out cervical spine damage', few
paramedics would, I suspect, be willing to take the risk of missing the
statistical 1% of 'c-spine' fractures.
Another situation often faced by crews is that of the simple rear end shunt,
where those involved insist on hospitalisation. In some cases demands for
collars and immobilisation are made, as well as those who refuse to get out
of a vehicle because they've got neck pain. It is not a case for using a
board for every neck pain, but we are sometimes put under pressure by the
patients themselves, and at times it is the hospital staff that provide the
pressure:
A couple of years ago I took a patient into A&E who had fallen 10ft. from a
ladder and sustained a femoral fracture. To cut a long story short, I
managed him with a scoop and a splint with gas for pain. In A&E the nursing
staff insisted that the patient was transferred to a spinal board, which he
was on for about 30mins prior to removal without x-ray.
The decision to remove a spinal board once in place I believe is the sole
remit of doctors. This is based on the increasingly developing culture of
'no win, no fee'. The fact is, that medical decisions have to be justified
legally. Who but a doctor is willing to stand up in court and justify a
decision that has left somebody paralysed?
For reference: http://www.traume.org/spine/cspine-stab.html
Vaughan Knight
Paramedic, Manchester.
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