Dear All,

Sorry to return to this thread rather late in the day, but given the
forthcoming HTA call for research in trauma/emergency care is something on
spinal immobilisation too radical?

Obviously spinal immobilisation has become an accepted principle, and has
some logic to support it, but have we gone too far? Has anybody seen a
mobile GCS 15 individual sustain a significant sudden spinal cord injury (or
increase in existing neurological deficit) as a result of not being
immobilised in the traditional fashion: I don't think I have. We all tell
stories of "walk in" C-spine factures, but the alert patient seems to do a
pretty good job of protecting their own neck.

Patients who cannot protect their own spine (e.g. a substantially lowered
GCS) and those unable or unwilling to move would still need to be
immobilised, but does anybody fancy a trial of immobilisation versus no
immobilisation for the patient who is alert and mobile at scene? Could make
for an interesting ethics committee meeting, but challenging accepted
practice is a strength of our specialty, and consider the benefits. Who
would have thought a decade ago that "permissive hypotension" would become
an accepted practice in resuscitation?

Does anybody else think this is worthy of further consideration, or have I
just been working too hard lately?

Regards to the list,

Jonathan Benger. 

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of david menzies
Sent: 12 March 2007 23:49
To: [log in to unmask]
Subject: Re: Key clinical evidence in Emergency Medicine

Cochrane review (2001) found no evidence to support their use.  Absence of
evidence of benefit doesn't always equate to absence of benefit though.
(Apologies for that last sentence!)



________________________________
> Date: Mon, 12 Mar 2007 16:29:45 +0000
> From: [log in to unmask]
> Subject: Re: Key clinical evidence in Emergency Medicine
> To: [log in to unmask]
> 
> Fine so far but the question was is there any evidence for their use.   We
all know the scenarios and the anecdotes.
> -----Original Message-----
> From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Vic
> Sent: 12 March 2007 16:27
> To: [log in to unmask]
> Subject: Re: Key clinical evidence in Emergency Medicine
> Because they are so detrimental to people with spinal injuries I (and
others) insist they should be called "long boards". The only advantage to
them is that they allow a floppy patient with no handles to become a stiff
patient with handles. As such they make casualty handling safer.
> The spinal injury debate goes like this. As soon as the car crashes
everyone who has been hit thinks "compensation" and has a neck injury. If
you have two cars with four in each then seven people will claim whiplash
whilst one claims everyone including himself is fine. To take seven people
to hospital on long boards means that you use seven ambulances, a nightmare
for any Ambulance Control. Paramedics then use JRCALC guidelines to "clear
the spine" at scene, boarding only those who can't be cleared. Nonetheless
some walking spinal injuries do get missed.
> It is a lot easier to "clear the spine" in a warm, well lit A&E when the
person has had a chance to get bored of the board, than down a motorway
embankment with a hysterical inebriate dressed in nightclub attire. Please
don't knock the Ambulance crews because they ere on the side of caution. You
don't see the Mechanism of Injury, they do. If they are overcautious they
get bollocked by you and their bosses. If they sever a spinal cord they get
bollocked by you, their bosses, the courts, their professional body and
their conscience.
> Vic Calland
> -----Original Message-----
> From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Scott, Charles
> Sent: 12 March 2007 14:30
> To: [log in to unmask]
> Subject: Re: Key clinical evidence in Emergency Medicine
> Is there any evidence to show that "spine boards" and neck immobilisation
at the trauma scene has any validity, particularly in the walking well who
are treated by zealous paramedics?
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