This is another one of those EMS related posts. For those of you who are not in the medical field, I am sorry if this post makes your eyes glaze over a bit.
We have been taught to backboard every trauma patient. My protocols have us routinely backboarding patients who have been in car accidents, falls, penetrating trauma to the neck or torso, and a host of other accidents. Even when there is no sign of damage to the spine, we backboard. This is a result of the practice of defensive medicine. That is, we do this under the theory that we could be sued by the ambulance chasing "if I don't get you a big payoff, I don't collect a fee" lawyers that are always on the television during the day. The belief goes that if the patient needed to be immobilized and wasn't, there is a chance we could lose, but throwing someone who isn't really injured on a backboard doesn't hurt the patient, so we cover our collective butts by doing it to everyone.
Studies are starting to show that immobilizing patients is not a benign treatment. In fact, this 2010 study of over 45,000 trauma patients shows that patients who are victims of penetrating trauma to the torso, but do not present with any specific neurological deficit, experience a higher mortality rate when immobilized than similar patients who are not immobilized. We need to cease backboarding everyone. We are killing people. The lawyers are killing people. This needs to stop.
We stopped routinely immobilizing penetrating chest trauma patients years ago. It wasn't without some push back, but we persisted.
ReplyDeleteEven patients shot to the head have an incredibly low rate of occult C Spine trauma. That's been known since the Vietnam War, but we persist in doing silly things even when we know better.
Next we are going to find out that most MVA patients do better when not immobilized. God alone knows how long it will take after that for EMS practice to actually change. I'll be long retired, I'm sure.
It's too bad the risk management and politics do more to influence EMS than does science.