Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

ABEM Press Release: Board Certification in EMS

 
I am only a month late in noticing this, but I am glad to see that there is some recognition of the differences between EM (Emergency Medicine – in-hospital treatment of emergency patients) and EMS (Emergency Medical Services – out-of-hospital treatment of emergency patients).
 

The American Board of Emergency Medicine has been approved to grant certification in the subspecialty of Emergency Medical Services (EMS). Certification in EMS is open to any physician who is certified by an American Board of Medical Specialties (ABMS) Member Board and fulfills the ABEM Policy on Medical Licensure and the EMS Eligibility Criteria. Both of these documents and the Core Content of EMS Medicine are available on the ABEM website.[1]

 

There are some questionable parts of the core content –
 

Emergency Medical Services (EMS) is a medical subspecialty that involves prehospital emergency patient care, including initial patient stabilization, treatment, and transport in specially equipped ambulances or helicopters to hospitals. The purpose of EMS subspecialty certification is to standardize physician training and qualifications for EMS practice, improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and facilitate further integration of prehospital patient treatment into the continuum of patient care.[2]

 

It looks good – until I see this:
 

1.2.1.5 Management of spine trauma (application of spinal immobilization, selective immobilization)[3]

 

Why should mythology be a part of the core content?

Isn’t the purpose of board specialty, or subspecialty, to have a specialized knowledge based in reality, rather than mythology?

Why let mythology take precedence over reality?
 


 

This year the NAEMSP (National Association of EMS Physicians®) considered passing a Position Statement with the following –
 

The National Association of EMS Physicians believes that:

  • There is no demonstrated outcome benefit of maintaining rigid spinal immobilization with a long backboard during EMS transport of a trauma patient.[4]

 

That statement is completely true.
 

  • Securing a trauma patient to an EMS stretcher without a long backboard whether or not a cervical collar is being used is acceptable for maintaining spinal precaution during transport.[4]

 

That statement is a reasonable conclusion, based on the the available evidence.

No.

Let me be more clear.

That statement is the most reasonable conclusion, based on the the available evidence.
 

  • Implementation of protocols that deemphasize the use of the long backboard should involve all affected partners in the EMS system.[4]

 

Since there is no evidence that placing a rigid collar on the neck and strapping the patient to a board works, and there is plenty of evidence of harm, we should stop harming our patients by treating them with this dangerous myth.

Our patients deserve better.

Perhaps the next NAEMSP can finalize this necessary position statement that opposes harming emergency patients in order to protect the myth that long board spinal immobilization protects the spine as their next position statement.

If not, should we also leave cookies out for the Spinal Immobilization Fairy?

Board certification should require correction of the myth of a board to protect the spine from further injury.
 

Also see what I wrote yesterday –

Stop the Madness! Reducing Unnecessary Spinal Immobilizations in the Field – Part I

Footnotes:

[1] ABEM Press Release: Board Certification in EMS
October 9, 2012
NAEMSP (National Association of EMS Physicians®)
Press release.

[2] Overview
Emergency Medical Services
ABEM (American Board of Emergency Medicine)
Web page.

[3] The 2012 Core Content of Emergency Medical Services Medicine
ABEM
Jan 10, 2012
Published in Prehospital Emergency Care
ABEM link to Free Full Text Download in PDF format.

[4] EMS spinal precautions and the use of the long backboard
Proposed Position Statement
NAEMSP
Not available on NAEMSP web site, but forwarded by NAEMSP members interested in increasing awareness of the issue.

.

Comments

  1. Hey Rogue could you post the content of that forwarded letter you’re using for source four? The NAEMSP statement on backboards.

  2. “Core content” describes what the EMS Physician will need to understand (ie evidence-based literature) and then apply, appropriately. Core content is not “scope of practice” (ie ABEM did not say “strap patients to a board”). EMS physicians graduating from accredited fellowships are expected to understand the literature, distill quality studies out and apply relevant studies to their practice. Some research may not be relevant to other locales. You’re right, this is a mode of transport that is misunderstood and assumed to be treatment. Backboarding (I am not talking about cervical spine immobilization) leads to increased pain, increased xrays, longer hospital stays, and increased morbidity. Communicating the best research out to all providers is huge – thank you for bringing up all sorts of issues, but especially this one.