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

- Rogue Medic

EMS Witch Doctors at Work

 


John J. Jankowski Jr./Special to The News Journal[1]
 

Is it really fair to place all of the blame on the people walking patients to the magic backboards?

They are probably doing what their medical directors and quality control departments tell them must be done.
 


John J. Jankowski Jr./Special to The News Journal[1]
 

However, why are medical directors encouraging this charlatanism?

Why is quality control discouraging quality patient care?

Is there any evidence that anyone walking will benefit from laying on a backboard?
 


John J. Jankowski Jr./Special to The News Journal[1]
 

This is a legitimate question. If someone has good evidence that placing a walking patient on a backboard has improved the patient’s outcome, please produce that evidence.
 

Even the ACS COT (American College of Surgeons Committee On Trauma) does not recommend a backboard for patients walking on scene. The ACS COT are the authors of the PHTLS (PreHospital Trauma Life Support) guidelines.

The NAEMSP (National Association of EMS Physicians) does not require a backboard for patients walking on scene.
 

Spinal precautions can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher, and may be most appropriate for:

  • Patients who are found to be ambulatory at the scene
  • Patients who must be transported for a protracted time, particularly prior to interfacility transfer
  • Patients for whom a backboard is not otherwise indicated[2]

 

A collar and no board appears to be the standard of care.
 

What kind of defense will work if there is disability to a patient when they were walking on scene before being placed on this backboard that is clearly not recommended?

Something like –

We really really believe in witchcraft!!!11!!!

Annie was walking before we put her on the board, but now she can’t walk.

Is there any reason to believe that does not happen?

should we expect the ACS COT and/or the NAEMSP to defend this use of witchcraft?

Here is what the ACS COT and NAEMSP write about not putting walking patients on backboards –
 

This is the official position of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma regarding emergency medical services spinal precautions and the use of the long backboard.[2]

 

When the experts eliminate some witchcraft, should we continue that witchcraft?

When the experts admit that they were wrong, should we continue doing things the wrong way?

Are we here to try to protect our reputations or to try to protect our patients?

Is EMS a profession with ethical standards?

Are we capable of learning to be better?

Footnotes:

[1] DART bus crash
delawareonline
John J. Jankowski Jr./Special to The News Journal
Article

[2] EMS spinal precautions and the use of the long backboard.
[No authors listed]
Prehosp Emerg Care. 2013 Jul-Sep;17(3):392-3. doi: 10.3109/10903127.2013.773115. Epub 2013 Mar 4.
PMID: 23458580 [PubMed – in process]

Free Full Text in PDF Download format from NAEMSP.

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Comments

  1. God forbid we not blindly follow the state’s/medical directors “protocols” that are most certainly carrying the weight of law. If we disobey them and heaven forbid bring someone from a car accident with no complaints not on a board, won’t it be as bad as crossing the streams? When will these medical directors/states grow a set and say, “No, we won’t be party to this” which is tantamount to patient abuse? This is just ridiculous.