So a few weeks ago I was called to attend a car crash. A male had been seen driving at high speed in a high end sports car, before apparently suffering from an acute loss of talent. This resulted in him losing control, spinning out, bouncing off several curbs (which left his wheels pointing in 4 different directions – sub-optimal in terms of cornering performance I believe) before coming to rest in a fence. Witnesses then watched as he climbed out of the window, ran across the road, climbed a 2 meter high chain link fence and legged it through industrial inner west Melbourne (no idea why, I’m sure he was the lawful owner of said car…) Whilst admiring the athletic ability of the now absent “patient” I felt no need to remain at scene and instead raced off to
palliate resuscitate a 97 year old nursing home resident who had abruptly and unexpectedly succumbed to one of the 8 different listed terminal medical issues she had (sadly I was not successful: my necromancy clearly needs some work)
However, the driver was eventually found by police some 2km from the scene, having scaled some more fences before hiding in a garden. He was duly arrested, handcuffed and taken back to the scene in the back of the police van. Once there the crews subsequently called to check him out (including a senior Intensive Care Paramedic) decided that he urgently needed to be strapped to a spineboard with a c-collar cinched tight around his neck, tape over his forehead, headblocks wedged in firmly, before being raced off to the trauma center. Because mechanism.
(I had stopped back by out of curiosity to see this person who should really be a track and field star, but was alarmed at what I saw. I ended up backing slowly away without making any loud noises or sudden moves, lest I find myself similarly trussed up like some victim of a drunken practical joke)
Call me negligent, but I reckon that by demonstrating such acts of physical prowess that one would get an automatic pass in the S.A.S. recruitment process for escape and evasion, one is ruled out of having an unstable spine. I was once again set to tearing hair and gnashing teeth about the current culture of stupid that we labour under when it comes to necks.
I was very happy, therefore, that my favourite Vikings have been hard at work dismantling such nonsense for me. Thomas has posted a fantastic video over at ScanCrit of Dr Ryan Jacobsen, Director of Johnson County EMS talking about why his service will not be using spineboards any more.
The video is somewhat long (clocking in at nearly 90 minutes) but I can assure you that it is well worth watching. Dr Jacobsen discusses the genesis of our current practice from the US, as well as the evidence for and against these standards, in a clear, easy to follow (and well referenced) manner. He also discusses some of the evidence we now have regarding the benefits (or lack thereof) of our current model of care in what I believe to be a fairly unbiased fashion.
It may seem somewhat Quixotic at times, but I believe we may be on the cusp of some significant change in this area of prehospital care. It saddens me that we here down-under are behind the curve when it comes to making these changes, but I hope that we will one day catch up.
In and effort to move things along, I have developed Driver Robbie’s Rule Out Criteria for spinal injuries: If your patient is actively fighting you off, or running away, or scaling fences, or leaping tall buildings in a single bound, they do not have a spinal cord injury.