Episode 66 Backboard and Collar Nightmares from Emergency Medicine Update Conference

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 9 June 2015

⏱️ 22 minutes

🔗️ Recording | iTunes | RSS

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Summary

In the first of our series on Highlights from North York General's Emergency Medicine Update Conference, Dr. Kylie Boothdiscusses Backboard and Collar Nightmares. The idea that backboards and c-spine collars prevent spinal cord injuries came from level 3 evidence in the 1960's and there has never been an RCT to prove this theory. In fact a Cochrane review on the topic in 2007 concluded that "the effect of pre-hospital spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain" and that "the possibility that immobilisation may increase mortality and morbidity cannot be excluded". There have subsequently been several observational studies that describe increased morbidity and mortality associated with backboard and collars in a subset of patients. Dr. Booth argues that the time has long past that a major paradigm shift needs to occur toward a safer more rational use of backboards and collars in our trauma patients.

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast.
0:05.8	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine
0:10.5	from EMC Studios in Toronto.
0:14.4	We as the Emerge Community must lead the change.
0:18.1	The greater ignorance, the greater the dogmatism. For penetrating trauma, placing
0:23.1	patients in spinal precautions is useless and actually it confers more injury than good. We need
0:29.1	to use our brains. We don't need to have this dogmatic, ritualized, backboard and collar
0:34.6	for all.
0:46.1	This year, the North York General Hospital's Emergency Medicine Update Conference was one of the best ever.
0:54.1	We had the pleasure of having Scott Weingart, Amomatu, Stuart Swarden, Michael Betzner, Walter Himmel, the list goes on. It was really quite amazing.
0:57.1	One of the talks that stood out for me was entitled Backboard and Collar Nightmares by Dr. Kylie
1:02.8	Bosman. She's an emergency physician as well as the chief of the emergency department at
1:07.4	Collingwood General Hospital. Now, Collingwood is a small city that sees four-season
1:12.7	trauma, skiers, snowmobilers and skaters in the winter, mountain bikers in the shoulder seasons,
1:18.6	and alcohol-related trauma in the summer. So without further ado, I'd like to introduce Dr.
1:23.2	Kylie Bosman to EM cases. So I'm going to talk about backboard and collar nightmares.
1:28.1	And I think the overarching nightmare here is your own nightmare.
1:31.4	When you look at the back hall of your EMS bay and you see the lineup.
1:36.5	And you know that each and every one of those patients needs at least three people to get them off.
1:40.2	They're yelling, they're screaming.
1:41.3	I got pain everywhere.
1:42.7	And so my hope today in this next sort of short 15 minutes is to challenge the dogma
	...

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