Drowning and C-Spine?

[mitllesmertz1]

How many of us routinely board and collar submersion victims?
From what I anecdotally hear, an aweful lot.

Why?

From Drowning and Near-Drowning in Children and Adolescents: A Succinct Review for Emergency Physicians and Nurses Burford, Amy E. MD*; Ryan, Leticia Manning MD†; Stone, Brian J.‡; Hirshon, Jon Mark MD, MPH§; Klein, Bruce L. MD[//] As printed in Pediatric Emergency Care Volume 21(9), September 2005, pp 610-616

In the ED, the patient's airway, breathing, and circulation are reassessed. The cervical spine needs to be examined for a possible fracture, and radiographs obtained, if necessary. In their review, Watson et al 65 found only 11 of 2244 submersion victims had cervical spine injuries. All 11 had been submerged in open bodies of water, had clinical signs of serious injury, and had a history of diving, motorized vehicle crash, or fall from a height (ie, a high-impact event). All patients with cervical spine injuries had a Glasgow Coma Scale less than 9 at the scene. None was younger than 15 years. If the history of the submersion event is clear and does not appear to include a risk of significant trauma, routine spinal immobilization and radiographs are probably unnecessary. This issue is significant because immobilization can make rescue more difficult and interfere with airway management.


Do we folllow the evidence, or just do it to CYA?

[yowzer]

CYA, of course. Personally, I think it should depend on the circumstances -- deep lake or ocean, no. Shallow river with lots of rocks and snags, probably. "He dove in off a tree and didn't come back up for a few minutes', probably.

[RFRDxplorer]

In lifeguarding class we were taught to backboard only drowning victims who would have an MOI (that wasnt how it was put in the class) that might indicate spinal injury. The guy who just cramps up in the middle of the pool or has a heart attack while swimming laps and goes under gets swum to the side of the pool without any real consideration for c-spine, and is put on a backboard just to get him out of the pool. (Slide him over, backboard is placed vertical. Two rescuers on land have a hand on backboard and a hand grabbing the victims hand and yank him out. Works extremely well.

[pkfd7505]

My guess would be that most do it to CYA. I've never done water rescue so I honestly do not know how much harder it is to rescue with c-spine immobilized as compared to no immobilization. My thought would be that it should depend on the situation, if taking the time to immobilize the c-spine would cause an IDLH then I would say forget the c-spine and get the pt out of danger. If it is only a matter of convenience then you should immobilize the c-spine. If you immobilize c-spine on 6,000,000 people who really don't need it without causing them (or the rescuer) any harm what has it cost you? But if you neglect to immobilize c-spine on that one person that actually has a c-spine injury then you are in a world of hurt. This is where good scene size-up and awareness comes in to effect, keep yours and your team’s safety in mind first, and then take the patients safety in to mind. If you can immobilize c-spine in a rescue situation without risking yours or the patients health unnecessarily then why wouldn’t you do it just to CYA? As I mentioned before I have never been trained or taken part in water rescue and I am sure that it is completely alien to anything I am used to dealing with. This is a good thread, I'm looking forward to learning something from it.

[mitllesmertz1]

Well, let me make a few comments.
1. Glad to see that CYA is still the excuse of choice for some providers.
2. The number one, most important goal in improving a drowning pt's outcome is to get ventilation restarted. Sure, they teach us how to do so in water rescue classes; however, having done this on a few occasions now, it is nearly impossible to get adeqaute ventilation with a pt floating/sinking in the water. Get the pt onto land as quickly as possible, any means necessary.
Eqaute this to a pt not breathing in a car on fire. Get the sense of urgency?
3. As noted by the Pediatric Emergency Care article, needless c-spice use is needless, and does interfere with rendering care. If it's not indicated, don't do it.

Please Please Please, from a former Navy aircrew SAR swimmer, get the damn pt out of the water immediately!!!!!!!!

[nmfire]

I'm thinking trying to make the patient alive again is probably a little more important than collaring a dead body so they don't sue you from their grave.

[pkfd7505]

Ok I read allot more in to your post then was actually stated, for some reason I was thinking about multiple situations such as a simple (if there is such a thing) water rescue in addition to a drowning. In my defense I did state that if there was a chance of IDLH I would forget the c-spine and remove the pt from danger. I would certainly consider no breathing and inadequate venting to be an IDLH, c-spine would take the back seat.

So this brings up a question, if a rescuer takes the time to immobilize the c-spine while they are not able to get adequate vents and they are not able to revive the pt afterward could they be accused of neglect? I think that neglect has to show a deviation from standard or care, that additional harm was caused and that the actions of the provider caused that harm? I'm sure there is a ton of grey area in this but I just wonder if CYA can be a two way door in a situation like this.

As a student this has helped drive home the idea of "follow the indications" and that is appreciated.

[NHBasic25]

Never done it for real, but in drills a board is a great way to get someone out of the water and is a good platform for CPR. Can't see the point in strapping and collaring without MOI, and REALLY can't see the point if they're not breathing.

I've taken swiftwater rescue training for whitewater paddlers(not fire/EMS), and immobilization isn't even mentioned -- this for folks who may have gotten churned and bounced off rocks before being pinned. It's all about getting them back up where they can breathe.

Off to more water rescue training next month, where I'm sure I'll learn something different...

[Dave1983]

Well, let me make a few comments.
1. Glad to see that CYA is still the excuse of choice for some providers.
2. The number one, most important goal in improving a drowning pt's outcome is to get ventilation restarted. Sure, they teach us how to do so in water rescue classes; however, having done this on a few occasions now, it is nearly impossible to get adeqaute ventilation with a pt floating/sinking in the water. Get the pt onto land as quickly as possible, any means necessary.
Eqaute this to a pt not breathing in a car on fire. Get the sense of urgency?
3. As noted by the Pediatric Emergency Care article, needless c-spice use is needless, and does interfere with rendering care. If it's not indicated, don't do it.

Please Please Please, from a former Navy aircrew SAR swimmer, get the damn pt out of the water immediately!!!!!!!!



- In some systems, if you dont practice CYA you dont practice at all. Of course in this case the "your" in CYA means the EMS system, your individual a** is not important. :rolleyes:

-ABCs, Im with you here. But same as with an auto extrication. If the patients not breathing and you cant secure an airway, you do a rapid extrication. If you can secure the airway, take the time and package the patient.

Case in point, two weeks ago we had a gentleman drive his car off a sea wall into about 30' of water. Car was about 50' of the wall and completely submerged when we arrived. Rescuers were sent out, a rapid extricatin was performed, and the patient removed from the water. No c-spine on this one, no time.

Case #2, about 3 months ago, gentleman dives into a swiming pool, strikes head on bottom, looses sensation to lower limbs. When we arive, patient is floating supine in the water, head/shoulders being supported by a bystander. This patient was given full c-spine treatment before removal from the water.

-Again, the article is one opinion. If the Dr. whos license you work under doesnt agree, you do what they say or you dont do at all.

-I dont work for the Navy.


I will say this, even if we were not required here to c-spine a drowning, we would at least put them on a LSB. Ours float, very well I might add, and its an excellent means to get patients out of the water.

[mitllesmertz1]

While you're dickin around with your floating piece of wood in the lake/pond/pool, why not jus tdrag them out of the water?
You mentioned a brilliant example of how you saved the life of a guy that HIT THE BOTTOM OF THE POOL AND COULDN"T FEEL HIS LIMBS!!!
For gawd's sake, wasn't it fairly clear that if there is an obvious mechanism they should be boarded?
that's the great example you bring?

There is nothing, more important for a drowning pt than to stop the drowning process.
Getting them out of the water achieves that.
Anything that slows that down is bad.
Wow, this is tricky.
Go get em Mr Hasselhoff...

[Dave1983]

While you're dickin around with your floating piece of wood in the lake/pond/pool, why not jus tdrag them out of the water?
You mentioned a brilliant example of how you saved the life of a guy that HIT THE BOTTOM OF THE POOL AND COULDN"T FEEL HIS LIMBS!!!
For gawd's sake, wasn't it fairly clear that if there is an obvious mechanism they should be boarded?
that's the great example you bring?

There is nothing, more important for a drowning pt than to stop the drowning process.
Getting them out of the water achieves that.
Anything that slows that down is bad.
Wow, this is tricky.
Go get em Mr Hasselhoff...



Whats your problem? Why do you have too be such a jerk? I thought we are all here to exchange information and share experiances. I guess some are just here to be rude and slam people who dont do things the way you do. Get over yourself.

I guess you missed when I said in some systems you do what the people that run it say or you dont work at all. It has nothing to do with if you agree or not.

Maybe its not that way where you work. Good for you.

Most of our drownings are off of sea walls, so we have to deal with a 6' to 12' drop. The easiest way to get the patient out of the water and over the wall is to float an LSB under them, strap them down and lift or hoist. Maybe you think it better if we just throw a rope around their neck and pull. Your right, it would be quicker then messing with that stupid LSB.

[RyanEMVFD]

Our boards don't fit in bathtubs.

[mitllesmertz1]

https://www.pacificrescue.com/store.php?id=35078&c_id=21000

One option for pulling em out of water, takes about 2 secs to slip over head. If ya can't just drag them out, the sling is used to hoist them out.

Oh, and sorry for getting annoyed with the 'tards that can't make intelligent posts or string together a coherent sentence.
My mistake for expecting too much from the "professional" society we are.

[Scotttt]

Well, let me make a few comments.
1. Glad to see that CYA is still the excuse of choice for some providers.
2. The number one, most important goal in improving a drowning pt's outcome is to get ventilation restarted. Sure, they teach us how to do so in water rescue classes; however, having done this on a few occasions now, it is nearly impossible to get adeqaute ventilation with a pt floating/sinking in the water. Get the pt onto land as quickly as possible, any means necessary.
Eqaute this to a pt not breathing in a car on fire. Get the sense of urgency?
3. As noted by the Pediatric Emergency Care article, needless c-spice use is needless, and does interfere with rendering care. If it's not indicated, don't do it.

Please Please Please, from a former Navy aircrew SAR swimmer, get the damn pt out of the water immediately!!!!!!!!

The amusing aspect of these "discussions" is that you take the stance that anyone who practices differantly than you or evidence based medicine is somehow an utter fool or purposefully turning a blind eye to new realities/ideas. The simple truth is that many do not know any better; further, potential legal liability or "CYA" is a concern and an influence in all aspects of medical practice, certainly not lmited to paramedicine. You're not here as our great educator, a paramedic prophet here to enlighten us to new ideas or new studies. You're here to, essentially, stand on a pedestal and point fingers at the 'down-trodden idiot medics'. Again, MANY medics/emts were taught how to assess and treat in a certain manner. Many of them are not updated, many may not be allowed to act otherwise and may be forced to comply with "backwards" practices and protocols. You know it, but medical directors direct our actions in the field, if one says to board and collar everyone then until "we" convince that physician otherwise, we have to do it.

This all comes down to education. Many EMS institutions are less than optimal as far as the education given. But it's not far-fetched for a person enrolling in a program to expect a proper education and accept what is taught as fact and standard of care. Providers don't just reach down and pull the CYA concept from their *****, it's typically drilled in to their heads in all aspects of education. It may take years for the fear of litigation to wear off, for some it may never wear off.

In closing, get over yourself, Mittelschmerz (note: proper spelling of "mittlesmertz"... OMG, you horrible speller, you must be a dunce, a total ignoramus!!1!!1 :rolleyes: ). Anyone who follows discussion/arguments in this forum knows that your are experienced and knowlegable, but sometimes your pompous arrogance detracts just as much as your oft sounds logic and information adds.

[wnwd00]

i am in favor of a board/collar c-spine for the simple reason that is makes the patient easy to move as one unit as well as erring on the side of caution for the patient by providing c-spine.

of course as in any situation you always have to do what is the safest for everyone involved but even if the patient was "dragged" out of the water as somone suggested i still think that i would put the patient on a board for ease of transport as well as CYA. there is no reason not too, plus if anything ever did come from it you would get your butt handed to you in court because every piece of educational material i have read clearly indicates c-spine protection is indicated in any drowning with any suspicion of trauma. in my expierence working in an urban setting with pools and a different beach area most legit drownings are associated with trauma or alcohol which = c spine no matter which way you slice it.

[mitllesmertz1]

The amusing aspect of these "discussions" is that you take the stance that anyone who practices differantly than you or evidence based medicine is somehow an utter fool or purposefully turning a blind eye to new realities/ideas.
A well written response, Scottttt.
I do believe that many medics are utter fools, just for the record.
I believe my initial post said something like this, "How many of us routinely board and collar submersion victims?
From what I anecdotally hear, an aweful lot.
Why?"

From here I posted an interesting (to me) article that backs up something I believe. I perceive that many are doing something that goes against (1)common sense and (2)best practice for the patient.
I closed with a statement/question:"Do we folllow the evidence, or just do it to CYA?"
Seems like an ok post to me, fairly clear cut; the study found out of 2,244 submerged patients, only 11 had c-spine problems, and all of those had clear cut indicators of that injury.

In response to the post, I read this:"Case #2, about 3 months ago, gentleman dives into a swiming pool, strikes head on bottom, looses sensation to lower limbs. When we arive, patient is floating supine in the water, head/shoulders being supported by a bystander. This patient was given full c-spine treatment before removal from the water."
A poster used this an as example of why we should routinely board and collar patients in the water.

Now, does that make sense to you?

Other posters used the favorite "cya" excuse.
I take issue with using "cya" as a reason to validate any medical procedure, including c-collar/bboard. Unless there is a medically valid reason for doing it, I question why.
If all a poster can come up with is "cya" or "because I'm told to", I say that's not good enough.

My position is that we should strive for excellence, not mediocracy. We should go to the MD in charge and demand that policies be reviewed or changed.
We should continually look at what we are doing, and why we are doing it, and can we do it better?
I take issue with medics that think it's ok to get 1 or 2 tubes a year, or see 4 or 5 critical patients a month.
I expect medics to be excellent at what they do, not just "ok".
Some medics out there are content to lay down, take the easy way, don't buck the system, and use "cya" or "it's the protocol" as an excuse.
I challenge all of us to do more.

If that comes across as being on a pedestal, so be it.
But I HAVE gone to the MD.
I HAVE fought for change.
I HAVE helped to write new protocols, even though it wasn't accepted, I tried.
So I feel like I have the right to challenge others to do the same.

A constant thread on these boards relates to the lack of respect, lack of pay, and lack of "advanced practice" given to medics nationally.
I would ask, what have you done to earn it?


In closing, get over yourself, Mittelschmerz (note: proper spelling of "mittlesmertz"... OMG, you horrible speller, you must be a dunce, a total ignoramus!!1!!1 :rolleyes: ).
A nice point, Scotttt, but if you've been around a while you may have noticed this is my third screen name- from Mittelschmerz, to Mitllesmertz, to Mitllesmertz1.
When ya can't remember the damn password, sometimes ya just make a new screen name.
I doubt you routinely spell your name as SCOTTTTT either, correct?
You can spell your name, right? :)

Anyone who follows discussion/arguments in this forum knows that your are experienced and knowlegable, but sometimes your pompous arrogance detracts just as much as your oft sounds logic and information adds.
Well, I guess I could try to be a little more user friendly.
And as has been noted before, I am a Paragod.

[Dave1983]

A well written response, Scottttt.
I do believe that many medics are utter fools, just for the record.
I believe my initial post said something like this, "How many of us routinely board and collar submersion victims?
From what I anecdotally hear, an aweful lot.
Why?"

From here I posted an interesting (to me) article that backs up something I believe. I perceive that many are doing something that goes against (1)common sense and (2)best practice for the patient.
I closed with a statement/question:"Do we folllow the evidence, or just do it to CYA?"
Seems like an ok post to me, fairly clear cut; the study found out of 2,244 submerged patients, only 11 had c-spine problems, and all of those had clear cut indicators of that injury.

In response to the post, I read this:"Case #2, about 3 months ago, gentleman dives into a swiming pool, strikes head on bottom, looses sensation to lower limbs. When we arive, patient is floating supine in the water, head/shoulders being supported by a bystander. This patient was given full c-spine treatment before removal from the water."
A poster used this an as example of why we should routinely board and collar patients in the water.

Now, does that make sense to you?

Other posters used the favorite "cya" excuse.
I take issue with using "cya" as a reason to validate any medical procedure, including c-collar/bboard. Unless there is a medically valid reason for doing it, I question why.
If all a poster can come up with is "cya" or "because I'm told to", I say that's not good enough.

My position is that we should strive for excellence, not mediocracy. We should go to the MD in charge and demand that policies be reviewed or changed.
We should continually look at what we are doing, and why we are doing it, and can we do it better?
I take issue with medics that think it's ok to get 1 or 2 tubes a year, or see 4 or 5 critical patients a month.
I expect medics to be excellent at what they do, not just "ok".
Some medics out there are content to lay down, take the easy way, don't buck the system, and use "cya" or "it's the protocol" as an excuse.
I challenge all of us to do more.

If that comes across as being on a pedestal, so be it.
But I HAVE gone to the MD.
I HAVE fought for change.
I HAVE helped to write new protocols, even though it wasn't accepted, I tried.
So I feel like I have the right to challenge others to do the same.

A constant thread on these boards relates to the lack of respect, lack of pay, and lack of "advanced practice" given to medics nationally.
I would ask, what have you done to earn it?


A nice point, Scotttt, but if you've been around a while you may have noticed this is my third screen name- from Mittelschmerz, to Mitllesmertz, to Mitllesmertz1.
When ya can't remember the damn password, sometimes ya just make a new screen name.
I doubt you routinely spell your name as SCOTTTTT either, correct?
You can spell your name, right? :)


Well, I guess I could try to be a little more user friendly.
And as has been noted before, I am a Paragod.

Well, I should just let this go, as its clear youve got a major burr under your saddle, or I peed in your Capn Crunch (not sure which). But as you've pointed out, Im not very bright.

I didnt use that example in the way you read it. It was an example as to why you should c-spine certain patients and not just jerk them out of the water, every time, as you suggest.

I also dont understand why you cant grasp the fact that some of us work in systems were we MUST do what we are told, like it or not, or we will find ourselves out of work. Other posters understand this, why cant you? I guess its just easier to call us all idiots and crappy providers for following protocol then try and see things through our eyes.

[mitllesmertz1]

I guess its just easier to call us all idiots and crappy providers for following protocol then try and see things through our eyes.
No sir, I call people idiots to cover up my own sense of insecurity brought about by the lack of a warm, nuturing environment when I was a child.
I believe what I just stated was, if your protocol doesn't make sense, or strikes you as wrong, asinine, or ***-backwards, do something about it.

When the response to someone who questions your actions is, "because thats what I'm told to do", there are some people that might say, "well, that's kinda stupid."
And as a wise man once said,
"Stupid is as Stupid Does, Sir."

If you don't strive for change, who else will?

[Dave1983]

No sir, I call people idiots to cover up my own sense of insecurity brought about by the lack of a warm, nuturing environment when I was a child.

Well, sorry to hear that...Ill share my Capn Crunch. :D

[mitllesmertz1]

It's taken alot of money and years of therapy to be able to say that...

[medx69]

I was a lifeguard in 7th-12th grade and was taught c-spine and boarding in the water , still use it today.

[LasVegasEMS]

I was a lifeguard in 7th-12th grade and was taught c-spine and boarding in the water , still use it today.

Who let their little brother on their screen name???

[mitllesmertz1]

this one time, at band camp...

[LasVegasEMS]

this one time, at band camp...

You put a backboard where.....................?

[armymedic571]

You put a backboard where.....................?

Mit... Nice to see your sense of Humor is not lacking.

Let me say I agree with you. Getting the person out of the water is priority. It is possible to maintain C-spine control (IF NECESSARY) without placing the pt on a back board. I will contend however, that if there is a suspected neck or back injury and the scene is safe. I would consider placing C-spine precautions in the water. This is situationally dependant, but I would consider it.

On another note... Mitlle I would also agree that paramedics in some areas are undereducated (and don't even known it). 'We' as a group need to start avocating for one another. It is obvoius to me that groups like NR and NAEMT are not going the distance.

OK..

[shrevo23]

Back to basics...I do believe that proper c-spine control would also = Better airway control wether advanced or basic interventions are used. The use of a spineboard just makes sense when it comes to moving any unresponsive patient.

No brainer

shrevo23

[hfd326]

Mitl question for you.
You get called to an apt. complex pool, upon arrival you find Buffy the bystander doing CPR on a 60yoa overweight male, who is unresponsive and was apparently swimming (wet, has on swim suit). The male has relatively ok color (for the situation) and is still warm to the touch. There are no other remarkable findings. Buffy says that she was walking by approx 5min ago and saw him partialy submerged. She stated that she pulled him out of the water, started CPR and called 911 on her Pink Razor cell phone. Do you board and collar?

[ElectricHoser]

(I'm only a lowly First Responder now, but I used to be an EMTB, and I stayed at the Holiday Inn Express last night.)

Item #1: Is an Airway established?
Item #2: Is the pt Breathing?
Item #3: Is the pt's blood Circulating?

If the answer to any of those is "no", the only reason a backboard should immediately get involved is if it will be specifically useful in changing the answers to "yes".

No place for a collar or c-spine management until all the answers are "yes". Basics!

After that is settled, it would depend on the MOI, no different than any other call.

[DeputyMarshal]

After that is settled, it would depend on the MOI, no different than any other call.

No MOI is known but trauma is a distinct possibility.

Spinal precautions are indicated.

[hfd326]

Burford et al said: "If the history of the submersion event is clear and does not appear to include a risk of significant trauma, routine spinal immobilization and radiographs are probably unnecessary."

It appeares that for unknown situations Burford et al support full spinal imobilization.

May be a better question would be: If there is no suspected trama incured in the incident do we still board and/or collar the pt? If so why.

I'd board if CPR is in progress just for the compression surface and ease of movement.

[btroutm]

Item #1: Is an Airway established?
Item #2: Is the pt Breathing?
Item #3: Is the pt's blood Circulating?
...
No place for a collar or c-spine management until all the answers are "yes". Basics!
ElectricHoser, in patients with a possible spinal injury, C-spine maintenance should be initiated as you check the Airway and continued throughout the call until the pt is immobilized. You should not be working on Breathing and Circulation without some sort of C-spine maintenance (either manually or with a collar, preferably both). Performing CPR can cause significant movement of the patient's head and neck if they're not properly supported. It wouldn't make much sense to get someone breathing again if you cause significant c-spine injury in the process.

hfd326, to answer your hypothetical... yes, I would immobilize this pt because there is the possibility of significant spinal trauma. Since it was unwitnessed, there's no way to determine what caused the pt to become unresponsive (i.e., perhaps the pt dove head-first into the shallow end). It is similar to when you find an unresponsive pt on the ground and nobody knows how the pt ended up that way - immobilization is indicated.

[Resq14]

ElectricHoser, in patients with a possible spinal injury, C-spine maintenance should be initiated as you check the Airway and continued throughout the call until the pt is immobilized. You should not be working on Breathing and Circulation without some sort of C-spine maintenance (either manually or with a collar, preferably both). Performing CPR can cause significant movement of the patient's head and neck if they're not properly supported. It wouldn't make much sense to get someone breathing again if you cause significant c-spine injury in the process.

hfd326, to answer your hypothetical... yes, I would immobilize this pt because there is the possibility of significant spinal trauma. Since it was unwitnessed, there's no way to determine what caused the pt to become unresponsive (i.e., perhaps the pt dove head-first into the shallow end). It is similar to when you find an unresponsive pt on the ground and nobody knows how the pt ended up that way - immobilization is indicated.

Could some please point me to a real case where a drowning patient received CPR but was paralyzed/died, *AND* poor spine management during resucitative efforts was the PROXIMATE CAUSE of said death/paralysis???

Sounds like a chicken/egg thing to me...

Enough from the peanut gallery. Please, carry on.

[mitllesmertz1]

I would be willing to play the odds on this one.
Is it more likely that (a) the obese 60 year old made a beautiful swan dive into the pool, landed on their head, fractured their spine, and then became unconscious/apneic/dead?
or (b) they had a catastrophic medical event that resulted in being dead?
Personally I'm not too worried about cspine on this one.
Change it to a 16 year old at the beach? sure.
A 20 year old at the pool with his buddies?sure.

And, the point of the discussion was people fumble-f***kin around IN THE WATER with cspine. If they're already out, throwing a collar on em costs little or no time at all.
Of course, our lawyer/EMT's will hold the little bystander fully responsible for paralyzing this clearly traumatically injured dead person....

[ElectricHoser]

ElectricHoser, in patients with a possible spinal injury, C-spine maintenance should be initiated as you check the Airway and continued throughout the call until the pt is immobilized. You should not be working on Breathing and Circulation without some sort of C-spine maintenance (either manually or with a collar, preferably both). Performing CPR can cause significant movement of the patient's head and neck if they're not properly supported. It wouldn't make much sense to get someone breathing again if you cause significant c-spine injury in the process.

I don't disagree. I'm no EMS expert, but I did allude to what you're saying with my next sentence.. "If the answer to any of those is "no", the only reason a backboard should immediately get involved is if it will be specifically useful in changing the answers to "yes"."

Thanks.

[hfd326]

I would be willing to play the odds on this one.
Is it more likely that (a) the obese 60 year old made a beautiful swan dive into the pool, landed on their head, fractured their spine, and then became unconscious/apneic/dead?
or (b) they had a catastrophic medical event that resulted in being dead?
Personally I'm not too worried about cspine on this one.
Change it to a 16 year old at the beach? sure.
A 20 year old at the pool with his buddies?sure.

And, the point of the discussion was people fumble-f***kin around IN THE WATER with cspine. If they're already out, throwing a collar on em costs little or no time at all.
Of course, our lawyer/EMT's will hold the little bystander fully responsible for paralyzing this clearly traumatically injured dead person....


I half agree and half disagree with you.

I disagree with you on the scenario. With out knowing what the history of the submersion event is, full c-spine precautions are warranted. Burford et al seem to agree when they state: "If the history of the submersion event is clear and does not appear to include a risk of significant trauma, routine spinal immobilization and radiographs are probably unnecessary."
Now I would agree if it is a known medical event c-spine precautions would not be warranted.

I agree with you that completing full c-spine precautions in the water on a patient in respiratory and/or cardiac arrest is wasting time, and that geting them to an area where efficent CPR can be preformed is parmount. But in moving them I would also attempt to maintain as much c-spine stabilization as possible.

[ElectricHoser]

Performing CPR can cause significant movement of the patient's head and neck if they're not properly supported. It wouldn't make much sense to get someone breathing again if you cause significant c-spine injury in the process.

In retrospect, I am going to disagree on that one. It sounds like you just said that it makes no sense to resuscitate if you might paralyze. Better dead than disabled? I don't really think you meant it that way. I have no doubt that on a scene you and I would work without disagreement. Just splitting hairs over semantics.... no flame intended. ;)

[btroutm]

In retrospect, I am going to disagree on that one. It sounds like you just said that it makes no sense to resuscitate if you might paralyze. Better dead than disabled? I don't really think you meant it that way. I have no doubt that on a scene you and I would work without disagreement. Just splitting hairs over semantics.... no flame intended. ;)

I didn't mean to imply generally that it is better to be dead than paralyzed, only that it is better to be alive without paralysis than with paralysis and c-spine control during CPR could make that difference (although I'm sure that occurrence would be rare). My point is that, if you have the manpower, c-spine maintenance should by initiated immediately (out of the water... I would only bother attempting spinal immobilization in the water in cases with obvious head/neck/spine injuries, such as a witnessed head-first dive into the bottom of the pool) and maintained throughout the call. Now, if you're by yourself or with one other person and resources are limited, CPR obviously trumps c-spine (although if you're working on a rig and have at least two people, one person could certainly take the time to throw a collar on).