Tactical combat casualty care ( TCCC )
- Thread starter starlight_745
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D
docrogerking
Guest
Thanks for the welcome. I look forward to your comments and, as you say, stimulating conversation. Fire away with any questions if you think I might have an answer. Cheers
Roger
Roger
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Roger,
You seem to have created quite a snowball in the medical world at least. Now we just have to roll it down hill and see if stuff sticks to it.
Granted it will be hard to get the integration of zero trades and medical in one course but all those hurdles can be overcome if the leadership wants the best training for their troops. Your integration of the Course O as the Target Combat arms branch and then a MO being the adviser seems to be the best way to go. What about the training cadre? Are the medics predominately in the classroom for your model and then as DS assessors in the field with the combat arms instructors?
I the reserve world we have infanteers with their PCP and even MD and RNs. We then have medics who are SWAT. How would you see the integration.
IMHO I would like to see the medics take charge of the theoretical portion until the application phase. Then during the field phase have the medics take an advisory stance and let the tactics direct the care. I know you touched on the way it was implemented in your earlier post but I would ask you to go more into detail so that we could start to have an idea of the way this will actually work in the future in the nitty gritty.
Who is the Crs WO Med or Cbt Arms
Who are the Secton/syndicate commanders Med Or Cbt Arms
etc.
GF
You seem to have created quite a snowball in the medical world at least. Now we just have to roll it down hill and see if stuff sticks to it.
Granted it will be hard to get the integration of zero trades and medical in one course but all those hurdles can be overcome if the leadership wants the best training for their troops. Your integration of the Course O as the Target Combat arms branch and then a MO being the adviser seems to be the best way to go. What about the training cadre? Are the medics predominately in the classroom for your model and then as DS assessors in the field with the combat arms instructors?
I the reserve world we have infanteers with their PCP and even MD and RNs. We then have medics who are SWAT. How would you see the integration.
IMHO I would like to see the medics take charge of the theoretical portion until the application phase. Then during the field phase have the medics take an advisory stance and let the tactics direct the care. I know you touched on the way it was implemented in your earlier post but I would ask you to go more into detail so that we could start to have an idea of the way this will actually work in the future in the nitty gritty.
Who is the Crs WO Med or Cbt Arms
Who are the Secton/syndicate commanders Med Or Cbt Arms
etc.
GF
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Sorry Spr.
That is not Combat first aid. What you learned for your tour was a stop gap measure. The literature now says that an IM injection of Morphine will not do much good, and High volumes of Crystaloids pre-facility may do more harm than good.
Neither of these measures are taught on the TCCC course. What is taught is how to deal with the big life threatening ABC until you can get to a medic.
Please see the thread on fluid resuscitation for more info or better yet talk to DF (ParaMedTec) he is quite current on latest trauma theory from a pre-hospital POV.
GF
That is not Combat first aid. What you learned for your tour was a stop gap measure. The literature now says that an IM injection of Morphine will not do much good, and High volumes of Crystaloids pre-facility may do more harm than good.
Neither of these measures are taught on the TCCC course. What is taught is how to deal with the big life threatening ABC until you can get to a medic.
Please see the thread on fluid resuscitation for more info or better yet talk to DF (ParaMedTec) he is quite current on latest trauma theory from a pre-hospital POV.
GF
L
locdawg
Guest
I work for the Canadian distributor of QuikClot and other wound care I couldn't help but noticing that our product seems to be somewhat of a topic in this forum. I would be happy to address any questions or comments (positive or negative) on the product and its usefullness in the battlefield and training ground.
Thank You
Andy
Thank You
Andy
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MedCorps said:
Yes there was conciderable interest in the product as with the US until field trials found that if used in instances like above there can be dire repercussions.
More study and increased attention to protocol must be in place before we start issuing this to members.
I would much rather have the TCCC pers use direct pressure and tourniquets and then evac were medical professionals can deal with the issue.
IMHO
D
docrogerking
Guest
RN PRN,
Your comments on QuikClot I second. Having reviewed extensive data on the subject and having had the input from experts in the field (Both US and Canadian) there is no doubt that using QuikClot is potentially dangerous. The issue of users not following the correct procedures is true (see field report) but even so, there are other products that seem more efficacous and don't have the exothermic reaction associated with it.
Also, thanks for clearing up the misconception that TCCC and Combat First Aid are the same. Nothing could be further from the truth as you know. IM morphine is dangerous and should be considered for discontinuation due to the slow onset of action and the propensity for users to give a second dose due to the slow onset, thus causing side effects. Also, the contraindications to morphine use frequently prohibit its use on the battlefield (altered Level of consciousness, difficulty breathing, uncontrolled hemorrhage and hypotension). Unlike what we see from Hollywood, using morphine for combat casualties should be the exception rather than the rule. Likewise, data from many surgical studies has shown that there may be a propensity to a higher mortality rate if liberal fluid rescuscitation is given to victims with uncontrolled hemorrhage. Permissive hypotension is the rule of thumb, i.e. in a patient with uncontrolled hemorrhage, if they can perfuse their brain enough to stay awake, who cares what their blood pressure is. You treat the patient not the monitor. Those are two good examples of how medical treatment has evolved in the last two decades wrt combat casulaties. TCCC takes into account thes issues and more, such as: medical rescue under fire, medical interventions under fire, CPR in the trauma victim, C-spine immobilization in the penetrating trauma victim, battlefield antibiotics, tourniquets, carries, lifts, and mobilization techniques, and the list goes on. The point is, TCCC is, in no way, combat first aid and confusing the two is the first misconception that needs to be cleared up in the military community.
I'm not telling you anything you don't already know. I'm merely posting these comments for the wider audience.
Now, to answer your earlier questions. The training cadre for our pilot consisted of 031 and 711 MOC's. All were put through a week of trianing and lecture standarization prior to the course commencing. That way, the entire course staff was working off the same page. So, in a way, the 031 staff had taken the academic part of the course prior to the course commencing. The Crse O wasn't the only zero trade. There was also the course warrant O and there were two 031 MCpl/Sgt's. The MCpl/Sgt's were the tactical advisors / Tactical assessors but also attended all lectures, again so we were all on the same page. Also, they gave comments and a "tactical face" to the classroom discussions. The medics were classroom instructors and were medical assessors in the field. So after every scenario, candidates got debriefed on both their medical and tactical approach to the scenario. The section commanders and sections were candidates themselves. They were asked to go into a scenario with a candidate section commander and a candidate "acting as TCCC medic". That way two people got assessed in different areas for each scenario. The overriding concern is obviously the medical stuff, but if their tactics were such that they were getting members of their section "killed" then that was also addressed. Unlikely we would fail someone off the course for their tactics unless they were grossly incompetent. That's what I mean by integrated, and that's why I think it's going to be so hard for the CF to standardize a course like this. I've done briefings in Ottawa on this course, and I can tell you, in my opinion, it's not going to be an easy sell to acheive the type of course that is required.
I believe that was all your questions.
Obviously, I have been through the buildup phase of this initiative and I can tell you that it worked very well when there was that level of intimate cooperation. However, what I've seen since has amounted to a bit of a turf battle between zero trades and med branch about who's responsible for what. In the end, that just results in a suboptimal product for the soldiers on the pointy end.
Just my thoughts.
Roger
Your comments on QuikClot I second. Having reviewed extensive data on the subject and having had the input from experts in the field (Both US and Canadian) there is no doubt that using QuikClot is potentially dangerous. The issue of users not following the correct procedures is true (see field report) but even so, there are other products that seem more efficacous and don't have the exothermic reaction associated with it.
Also, thanks for clearing up the misconception that TCCC and Combat First Aid are the same. Nothing could be further from the truth as you know. IM morphine is dangerous and should be considered for discontinuation due to the slow onset of action and the propensity for users to give a second dose due to the slow onset, thus causing side effects. Also, the contraindications to morphine use frequently prohibit its use on the battlefield (altered Level of consciousness, difficulty breathing, uncontrolled hemorrhage and hypotension). Unlike what we see from Hollywood, using morphine for combat casualties should be the exception rather than the rule. Likewise, data from many surgical studies has shown that there may be a propensity to a higher mortality rate if liberal fluid rescuscitation is given to victims with uncontrolled hemorrhage. Permissive hypotension is the rule of thumb, i.e. in a patient with uncontrolled hemorrhage, if they can perfuse their brain enough to stay awake, who cares what their blood pressure is. You treat the patient not the monitor. Those are two good examples of how medical treatment has evolved in the last two decades wrt combat casulaties. TCCC takes into account thes issues and more, such as: medical rescue under fire, medical interventions under fire, CPR in the trauma victim, C-spine immobilization in the penetrating trauma victim, battlefield antibiotics, tourniquets, carries, lifts, and mobilization techniques, and the list goes on. The point is, TCCC is, in no way, combat first aid and confusing the two is the first misconception that needs to be cleared up in the military community.
I'm not telling you anything you don't already know. I'm merely posting these comments for the wider audience.
Now, to answer your earlier questions. The training cadre for our pilot consisted of 031 and 711 MOC's. All were put through a week of trianing and lecture standarization prior to the course commencing. That way, the entire course staff was working off the same page. So, in a way, the 031 staff had taken the academic part of the course prior to the course commencing. The Crse O wasn't the only zero trade. There was also the course warrant O and there were two 031 MCpl/Sgt's. The MCpl/Sgt's were the tactical advisors / Tactical assessors but also attended all lectures, again so we were all on the same page. Also, they gave comments and a "tactical face" to the classroom discussions. The medics were classroom instructors and were medical assessors in the field. So after every scenario, candidates got debriefed on both their medical and tactical approach to the scenario. The section commanders and sections were candidates themselves. They were asked to go into a scenario with a candidate section commander and a candidate "acting as TCCC medic". That way two people got assessed in different areas for each scenario. The overriding concern is obviously the medical stuff, but if their tactics were such that they were getting members of their section "killed" then that was also addressed. Unlikely we would fail someone off the course for their tactics unless they were grossly incompetent. That's what I mean by integrated, and that's why I think it's going to be so hard for the CF to standardize a course like this. I've done briefings in Ottawa on this course, and I can tell you, in my opinion, it's not going to be an easy sell to acheive the type of course that is required.
I believe that was all your questions.
Obviously, I have been through the buildup phase of this initiative and I can tell you that it worked very well when there was that level of intimate cooperation. However, what I've seen since has amounted to a bit of a turf battle between zero trades and med branch about who's responsible for what. In the end, that just results in a suboptimal product for the soldiers on the pointy end.
Just my thoughts.
Roger
L
locdawg
Guest
Interview with
Captain Frank K. Butler, M.D.
Command Surgeon United States Special Operations Command
Q: What are some of the promising technology solutions currently emerging that might enhance emergency medical care on the battlefield in the near future?
A: Penetrating head trauma or other wounds that are inevitably fatal cause many of our deaths on the battlefield. The battlefield trauma care that holds the most promise is that aimed at effectively addressing preventable causes of death. We are making some real progress here. The most common cause of preventable death on the battlefield is bleeding to death from extremity wounds. The Institute of Surgical Research has just completed testing of commercially available tourniquets and recommended two: the Combat Application Tourniquet System for all combatants and the EMT tourniquet for combat medics. We are moving forward with field-testing on both of these items. Using the TCCC Transition Initiative, the elapsed time between ISR identifying the best tourniquet for SOF operators and the time when we began fielding it for deploying SOF units was less than a month.
Bleeding to death from torso wounds where the source of bleeding is accessible by the first responder is another cause of preventable death. The MRMC has tested the HemCon dressing and found it to be effective in stopping this type of bleeding. We have been fielding this dressing for several years. The Committee on Tactical Combat Casualty Care has recently conducted a review of hemostatic agents and updated guidelines, to be published next year, to incorporate the use of QuikClot into the hemostasis algorithm as well. The anticipated guidelines will call for HemCon to be used first in situations where hemostatic agents are appropriate and QuikClot to be used as the second option if HemCon is not effective.
Other promising technologies that might help first responders save lives on the battlefield are hemoglobin-based oxygen carriers, better prevention and treatment of hypothermia in casualties, better airway devices, an injectable hemostatic agent for internal bleeding and adding improved casualty evacuation equipment to the vehicles currently being used for combat operations.
Perhaps most important of all is for us to continue to work to ensure our deploying forces have today's technology and the best training possible.
Thanks for getting back to me so quickly:
It seems that the USSOCOM is starting to think a bit differently now. Every US Marine in the United States is also carrying a pouch of QuikClot and some are using it with amazing results. It is true that the product should not be used in all major trauma, but in some cases it can save lives.
Andy
Captain Frank K. Butler, M.D.
Command Surgeon United States Special Operations Command
Q: What are some of the promising technology solutions currently emerging that might enhance emergency medical care on the battlefield in the near future?
A: Penetrating head trauma or other wounds that are inevitably fatal cause many of our deaths on the battlefield. The battlefield trauma care that holds the most promise is that aimed at effectively addressing preventable causes of death. We are making some real progress here. The most common cause of preventable death on the battlefield is bleeding to death from extremity wounds. The Institute of Surgical Research has just completed testing of commercially available tourniquets and recommended two: the Combat Application Tourniquet System for all combatants and the EMT tourniquet for combat medics. We are moving forward with field-testing on both of these items. Using the TCCC Transition Initiative, the elapsed time between ISR identifying the best tourniquet for SOF operators and the time when we began fielding it for deploying SOF units was less than a month.
Bleeding to death from torso wounds where the source of bleeding is accessible by the first responder is another cause of preventable death. The MRMC has tested the HemCon dressing and found it to be effective in stopping this type of bleeding. We have been fielding this dressing for several years. The Committee on Tactical Combat Casualty Care has recently conducted a review of hemostatic agents and updated guidelines, to be published next year, to incorporate the use of QuikClot into the hemostasis algorithm as well. The anticipated guidelines will call for HemCon to be used first in situations where hemostatic agents are appropriate and QuikClot to be used as the second option if HemCon is not effective.
Other promising technologies that might help first responders save lives on the battlefield are hemoglobin-based oxygen carriers, better prevention and treatment of hypothermia in casualties, better airway devices, an injectable hemostatic agent for internal bleeding and adding improved casualty evacuation equipment to the vehicles currently being used for combat operations.
Perhaps most important of all is for us to continue to work to ensure our deploying forces have today's technology and the best training possible.
Thanks for getting back to me so quickly:
It seems that the USSOCOM is starting to think a bit differently now. Every US Marine in the United States is also carrying a pouch of QuikClot and some are using it with amazing results. It is true that the product should not be used in all major trauma, but in some cases it can save lives.
Andy
L
locdawg
Guest
Here are some frequently asked questions on QuikClot:
Q. How Does QuikClot Work?
A. It works by providing a hemo-concentration effect in the blodd that is exiting a wound. The body's natural clotting process is accelerated by the increased concentration of platelets and clotting factors at the wound site.
Q. What Causes the Hemo-Concentration?
A.QuikClot's main component material is called an adsorbent, it is actually a synthetic derivative of volcanic rock. It has many pores, internal and external, which capture and hold the water molecules that make up the majority of the blood. The ability to attract and hold the water molecules is due to the electrostatic forces that are present in the pores of QuikClot material when it is dry and are liberated when the QuikClot is saturated. These are the same types of forces that cause static cling, but in the formulation of QuikClot, they are much stronger. Water molecules are held very strongly.
The clotting factors, protiens in the blood, and the cellular components of the blood are not attracted nor held by the QuikClot, because they are simply too big to fit in the pore structure of the QuikClot material. This leaves them free to do their work at the wound site.
Q. Is there a chemical reaction involved?
A. No, the interaction of the QuikClot and the water in the blood (called adsorption) is purely physical in nature. Upon application, QuikClot rapidly attracts water molecules, and almost instantly the internal pores are filled. There are no chemical changes to the blood, the water, or the QuikClot. Since the reaction is physical, and not biological or chemical, there is almost no chance for an allergic reaction to occur.
Q. Are there any side effects?
A. The adsorption of water into the QuikClot granules can cause an instantaneous release of heat, called an exothermic reaction. The release of heat stops when the pores of QuikClot become filled, when due to QuikClot's strong attraction for water, is only a second or two.
Q. What Causes the Heat?
A. The heat is generated by a phenomenon called the Heat of Absorbtion. The electrostatic charge in each pore of the QuikClot, which attracts the water molecules, is released when the pore is filled. The liberated enegy is in the form of heat.
If you have any more questions on QuikClot would be happy to answer them for you.
Thanks Andy
Q. How Does QuikClot Work?
A. It works by providing a hemo-concentration effect in the blodd that is exiting a wound. The body's natural clotting process is accelerated by the increased concentration of platelets and clotting factors at the wound site.
Q. What Causes the Hemo-Concentration?
A.QuikClot's main component material is called an adsorbent, it is actually a synthetic derivative of volcanic rock. It has many pores, internal and external, which capture and hold the water molecules that make up the majority of the blood. The ability to attract and hold the water molecules is due to the electrostatic forces that are present in the pores of QuikClot material when it is dry and are liberated when the QuikClot is saturated. These are the same types of forces that cause static cling, but in the formulation of QuikClot, they are much stronger. Water molecules are held very strongly.
The clotting factors, protiens in the blood, and the cellular components of the blood are not attracted nor held by the QuikClot, because they are simply too big to fit in the pore structure of the QuikClot material. This leaves them free to do their work at the wound site.
Q. Is there a chemical reaction involved?
A. No, the interaction of the QuikClot and the water in the blood (called adsorption) is purely physical in nature. Upon application, QuikClot rapidly attracts water molecules, and almost instantly the internal pores are filled. There are no chemical changes to the blood, the water, or the QuikClot. Since the reaction is physical, and not biological or chemical, there is almost no chance for an allergic reaction to occur.
Q. Are there any side effects?
A. The adsorption of water into the QuikClot granules can cause an instantaneous release of heat, called an exothermic reaction. The release of heat stops when the pores of QuikClot become filled, when due to QuikClot's strong attraction for water, is only a second or two.
Q. What Causes the Heat?
A. The heat is generated by a phenomenon called the Heat of Absorbtion. The electrostatic charge in each pore of the QuikClot, which attracts the water molecules, is released when the pore is filled. The liberated enegy is in the form of heat.
If you have any more questions on QuikClot would be happy to answer them for you.
Thanks Andy
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Once again I will stress,
The CF does not, I say again, NOT advocate the use of quickclot in any documentation that I have found.
Until such time as they do I would not encourage any CF pers from carrying this product while in uniform only because of the temptation of its use.
If this product is used incorrectly it has the potential to cause serious circulatory and nerve damage distal to the application site.
Please only use those procedures that you have been taught in CF sanctioned courses and training for first aid purposes.
GF
The CF does not, I say again, NOT advocate the use of quickclot in any documentation that I have found.
Until such time as they do I would not encourage any CF pers from carrying this product while in uniform only because of the temptation of its use.
If this product is used incorrectly it has the potential to cause serious circulatory and nerve damage distal to the application site.
Please only use those procedures that you have been taught in CF sanctioned courses and training for first aid purposes.
GF
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This is excellent. The info is great and will give everyone something to think of. I would like to know why all deploying pers are not getting this training in some form. My unit (CFJSR) sends people out the door every few months and only require them to have SFA. I wish we would have had this course for Kabul Roto 0 and in my det, myself and my partner in crime are ussually deploying by ourselves with limited security in some of the hottest places in the world. Although not a combat arms unit, we do deploy frequently.
D
docrogerking
Guest
Radop,
For what's it's worth, and having seen you guys work in '02 in Kandahar, I completely agree with you. You guys are a good example of a unit who, although not combat arms, could definitely use this training. All I can say is keep pushing for it and raising awareness at your level. The only reason we got the course off the ground within 1 CMBG in the first place was that we went straight to the operators and sold them on the idea. If we had left it to the med branch, well......., I fear we'd still be no further ahead. Not bitter, just realistic. Hope you've gotten something from my posts to date. Feel free to e-mail any questions. Cheers.
Roger
For what's it's worth, and having seen you guys work in '02 in Kandahar, I completely agree with you. You guys are a good example of a unit who, although not combat arms, could definitely use this training. All I can say is keep pushing for it and raising awareness at your level. The only reason we got the course off the ground within 1 CMBG in the first place was that we went straight to the operators and sold them on the idea. If we had left it to the med branch, well......., I fear we'd still be no further ahead. Not bitter, just realistic. Hope you've gotten something from my posts to date. Feel free to e-mail any questions. Cheers.
Roger
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Sorry but I lost the name of the cpl who wrote the Dispatches article but I was amazed that he was able to put that togeather and that his chain of command accepted to try it especially when it included coordination with the medical branch. I had heard that he is now a sar tech. I hope it is true as he seamed like a very knowledgeable person when it came to medical treatment in a field environment.
A question I have for you has to go with this scenerio in a field environment within Canada. We were on ex in Sept this year when a Sgt fell and struck his head on a rock and knocked himself out. We had no medical support but there were several of us who were First aid instructors. We wanted to immobilize him but a capt ordered us to put him on a stretcher and put him in the back of an LSVW to transport him to a hospital because they were concearned an ambulance would not be able to get to our location. The first aider on the scene advised them that this procedure was incorrect but they insisted. The first aider then log rolled him onto a litter and secured him in place.
Now my question. What type of training is given to officers in regards to safe practices for first aid (anything other than SFA)? Which would you have done, transport him yourself or wait for an ambulance? I actually got my first aid instructors course after this ex and have been mauling this over ever since. Thanks.
A question I have for you has to go with this scenerio in a field environment within Canada. We were on ex in Sept this year when a Sgt fell and struck his head on a rock and knocked himself out. We had no medical support but there were several of us who were First aid instructors. We wanted to immobilize him but a capt ordered us to put him on a stretcher and put him in the back of an LSVW to transport him to a hospital because they were concearned an ambulance would not be able to get to our location. The first aider on the scene advised them that this procedure was incorrect but they insisted. The first aider then log rolled him onto a litter and secured him in place.
Now my question. What type of training is given to officers in regards to safe practices for first aid (anything other than SFA)? Which would you have done, transport him yourself or wait for an ambulance? I actually got my first aid instructors course after this ex and have been mauling this over ever since. Thanks.
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I'll let someone else answer the first part about officer training.
A fall from a standing position may not seem like a big deal to some, but a blow to the head causing a loss of consciousness should immediately fall into the "high index of suspicion" category for head or spinal injury. This Sgt. should have had spinal precautions taken (collar and board), and then brought to a hospital for examination. The officer(s) should have waited for an ambulance to come out from the base. This was training, and there is no training important enough to risk a spinal injury to a member. If an LSVW was at the location, It could not have been that remote a spot. If it was remote, then a stretcher team could have been formed on direction of the medics to carry this man to the closest ambulance access point.
those are my 2 cents.
A fall from a standing position may not seem like a big deal to some, but a blow to the head causing a loss of consciousness should immediately fall into the "high index of suspicion" category for head or spinal injury. This Sgt. should have had spinal precautions taken (collar and board), and then brought to a hospital for examination. The officer(s) should have waited for an ambulance to come out from the base. This was training, and there is no training important enough to risk a spinal injury to a member. If an LSVW was at the location, It could not have been that remote a spot. If it was remote, then a stretcher team could have been formed on direction of the medics to carry this man to the closest ambulance access point.
those are my 2 cents.
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Thanks for confirming what I thought should have been done. As it turned out, he spent 10 days in hospital with his 7th concussion and was still having headaches up until the end of Nov. Our base is strange in that we have no medics on call after hours. The civis do this for the base. For some reason, they feel it is cheaper to do it this way. The accident was less than 20 meters from a "MSR" and I too believe an ambulance would have made it in. The powers that be desided that they could posibly be delayed so they sent him in a back of an LSVW because "it was only a bump on the head".
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In liue of the amb showing up, C-spine control can be improvised using a CF issued stretcher (more imp later) with tape, towel/blanket roles and manual stabilization in this case. Also in addition to the stretcher straps, tape the body to the stretcher (2 inch wide gun tape, packing tape etc) to ensure min movement is you have to rotate the patient for airway. As a dismounted medic in the fd we might not alwys have the luxury of a back board, so the goal then would be to min movement and ensuring airway patency as best you can in your scope.
So in this case, plywood, a 6 foot table, or even a large piece of cardboard that can fit into the back of the truck with manual stabilization would suffice.
With the LOC, this case is an urgent case and by right should be at care (Hospital, not just a UMS) within the hour (not condoning the descision).
A fall from above your body height in feet (ie, for me above 5 ft as I am 5'8") would be an absolute indication for c-spine precautions to be used. ref BTLS 5th ed.
So in this case, plywood, a 6 foot table, or even a large piece of cardboard that can fit into the back of the truck with manual stabilization would suffice.
old medic said:
With the LOC, this case is an urgent case and by right should be at care (Hospital, not just a UMS) within the hour (not condoning the descision).
A fall from above your body height in feet (ie, for me above 5 ft as I am 5'8") would be an absolute indication for c-spine precautions to be used. ref BTLS 5th ed.
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For those of you reading these posts down the road, I'm going to re-emphasis my saying "brought to a hospital" in the above posts,
and what Armymedic said about "Hospital, not just a UMS".
The only way to clear someone off a backboard is to take an x-ray or scan of the spinal column and look for injury.
Your not going to find that equipment in the UMS.
that said, I still run into the odd nurse who immediately pulls the collar and straps off a patient in a ED after asking the patient if
their neck is sore, or maybe feels along the cervical spine once........... :-X
and what Armymedic said about "Hospital, not just a UMS".
The only way to clear someone off a backboard is to take an x-ray or scan of the spinal column and look for injury.
Your not going to find that equipment in the UMS.
that said, I still run into the odd nurse who immediately pulls the collar and straps off a patient in a ED after asking the patient if
their neck is sore, or maybe feels along the cervical spine once........... :-X
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old medic said:
Not on my shift and not if you value your license.
Usually we will get the person of the back board ASAP once they are in the ED. Before we log roll them to assess the back we will do a full neurological exam including CSM. Once the patient is rolled and the spine is examined and palpated along with assessing rectal tone will we do away with the board. The collar will remain in place and the patient supine until the X-Ray / CT clears the spine. Then and only then will the collar be removed.
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