EMS Continuing Education
The Trends and Issues in EMS section of the EMS Continuing Education Portal will be dedicated to exploring the current research and topics impacting EMS Providers in the field. Though a majority of this content will focus on the quality improvement of patient care, we will from time to time spotlight non-care related topics; such as work environment, safety, wellness, specialized responses, and medico-legal issues
Back-boarding the patient; Is it time to let go of a “tradition”?
By now, surely you have heard of the evolving debate about the efficacy and effectiveness of spinal immobilization. Well, if you haven’t, here is a study and a presentation that you should check out. Unfortunately, the ubiquitous shape of EMS has been long forged by its “relationships” to several different industries. I say “unfortunately” because I feel that our tenet in EMS has been to fill a needed void, identified now some fifty years ago, at any cost while trying to serve multiple masters, if you will. What I mean to say is, who are we anyway? I mean aside from the obvious answers; do-gooders, adrenalin junkies, and those driven by a sense of moral servitude. Are we healthcare professionals, or some dysfunctional family member of multiple other industries?
The evolution of EMS has been an interesting one. From the days of morticians part-timing as ambulance drivers through to what many identify as the official birth of EMS by the efforts of the U.S. Department of Transportation. To this day, a rather advanced and invasive thing such as “saving a life” (outside of a healthcare facility, anyway) is regulated by an agency charged with “…ensuring a fast, safe, efficient, accessible, and convenient transportation system…” That strikes me as odd. That also helps me identify some of the challenges that have prevented, or at least impeded, our profession’s maturation and advancement. Not to mention the mission creep of other industries into our realm of operation (insert Fire Service, Law Enforcement, local and state Public Health, etc.)
But, I digress. Let’s pull in the reins a bit and focus on my original issue. If, within the healthcare industry, we are focused on evidence-based best practice, why are so me many of our colleagues reluctant to implement change (especially when we think about those practice changes that have a direct and life-altering effect on our number one priority; the patient)? I am confused. I constantly hear from colleagues (some of them quite brilliant and clinically adept) bemoan the narrowness and limit of our scope of practice. They drone on, lamenting about our hierarchal position in the healthcare food chain, in comparison to other healthcare professions (ie. nurses, physician assistants, nurse practitioners, respiratory therapists).
“We should be able to do that.”
“You can teach a monkey to that.”
Yet these same respected colleagues rebuff a well-respected and adhered to axiom held throughout all of healthcare professions; that ideal that patient care should be evidence-based. What does this “evidence-based” concept mean? Well, it means that what we are doing to patients has been scientifically proven (studies, data) to be of benefit and actually works. You’ve seen this in action before. Remember that last time you had to sit through one of those card classes?
“Oh, great! They’ve changed the compression to ventilation ratio again, so they can sell more books.”
“I don’t care what they say, I’m still gonna give lidocaine.”
We have all been there (or at least witnessed this train wreck of professionalism). But really, why do those “guidelines” change? Because real healthcare professionals have been out there working hard to either prove what we do really does work (not a coincidence) or to find the best way to accomplish a prescribed outcome. It’s called science. You know, that collection of tidbits that we were forced to learn during technician or paramedic school? The more delicate yet intricate aspects of “air goes in and out, blood goes ‘round and ‘round.”
Yes, science, my friends. It is what’s for dinner! Science validates, or changes, how we care for our fellow humans. It helps us determine patient care that produces positive outcomes. It even demonstrates, at times, that we, us, EMS, are invaluable part of the total patient care continuum. When was the last time you heard a patient outcome tied to something that EMS did or did not do? Exactly! It’s time we stop being a foregone conclusion. It’s time for us to move one over from the kiddy table and thrust ourselves into the grown-up conversation. Right after we start to change our practice, and our mindset; we must be compelled to provide evidence-based care management and implement industry best-practices into our operations.
I would like to leave this thought with the following tidbits of “science” from the guy behind the green curtain (for those of you who get the reference). We have long practiced the procedure of spinal immobilization and integrated it into our practice. So much so, that it is not a fundamental tenet of our being. Yet, what data or proof was cited for the inclusion of this procedure within our scope of practice? Frankly, I am not sure. What I am sure of, the amount of data now piling up out there demonstrating the not only a lack of a causal link between spinal immobilization and improved outcomes, but rather data showing that it may actually be detrimental to our patients.
I hope that you will take a few moments to review the study from School of Medicine at the University of New Mexico. And, if that wets your appetite, take a look at the presentation that Dr. George Lindbeck prepared and posted to the National Association of State EMS Officials website.
Hauswald, MD, M., Ong, G., Tandberg, MD, D., & Omar, Z. (1998). Out-of-hospital Spinal Immobilization: Its Effect on Neurologic Injury. Academic Emergency Medicine, 214-219.
Lindbeck, MD, G. (2012, January). Medical Directors Council Documents & Resources. Retrieved February 28, 2014, from National Association of State EMS Officials: