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A Solution in Search of a Problem?

In, we read about Lee County, FL adopting a cool new piece of spinal immobilization equipment:

With the field trial complete, the team gained the approval from the Lee County Protocol Committee in February 2013. In March 2013, the Lee County Medical Care Council unanimously approved the “XCollar and Discriminate Spinal Immobilization Guideline.” (See Figure 1.) The guideline went live in the third quarter of 2013.

Emegear returned to Lee County following the field trial and provided XCollar factory training, offering several sessions every day for a three-week period. This training touched over 250 field providers and 24 EMS supervisors.

More than 300 primary providers in the county were trained. When factory training was complete, the LCEMS Field Training Supervisors and FTOs—using the agency’s Mobile Simulation Lab—made rounds to the various fire districts and hospitals to educate their respective staffs.

I've seen the XCollar demonstrated at trade shows, and I've had it applied to myself. Without question, it's a nice piece of equipment, and does a far better job of immobilizing someone's neck than most traditional cervical collars.

Lost somewhere in the New Toy Euphoria, however, is the fact that no cervical collar or spine board – including their fancy new one – has been proven to benefit patients with spinal fractures in any way. There is a growing body of evidence of harm, and the only data to support the practice would seem to indicate that, at best, prehospital spinal immobilization does no further harm.

File that under: faint praise, damning with.

Knowing that, I can't help but observe that, increasingly, all these fancy adjuncts are simply solutions in search of a problem. I'm not criticizing the folks at Lee County, by any means. From reading the article, it seems that they're doing their best to adopt the guidelines set forth in NAEMSP's 2013 position paper on spinal immobilization. That's a step better than the way we used to do it, but let's not kid ourselves that what we're doing even now is supported by evidence.

It's not.

It's simply a compromise between the mountain of evidence that shows no benefit or evidence of harm, and some theoretical evidence of benefit yet to be found.

There's a word for that we use outside of scientific circles: wishful thinking.

It's stories like this that remind me of the similarities between EMS and the shooting community. Whether it is XCollars or tungsten 1911 guide rods or boutique bullets, we're all entranced by shiny new toys and most of us seem distressingly prone to belief that the Next Big Thing is an adequate substitute for better education and training.

And it would seem that none of us, no matter what our field of expertise, are immune to derp. I know EMS guys rabidly committed to evidence-based medicine, who will eagerly fork over money for the most ridiculous gun crap based upon some slick marketing video, and knowledgeable gun guys who absolutely believe in the anti-vaccine nonsense.

Weird, that.

Comments - Add Yours

  • Christopher

    I see this as a good thing.


    Let’s go to the land of make believe! A land where “spinal immobilization” saves lives and is what Jesus intended EMT’s and Paramedics apply in all traumatic situations.

    IF you believe in this magical spinal immobilization fairy tale, you should at least be good at it. Doesn’t help your cause when you half ass the immobilization with something like a standard C-collar. A device which barely immobilizes 50% of the patients it supposedly “fits”. So if you do believe in that fairy tale, the X-Collar is a better option.

    …or we could stop believing in fairy tales.

    • Toasted Medic

      Yes, but we are simply paramedics here to drive the taxi and do the bidding of our medical director overlords. But we wouldn’t want to actually practice medicine. We have to do EVERYTHING WE POSSIBLY CAN! And oh no, they’re videotaping us! Make sure to immobilize them even though they have no spinal deficits or any reason to do it. The video camera demands it.

      Face it, we live in the Matrix, truth is no what is important, it is what they tell us is important that matters. Now take your blue pill and stop your whining!

      • Ambulance_Driver

        Proof that what you say is not true:

        1. Rotating tourniquets

        2. PASG

        3. Procardia in CVA

        4. Prophylactic lidocaine in MI

        5. CPR with interposed ventilations at 5:1

        Practice changes as scientific evidence shows us the old way is ineffective or harmful, and points us to better treatments. If we treated patients based on what looked cool to Eyewitness News, you’d still be intubating every patient early and be giving all those pointless and ineffective artificial ventilations.
        If your system is really that regressive, then I suggest you find a new home with a more benevolent medical director overlord.
        Kelly Grayson

  • Old_NFO

    But the real problems go unsolved… Because those are HARD, and take research $$ and lots of practical testing (at cost)…

  • Ambulance_Driver

    Love it!

    Kelly Grayson

  • EMS Artifact

    More rearranging the deck chairs on the Titanic of blind cervical immobilization. Maybe some day the practice will catch up with the science. Right after those flying monkeys catapult out of my anus.

  • anon

    NH is moving in the right direction!

    From the latest NH Bureau of EMS newletter:

    The New Spinal Injury Protocol
    I would like to take this opportunity to address the upcoming Spinal Injury Proto-col. When developing the new protocol the Protocol Committee together with the Medical Control Board reviewed the position statement EMS Spinal Precautions and the Use of the Long Backboard by the National Association of EMS Physicians and American College of Sur-geons Committee on Trauma. Their statement concluded there is no evidence that the use of backboards provide any benefit to our patient, but could cause harm.
    The paper pointed to evidence that backboarding can cause harm by inducing:
     Pain
     Patient agitation
     Respiratory compromise
     Decreased tissue profusion, which can lead to pressure ulcers.
    The new protocol will include a spinal injury assessment; if the patient is ruled to have a potential spinal injury, they will be placed in “Spinal Motion Restriction” and not onto a backboard.