A Solution in Search of a Problem?

In JEMS.com, 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.

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