EMS Evolution: Relaxation of Spine (Back) Boarding Rules Ahead?

Not sure if anyone has noticed or not, but the National Athletic Trainers' Association has a new blog directed to professionals and students in the field.  Content is generated via professionals from around the country, and a couple of days ago one was brought to my attention.
You can read it here.

While the post doesn't delve into specifics, it does state that several protocol changes are occurring in the area of spine boarding...most notably the prospective omission of the use of spine boards with suspected cervical injuries.  EMS appears poised to begin transporting certain cases (I am unsure at this point as to which ones) with a cervical collar only.   As Dr. Swartz points out, this should really spur ATC's to meet with their local EMS provider(s) to discuss their current protocols and how it might affect your overall management.    I'll certainly be looking forward to the upcoming position statement...

In the meantime, consider my curiosity piqued.  Two questions linger for me:
Are backboards even effective?
Are cervical collars even effective?
So, I did a bit of searching and this is what I found.

This article challenges conventional wisdom (perhaps a better term is conventional practice) regarding the blanket use of cervical collars.  In fact, validation for challenging the efficacy of cervical collars was studied a decade ago.  Which ultimately lead me to this article, which was a real eye opener.  There are a number of valid points the article raises, and one of them is the topic of patient comfort.  Having seen a full body vacuum splint used when I was in France a few years ago, I can honestly say it makes a lot of sense to potentially use one of those as compared to a traditional spine board.  It seemed far more comfortable compared to it's stiff counterpart.

So after becoming  more convinced evidence is lacking, I stumbled upon  Neurosurgery PreHospital Cervical Spinal Immobilization After Trauma, which states virtually the exact opposite of what other studies are saying. 

Needless to say, it will be very interesting to see how this situation develops, both regionally and nationally.  While I fully realize I'm not answering any definitive questions here, I am trying to illustrate the difficulty clinicians face when attempting to best care for their patient.  That headache, neck and/or back pain may be exacerbated by the very tools we use to "safely" care for them.   

PowerPlay Cold & Compression Product Review

Earlier this month, I was contacted to complete a product review for PowerPlay Portable Cold & Compression systems.  I replied that I would be more than happy to do so.  Before we begin, I offer  that I am not receiving reimbursement of any kind, and offer my objective and unbiased view of the product. 

I was shipped the PowerPlay Standard Kit, which included the Cold and Compression Ankle Wrap and the  Knee Wrap.  The entire contents of the system, which was shipped in a convenient and small bag (14" x 10.5"), weighed less than 10 pounds.  My initial thoughts were that this is a fantastic, lightweight, portable system which would travel easily.  As an ATC who travels, this would certainly be very easy to toss into my checked baggage.  The product was clearly designed with efficiency and portability in mind.  That said, it would work very easily in a standard sports medicine clinic as well.
 

The directions for each "unit" came with easy to read instructions, which included both written and diagram instructions.  The instructions were quite simple and straightforward, covering everything from contraindications to battery life, true to electrical modality form.  Set up only took 3 minutes, but I was fiddling around with it.  By the third time I used it, I could set it up in under a minute and a half.  Ease of use is a tremendous bonus with this product. 

For the compression unit itself, these items were included:
1. PowerPlay Pump

2. Cloth Sleeve (this serves as a protective area for exposed skin)
3. Gel Pack (one each for ankle and knee)
4. Compression Wrap (one each for ankle and knee)

Prior to applying,  the gel packs must be frozen for a minimum of one hour, remove from the freezer and then attach them to the inside of the Compression Wraps.  This is done via velcro attachments, which fit quite snugly inside.   You simply had to fit the patient, then attach the hose to one of the three ports on the PowerPlay Pump, which you then turned on.  I love the fact that there were three different ports, as you can treat multiple regions/body parts at once. The pump is small, but very efficient and easy to use.  It only has four buttons, a Power On/Off, and one each for the port of choice. 

Once attached, you press the port of attachment, and choose a level of compression both appropriate and comfortable for the athlete.  I did notice a discrepancy here, as the instructions indicate you can choose between 30 mmHg and 70 mmHg of pressure, however the pump only displays 50-70 mmhg, in 5 mm increments.  Not a huge deal, but a discrepancy nonetheless.  Once you set the pressure, the unit will automatically turn on and provide intermittent compression for a 20 minute time period, automatically shutting off at the conclusion.  Again, the design is so convenient and easy to use, I could see myself utilizing this product on a very regular basis. 

During it's first trial run, I kept getting a "HI" message on the LED screen, which upon further inspection revealed cord compression (the athlete's leg was compressing the cord, impeding airflow).  Simply moving the chord was not difficult, as each compression wrap has a 5 foot long air hose, which I thought was well thought out.  Not everyone likes to have a compression unit buzzing on their chest during treatment! If you needed a longer one, an additional 5 foot extension was located in the bag as well.

The compression was uniform and quite comfortable, as opposed to say, plastic wrap around an ice bag on a joint, which can be effective but also uncomfortable.  It was also surprisingly cold (in a good way), which surprised me.  Sometimes feedback from athletes is that it's not cold enough when compared to ice, but with this product, it was definitely not an issue. The gel packs themselves were designed well, and I was particularly fond of the knee wrap, which left a horizontal opening in back, allowing for a comfortable treatment of the knee not only in extension, but stages of flexion as well.

The unit is powered by an internal NiMH battery, which according to the manufacturer will run the system for 4-6 hours prior to needing a charge.  A wall charger is included in the package.  Of interesting note, it is recommended that the battery be charged every 60 days while NOT in use, and will last for roughly 500 recharges in between replacements.   Translation:  this should last you a long time.

In terms of price, it is very comparable to similar systems.  It is more expensive than traditional CryoCuff systems, but much less expensive than a Game Ready, both of which require water and ice. While cold therapy has had it's knocks over the past few years, I do still believe that it has a place in treatment, and can plainly see the advantages to using this.  In my opinion, this is a sound product and investment in the care of your patients and athletes. 

Two Months on the Road...A Sochi Recap

As I type, it has been two months since I've set foot in the United States.  I had the pleasure of working with the United States Bobsled and Skeleton Team both prior to and through the Winter Olympics.  The experience was awesome... but it's always good to be home. Our travels took us through Germany, Switzerland, Austria, and onto Russia.  The following are some musings I've had both during and after this experience. While difficult to capture concisely, I'll do my best to keep a bullet item style entry list.   The list is random and in no particular order of importance.

The US Bobsled and Skeleton Federation was very successful at the Olympics, garnering at least one medal in each event.  Congrats to the following medalists whom I had the humble honor of working with:
Matt Antoine:  Bronze Men's Skeleton
Noelle Pikus-Pace:  Silver Women's Skeleton
Steve Holcomb & Steve Langton: Bronze Men's Two Man Bobsled
Steve Holcomb, Chris Fogt, Curt Tomasevicz & Steve Langton: Bronze Men's Four Man Bobsled
Elana Meyers & Lauryn Williams: Silver Women's Two Man Bobsled
Jamie Greubel & Aja Evans: Bronze Women's Two Man Bobsled

I would be remiss if I did not mention the rest of the athletes who competed at the highest level; there are many that were on the World Cup team who didn't make it to the Olympics, just as there were Olympic athletes who didn't garner a medal. Simply getting to that point is a feat in and of itself; they are all shining examples of devotion to their sport and truly embodied the Olympic ideals...my heart ached for them when they didn't achieve what they desired to.  Just because an athlete doesn't medal, doesn't mean that they aren't giving their all, and I think that can be easily dismissed.

Apologies to the Dos Equis Guy, but fellow ATC Byron Craighead (pictured above) may truly be the most interesting man in the world.

The Olympics were an emotional roller coaster.  I teared up more times in the past two months than in the past two years.  OK, that's not true. I tear up a lot.  But the moments were raw, real, emotional, and to be a part of that, even a bit part, will leave an indelible mark on this athletic trainer.

Regarding those who complained  the facilities/hospitality were subpar, my advice is simple.  Gain some perspective, or come travel with me to some parts of the world where everything isn't tailored exactly to one's lofty expectations.  In many ways the region reminded me of my travels in the Dominican Republic.  Applying "first world" logic to all parts of the world simply doesn't work.  I took the experience for what is was; brand new infrastructure that went up in the blink of an eye.  Was it perfect?  No...but I've yet to find perfect anywhere.  The lodging was fine; the volunteers were amazing!  Their spirit was palpable on all levels.  I'm not sure I could ask for much more considering the region we were in.  Of course, to be fair, this was my first Olympics, so if I were only comparing to other Olympics, my perspective or expectations may have been different.  The people were great, and they did their job...plain and simple.  They deserve our gratitude, not our complaints.

I felt euphoria marching during opening ceremonies.  Not sure I deserved to be there as much as others, but it's certainly how I felt walking into that stadium.  I heard many thought the sweaters were ugly, but I have to tell you, walking in wearing the letters USA on your back, amidst a sea of your fellow teammates instills a sense of pride that transcends fashion.

I may be a teacher, but this experience was a strong reminder that I am still a student; I learned a multitude of information on this journey.  I need to be better at maintaining this mindset on a more permanent basis.  Speaking of which, I have yet to find the book that explicitly guides me on how to remain a confident, assertive practitioner while also remaining open to new ideas, proven or not.  If you find one, let me know.  Better yet, maybe I should start writing it.  I should be ready by the time I'm 90.

Dry needling is not acupuncture.  But it kind of is?  I need to learn more about it, but it does fascinate me.

Athletic Training does not have to be reactionary practice (post-injury); it can be performance enhancing.

Athlete's often know their body better than coaches/therapists.  LISTEN to them.
Coaches/Therapists often know an athlete's body better than the athlete.  DISCUSS with them.  The problem that can arise is a LACK of, or complete omission of communication and open mindedness which can impede athletic performance.  We can all learn from each other if all parties knock down traditional walls of professions.  It's a complicated dance at times, but quite lovely when all parties collaborate equally on the finished product. 

Message to ATC's:  If you haven't already, learn Kinesio Taping.  Learn manual therapy skills.  Practice them often.  Be open to new ideas, but don't be afraid to voice your own thoughts...through careful collaboration, the most positive outcome for the athlete can be attained.

Contrary to some colleagues, I would argue that classic taping with 1.5 inch white tape is not a dying breed...in fact I utilized it quite regularly throughout.

My thanks to the USOC, USBSF and USM for a wonderful experience!