Pause: You are about to make an important medical decision. Think about how you are making the decision. What information are you considering? What is influencing your decision?
You use the FSA protocol to confirm the findings in your PAS that there are no signs or symptoms of spine or spinal cord injury in this patient--the patient is reliable, sober, and not distracted; his CSMs are normal in all extremities; and there is no pain or tenderness when the spine is palpated. You report this to the patient who quickly agrees with your conclusion that you can release spine control. The patient sits up, carefully dons his cowboy hat, then heads off to gather his pack string.
You are still worried about a possible head injury and follow the horses to the trailhead. The goose egg on the head has become a bit smaller while it begins to turn a nice shade of purple. The cowboy denies a headache, says he is fine, thanks you for the help, and heads into the sunset. You take some time to reflect on your experience and the decision you made. You are proud of your work, yet wise enough to know your experience is now one real patient. There is much still to learn.
* The devil can be in the details when we evaluate science. This study was hospital- and physician-based. There are several follow-up studies that show that EMTs and paramedics can perform the protocol correctly.5,6 There are none we are aware of on WFRs or other laypeople performing the skill, and one that shows that WFA-trained people7 are inconsistent with their performance of the protocol.
1. Hoffman JR et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343:94-9
2. Domeier RM, Indications For PreHospital Spinal Immobilization: National Association of EMS Physicians Standards and Clinical Practice Committee Position Paper. Prehosp Emerg Care. 1999;3(3):251-3.
3. Forgey, W.W. (2006) Wilderness Medical Society Practice Guidelines For Wilderness Emergency Care. 5th Ed. Guiford, CT: Falcon Press
4. Johnson, D. et al. (2010, September 21) Wilderness First Responder Scope of Practice. Retrieved from http://www.outdoored.com/Community/blogs/wildmed/archive/2010/05/21/wfr-scope-of-practice-draft.aspx
5. Stroh G. Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med. 2001; 37(6):609-15.
6. Dunn T, Dorfman T, Dalton A. Are emergency medical technician-basics able to use a selective immobilization of the cervical spine protocol? A preliminary report. Prehosp Emer Care. 2004;8(2): 207-11.
7. Schumann SA, Schimelpfenig T, Sibthorp J, Collins RH. An examination of wilderness first aid knowledge, self-efficacy, and skill retention. Wilderness Environ Med. 2012;23:281–287