UT Health San Antonio EMS Fellowship

400+ EMS agencies now carry blood for 911 calls The Prehospital Blood Transfusion Coalition says the milestone reflects growing momentum to get blood products to patients with life-threatening bleeding before they reach a hospital

Here’s a blast from the past! June 2017 - welcome Dr. Winckler to the SAFD OMD as Deputy Medical Director!

Big congrats to our very own Dr. Pilkey, who was awarded this recognition by the graduating EM residents! 👏🏼

Bexar County will be under an Extreme Heat Warning with heat indices reaching up to 115 degrees, Thursday from noon to 8 p.m. It's important that we remember to check on our neighbors and look out for vulnerable populations. Heat related illnesses can impact anyone, so be sure to take breaks in the shade while outside, drink plenty of water, dress comfortably with light and loose fitting and never leave anyone or any pet in a hot car. For more safety information in how to prepare for the days ahead, visit www.bexar.org/extremeheat

Spring photo dump! Our EMS fellows and faculty have been busy!

- Dr. Danboise traveled to Chile to support Ironman, where she had the opportunity to do water rescue drills with the medical team as well as the Chilean Navy! 🚤

- Dr. Pilkey put on quite a challenge for our EM residents during the annual Survivor competition! Resident teams were put through an MCI drill that included donning PPE, correctly triaging patients, and answering EMS questions ☣️

- Dr. Campbell got to spend some time out in beautiful Big Bend where he helped teach their EMS refresher along with Terlingua Fire and EMS and the UT Health SA Wilderness team ⛰️

25 𝐲𝐞𝐚𝐫𝐬 𝐨𝐟 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞. 𝐈𝐭'𝐬 𝐭𝐢𝐦𝐞 𝐭𝐨 𝐫𝐞𝐭𝐡𝐢𝐧𝐤 𝐬𝐩𝐢𝐧𝐚𝐥 𝐢𝐦𝐦𝐨𝐛𝐢𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐄𝐌𝐒.

Since Hauswald's pivotal 1998 Malaysian study, we've had a quarter century of data pointing in the same direction. The evidence against routine spinal immobilization is substantial:

→ No demonstrable benefit in any study
→ Consistent evidence of harm: respiratory compromise, pressure ulcers, increased pain
→ Zero cases where withholding immobilization led to legal liability
→ Multiple cases where applying immobilization caused legal problems

The Wilderness Medical Society's 2024 guidelines, developed by a multidisciplinary team including orthopedic surgeons and EMS physicians, recommend against routine immobilization for suspected spinal injury.

So where does that leave us practically?

Personally, I'm not advocating for removing collars entirely. I'm advocating for using them selectively, based on clinical judgment. A stepwise approach, where paramedics can clinically clear the c-spine in the field, can eliminate the collar in roughly 80% of cases that would have received one under a reflexive protocol. The collar remains available for patients where clearing isn't possible.

The honest reality: the medicolegal concern keeping many of us from changing practice is, per the authors, a shibboleth grounded more in culture than evidence.

EMS culture adds interventions easily. Removing them, even with overwhelming evidence, is far harder.

The authors ask: "How many patients need to be harmed?"

What does your service's spinal management protocol look like today? This is a conversation all of us will benefit from, including our patients.

-PA

Read the full study:https://media.handtevy.com/website/Out-of-Hospital-Management-of-Suspected-Spinal-Cord-Injuries-How-Much-Evidence-Does-it-Take-to-Change-Practice-.pdf