I belong to a organization providing first aid and first aid training, which, per our code of conduct, shall remain nameless in this spate of public criticism.
For the past several years, they have been starting to try to push on us a new way to detect whether people have cervical spinal injuries (i.e. injuries to the top seven vertebrae) which need immobilization.
This is a rule that’s been vetted by researchers and proven to be effective. You determine whether the person is subject to the rule, check them for three high-risk criteria, then seven low-risk criteria, and, if you determine it’s safe, you have them move their head from side to side to see if they can move it without pain. If so, cool, you don’t need to immobilize.
I got to a disagreement today with our regional education coordinator about this rule.
The rule says that if there are any of the three high-risk criteria, you immobilize them. If not, and there is at least one of the low-risk criteria, you do the side-to-side check. Two of the low-risk criteria, though, don’t make sense for this: they seem to belong in the “if you can’t check this off, you should immobilize the patient” category (i.e a “high-risk” criterion, except written in the negative). And that’s what our coordinator was arguing the rule said (immobilize if you can’t check this off), even though that’s not what the text said.
After the disagreement, I did some self-study of the vetted, proven, research. Neither of those two criteria are present. Neither is present in the vetted, proven version of the rule they’re pushing on us; they were grafted on afterwards, without letting anyone know that we were no longer operating within the bounds that the research had proven safe.
I found where they (presumably) got those rules from: a list of “low risk criteria” from a different set of cervical spinal rules, where all of the factors had to be present in order to conclude that there were no spinal issues. No wonder they don’t fit. No wonder they don’t make any sense.
This hasn’t slipped by everyone, I know: it has always been a point of contention whether all of the low-risk factors must be present to to the side-to-side test, or just one. The former doesn’t make sense, practically with the alcohol and distracting injury rules in place (If they haven’t had something to drink, it’s automatically okay to ask them to turn their head?!); the latter doesn’t make sense in any plain reading of the rules’ wording (How is “If any one of the following” is present being twisted to mean “These two conditions must be present, plus any one of the others?”).
Still, I can’t believe that I’m the only one, in at least the past four years (my manual from four years ago has this rule, with the two not-researched bits included), who has bothered to look up the original rules, and compare them against the ones we’re using, which we say are the same as the original ones. Not one of the people working on the manual, not one of the regional education coordinators, not one of the people tasked with instructing the instructors themselves…
So, I guess, to bring this to the topic at hand, what really grinds my gears is when there is a complete and total failure at quality assurance, when bringing in a new procedure, to make sure that the changes you make to the procedure to make it relevant to your needs don’t make it completely stupid.
This is going to be a monumental embarrassment. Our region, in particular, has been drilling this rule as the way of the future, and to realize that we’ve screwed this up this badly… This is going to come back to bite someone hard.
Hope it’s not me, as the person reporting it.