EMS Provider Findings andInterventions with a Statewide EMS Spine-Assessment Protocol

Burton, John H.; Harmon, Nathan R; Dunn, Matthew; Bradshaw, Jay R.

doi:10.1080/10903120590962003

Cited by 27 publications

(23 citation statements)

References 12 publications

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“…Differences in incidence rates between countries are likely to relate to a variety of factors, including socioeconomic and geographic differences, but may also reflect heterogeneity in reporting and coding practices. Predominantly affecting males [2,3], traumatic SCI is primarily caused by motor vehicle collision [2,[4][5][6][7] and falls [3,8,9]. With changing demographic trends and injury patterns, the proportion of neck injuries causing a cervical SCI (CSCI) is reported to be growing (around 55-60% of all traumatic SCIs), whilst the incidence of neurologically complete lesions is reducing [10].…”

Section: Introductionmentioning

confidence: 99%

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Oteir

Smith

Stoelwinder

et al. 2015

Injury

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Section: Introductionmentioning

confidence: 99%

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Oteir

Smith

Stoelwinder

et al. 2015

Injury

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“…208 Altogether, there is a wide range of algorithms based on different clinical criteria for clearance of the cervical spine in the prehospital setting. [87][88][89][90][91]205,[208][209][210][211][212][213][214][215][216][217][218] Patients with reduced consciousness Patients with reduced consciousness have a higher prevalence of CSIs, and cervical spine clearance in such patients is not as clear cut as in conscious patients.…”

mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

148

115

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The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

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“…Clinical evidence reveals that pre-hospital emergency medical technicians can be trained to apply criteria to clear patients of cervical spinal injuries and immobilize patients suspected of having a cervical spinal injury to a level similar to that of emergency physicians (Armstrong et al, 2007;Benner et al, 2006;Brown et al, 1998;Burton et al, 2005Burton et al, , 2006Campbell, 1987;Domeier et al, 1997Domeier et al, , 1999Domeier et al, , 2002Domeier et al, , 2005Meldon et al, 1998;Muhr et al, 1999;Sahni et al, 1997;Stroh and Braude, 2001). There was no universal tool or triage index used in the studies.…”

mentioning

confidence: 99%

Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

Ahn

Singh

Nathens

et al. 2011

Journal of Neurotrauma

122

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An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients suspected of having cervical spinal injury.

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EMS Provider Findings andInterventions with a Statewide EMS Spine-Assessment Protocol

Abstract: Use of this prehospital spine-assessment protocol resulted in an EMS provider decision not to immobilize approximately 40% of EMS trauma patients. Few spine fracture patients were encountered during the investigational period, though all were immobilized.

Cited by 27 publications

References 12 publications

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

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