EMS Providers' Beliefs Regarding Spinal Precautions for Pediatric Trauma Transport

Chang, Cindy D.; Crowe, Remle P.; Bentley, Melissa; Janezic, Alyssa R; Leonard, Julie C.

doi:10.1080/10903127.2016.1254696

Cited by 6 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One possible explanation is that SMR has done more than simply provide alternative assessment and treatment options: in considering the limitations of past practice, it has also shifted baseline assumptions of potential harms and benefits of treatment -implicitly granting permission for more widespread practice change. This view corresponds with earlier opinions of SI as over-used, unnecessary, or sub-optimal, [1,17,18] and respondents to this survey described exactly this shift in practice in terms of "less fear in the workplace…towards not utilizing SMR" and a move away from "gross over-treatment". Whether this shift can be described as adequate correction or over-compensation remains to be seen.…”

Section: Discussionsupporting

confidence: 86%

“…First, the connection between the views of frontline providers and patterns of treatment has not been widely researched. Some studies have reported feelings of skepticism towards the value of SI or SMR among EMS personnel in a variety of settings, [1,17,18] and others have described differences in treatment before and after the transition to SMR, [19,45] but the relationship between provider beliefs and treatment patterns deserves more exploration [46]. In the service being surveyed, there has been a decreasing trend in the number of treatments over the last decade [47].…”

Section: Discussionmentioning

confidence: 99%

“…A recent survey from Norway evaluated the use of a new national prehospital spinal treatment guideline, but was focused on implementation, not attitudes towards practice [16]. Other available research shows that emergency medical technicians (EMTs) in the United States believed that the prior practice of spinal immobilization (SI) was generally over-used, and that those with advanced life support (ALS) qualifications in particular viewed it as often unnecessary or not optimal in certain cases [1,17,18]. Limited research on SMR across countries demonstrates that EMTs and paramedics feel empowered and positive towards what are seen as progressive advances [1,11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

2022

View full text Add to dashboard Cite

Background The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics’ attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. Methods This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss’ kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. Results Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics’ estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents’ composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21–4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09–0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. Conclusion Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

2022

View full text Add to dashboard Cite

show abstract

“…A small number of studies examining the attitudes of EMS personnel toward SI/SMR supports this interpretation. Research conducted before widespread SMR changes found that prehospital providers felt that SI was too frequently applied and that those with ALS qualifications in particular viewed it as often redundant or not helpful in certain cases 13,48,49 . The few published studies that have surveyed providers on changing standards have documented support for evolving guidelines and enthusiasm for moving beyond strict requirements and toward flexible approaches 13,50 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of change in prehospital spinal motion restriction: A retrospective database review

McDonald

Kriellaars

Pryce

2023

Academic Emergency Medicine

View full text Add to dashboard Cite

Background Acute management of trauma patients with potential spine injuries has evolved from uniform spinal immobilization (SI) to spinal motion restriction (SMR). Little research exists describing how these changes have been implemented. This study aims to describe and analyze the practice of SMR in one emergency medical services (EMS) agency over the time frame of SMR adoption. Methods This was a retrospective database review of electronic patient care reports from 2009 to 2020. The effects of key practice changes (revised documentation and a collar‐only treatment option) were analyzed in an interrupted time series using the rate of SI/SMR as the primary outcome. Secondary outcomes included patient age, sex, acuity, mechanism of injury, treatment provided, cervical collar size, and positioning. These were assessed for changes from year to year by Poisson regression. Associations between patient and treatment characteristics were investigated with binomial logistic regression. Results There were 25,747 instances of SI/SMR included. Among all patients, the median age was 40 (interquartile range 24–56), 58% (14,970) were male, and 20% (5062) were high‐acuity. The rate of SI/SMR declined from 31.2 to 12.7 treatments per 100 trauma calls per month. The proportion of high‐acuity patients increased by 9.6% per year on average (95% CI 8.7%–10.0%). When first available, collar‐only treatment was provided to 47% of patients, rising by 6.3% per year (95% CI 3.2%–9.5%) to 60% in 2020. Collar‐only treatment (compared to board‐and‐collar) was more likely to be applied to low‐acuity patients (as compared to high): odds ratio 3.01 (95% CI 2.64–3.43). Conclusions This study shows decreasing SI/SMR treatment and changing patient and practice characteristics. These patterns of care cannot be attributed solely to formal protocol changes. Similar patterns and their possible explanations should be investigated elsewhere.

show abstract

“…2,3 Historically, EMS providers have assumed the presence of CSI in all children after blunt trauma and instituted spinal motion restriction (SMR) in the field for transport to the emergency department (ED). [4][5][6] SMR, which typically consists of a rigid cervical collar and longboard, is premised on preventing neurologic injury by restricting motion of the cervical spine in the event unstable injuries are present. 5,6 However, the efficacy of SMR in limiting neurologic injury during EMS transport is unknown.…”

mentioning

confidence: 99%

Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients

Browne

Ahmad

Schwartz³

et al. 2020

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Background:The risk for cervical spine injury (CSI) must be assessed in children who sustain blunt trauma. The Pediatric Emergency Care Applied Research Network (PECARN) retrospectively derived CSI model identifies CSI risk in children based on emergency department (ED) provider observations. The objective of this pilot study was to determine the univariate association of emergency medical services (EMS) provider-observed historical, mechanistic, and physical examination factors with CSI in injured children. Secondarily, we assessed the performance of the previously identified eight PECARN CSI risk factors (PECARN model) based exclusively on EMS provider observation. Methods:We conducted a four-center, prospective observational study of children 0 to 17 years old who were transported by EMS after blunt trauma and underwent spinal motion restriction or trauma team activation in the ED. In the ED, EMS providers recorded their observations for a priori determined CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks and test characteristics for the PECARN model based solely on EMS provider observations. Results: Of 1,372 enrolled children, 25 (1.8%) had CSIs. Of the a priori determined CSI risk factors, seven factors had bivariable associations with CSIs: axial load, altered mental status, signs of basilar skull fracture, substantial torso injury, substantial thoracic injury, respiratory distress, and decreased oxygen saturation. The PECARN model (high-risk motor vehicle collision, diving mechanism, predisposing condition, neck pain, decreased neck mobility, altered mental status, neurologic deficits, and/or substantial torso injury) exhibited the following test characteristics when based on EMS provider observations: sensitivity = 96.0% (95% confidence interval [CI] = 88.3% to 100.0%); negative predictive value = 99.8% (95% CI = 99.4% to 100.0%); specificity = 38.5% (95% CI = 35.9% to 41.1%); and positive predictive value = 2.8% (95% CI = 1.7% to 3.9%). Conclusion:EMS providers can identify risk factors associated with CSI in injured children who experience blunt trauma. These risk factors may be considered for inclusion in a pediatric CSI decision rule specific to the prehospital setting.C hildren who suffer blunt trauma are frequently evaluated by emergency medical services (EMS) providers. 1 Although uncommon in children, when present, cervical spine injuries (CSI) carry substantial morbidity and mortality. Current standard of care requires EMS providers to determine the risk for CSI

show abstract

EMS Providers' Beliefs Regarding Spinal Precautions for Pediatric Trauma Transport

Abstract: EMS providers believe that rigid cervical collars and long backboards with soft conforming surfaces provide optimal spinal precautions. There were no consensus beliefs, however, for use of particular precautions based on age and risk factors.

Cited by 6 publications

References 34 publications

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

Patterns of change in prehospital spinal motion restriction: A retrospective database review

Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients

Contact Info

Product

Resources

About