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

Abstract

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.

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

“…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 . Respondents to a recent survey within this service have documented a belief that SMR is seen as less important than in the past as well as some skepticism toward the effectiveness, importance, and applicability of SMR 51 . Participants noted the discomfort that standard SI/SMR causes patients and reported consciously choosing smaller collars or alternative positioning to avoid aggravating patients, choices that reflect an underlying tension between balancing the need to adhere to protocols with that of providing care to diverse patients in unpredictable situations 51 .…”

“…51 Participants noted the discomfort that standard SI/SMR causes patients and reported consciously choosing smaller collars or alternative positioning to avoid aggravating patients, choices that reflect an underlying tension between balancing the need to adhere to protocols with that of providing care to diverse patients in unpredictable situations. 51 The data collected in this study illustrate these patterns. The significant increase in the proportion of high-acuity patients implies that patients with minor injuries or low-risk MOIs have received SI/SMR less frequently over time.…”

Restrição Do Movimento Da Coluna: Uma Análise Do Conhecimento Dos Profissionais De Enfermagem

“…Um deles se refere à divergência da terminologia, conformidade com as diretrizes e a implementação por parte das equipes 21 . Outra pesquisa realizada em um serviço pré-hospitalar no Canadá mostrou que equipes são céticas em relação a vários elementos do protocolo de RMC, contudo, acabam utilizando algumas estratégias para equilibrar a adesão ao protocolo com a otimização do cuidado durante os atendimentos 22 .…”

Restricted Movement of the Spine: An Analysis of the Knowledge of Nursing Professionals

“…One refers to the divergence of terminology, compliance with the guidelines, and implementation by the teams 21 . Another study carried out in a pre-hospital service in Canada showed that teams are skeptical about various elements of the SMR protocol but use some strategies to balance adherence to the protocol with optimizing care during visits 22 .…”