Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry

Pryce, Rob; McDonald, Neil

doi:10.1017/s1049023x1500552x

Cited by 17 publications

(7 citation statements)

References 29 publications

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“…Years of precise instruction based on assumptions have been appropriately challenged by scientific examination. [22][23][24][25] Regardless, this concept has been reinforced at all levels of prehospital and hospital provider education that has led to expected spinal immobilization practice competencies. 26 Unfortunately, the medico-legal application of standard of care has only further promulgated the doctrine, despite widely accepted studies demonstrating the contrary in most clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

Weinstein

Cuthbertson

Ragazzoni

et al. 2020

Prehosp. Disaster med.

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Abstract Introduction: Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs). Objective: What is appropriate SMR in RSEs? Methods: The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire. Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round. For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement. Results: Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus. Conclusions: Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

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Section: Discussionmentioning

confidence: 99%

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

Weinstein

Cuthbertson

Ragazzoni

et al. 2020

Prehosp. Disaster med.

View full text Add to dashboard Cite

show abstract

“…5 However, the lack of high-quality evidence has made it difficult to establish the independent efficacy of rigid cervical collars as part of the immobilisation procedure. 5 9 The effects of rigid collars on cervical motion during immobilisation have been investigated with other devices such as spinal boards [10][11][12] or head blocks. 13 Crucially, these studies evaluated motion immediately after collar application, rather than over the whole immobilisation and extrication procedure, so it is unknown whether any stabilising effect of rigid collars is maintained throughout the whole process.…”

Section: What Is Already Known?mentioning

confidence: 99%

Effect of a cervical collar on head and neck acceleration profiles during emergency spinal immobilisation and extrication procedures in elite football (soccer) players: protocol for a randomised, controlled cross-over trial

Callaghan

Hughes

Davin³

et al. 2021

BMJ Open Sport Exerc Med

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When immobilisation after a cervical spine or head injury is required, the role of the rigid cervical collar is unclear and controversial. There is a need for further studies investigating the use of a rigid cervical collar when head and neck trauma occurs in sport. This study will compare present practice (immobilisation with a cervical collar) to the same procedure without a collar during a simulated spinal immobilisation and extraction scenario from the field of play to the side-line in football (soccer). It will use a prospective cohort within-subjects cross over randomised, controlled trial design. Healthy participants will assume the role of players with a head or neck injury. Clinical practitioners will perform the immobilisation and extrication procedure according to current clinical guidelines. Three dimensional linear and angular acceleration profiles of the head and torso will be measured and the time taken to complete the procedure. The interventions will be a ‘cervical collar’ or ‘no collar’ in random order. Data from the IMUs will be transferred wirelessly to a computer for analysis. Accordingly, within-subject differences between each condition (collar vs no collar) will be assessed with parametric or non-parametric inferential statistics. Statistical significance will be set at p<0.05.Trial registration number:ISRCTN16515969

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“…If it is necessary to move the patient, multiple people should be involved in moving the patient without bending the spine. A rigid stretcher should be used to prevent excessive extension or bending of the spine [30, 31].…”

Section: First Aid Of Combat-related Spinal Injury At the Battle Scenementioning

confidence: 99%

Chinese expert consensus on the treatment of modern combat-related spinal injuries

et al. 2019

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The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

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Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry

Cited by 17 publications

References 29 publications

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

Effect of a cervical collar on head and neck acceleration profiles during emergency spinal immobilisation and extrication procedures in elite football (soccer) players: protocol for a randomised, controlled cross-over trial

Chinese expert consensus on the treatment of modern combat-related spinal injuries

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