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Prehospital Clearance of Spinal Injury


FL_Medic

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You sure, someone said you were a rich man....... :lol::lol::lol::lol::lol:

If I were I would be drinking wobbly pops with you right now ... :beer:

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Like every protocol in our EMS systems, the idea of pre-hospital clearing of c-spine has a time and place. First and foremost, communication with medical control should be done on a PT by PT and situation by situation basis. If you walk into a situation and before doing a thorough physical assesment, MOI and the presentation of the PT makes you think c-spine immobilization, do it. We all get the call when we are dispatched injuries from a fall, and we get there are little old lady is lying on the ground. Particularly for me, when grandma has kyphosis or lordosis and putting her on a backboard is going to do more harm than good, this is a good enough argument for considering clearing c-spine with appropriate assessment findings.

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Like every protocol in our EMS systems, the idea of pre-hospital clearing of c-spine has a time and place. First and foremost, communication with medical control should be done on a PT by PT and situation by situation basis. If you walk into a situation and before doing a thorough physical assesment, MOI and the presentation of the PT makes you think c-spine immobilization, do it. We all get the call when we are dispatched injuries from a fall, and we get there are little old lady is lying on the ground. Particularly for me, when grandma has kyphosis or lordosis and putting her on a backboard is going to do more harm than good, this is a good enough argument for considering clearing c-spine with appropriate assessment findings.

Whats Medical Control?

The whole idea of field clearance is looking at everything, then conducting a physical examination. THEN based on what is found you MAY decide to field clear them, however if there is any doubt, the guidlines I have read, state that you treat as spinal.

The elderly you describe would probably, in the literature I have seen, not qualify as they are at higher risk of cervical spine injury, dur to their conditions.

Edited by aussiephil
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The elderly you describe would probably, in the literature I have seen, not qualify as they are at higher risk of cervical spine injury, dur to their conditions.

In the protocols I'm working under right now, these pts would meet inclusionary criteria (meaning there's a higher likelihood of them having a spinal injury), but it doesn't mean we can't still clear c-spine with more assessment.

Not being argumentative here, just chiming in with more protocol examples.

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Some more recent studies on the topic of C-Spine:

INTRODUCTION: Research on skill acquisition and retention in the prehospital setting has focused primarily on resuscitation and defibrillation. Investigation into other first aid skills is required in order to validate practices and support training regimes. No studies have investigated competency using an extrication cervical collar for cervical spine immobilization. OBJECTIVE: This study was conducted to confirm that a group of first responders could acquire and maintain competency in the application of an extrication cervical collar over a 12-month period. METHODS: Participants attended a standardized training session that addressed the theory of application of an extrication cervical collar followed by hands-on practice. The training was presented by the same instructor and covered the nine key elements necessary in order to be deemed competent in extraction cervical collar application. Following the practical session, the competency of the participants was assessed. Participants were requested not to practice the skill during the 12-month period. Following the 12-month period, their skills were re-assessed by the same assessor. RESULTS: Of the 64 subjects who participated in the study, 100% were competent after the initial first assessment. Forty-one participants (64%) were available for the second assessment (12 months later); of these, 25 (61%) maintained competence. CONCLUSIONS: Although the sample size was small, this research demonstrates that first responders are able to acquire competence in applying an extrication cervical collar. However, skill retention in the absence of usage or re-training is poor. Larger studies should be conducted to validate these results. In addition, there is a need for research on the clinical practice and outcomes associated with spinal immobilization in the prehospital setting.

OBJECTIVE: Prehospital cervical spinal cord injuries (SCIs) are rare but potentially catastrophic. Although spinal immobilization is resource-intensive, emergency medical services (EMS) personnel commonly immobilize trauma patients to prevent exacerbation of unrecognized SCI during transport. We compared the stabilization properties of a novel rigid, cervical immobilization collar (XCollar) with those of one-piece and two-piece rigid collars commonly used in the prehospital setting. METHODS: This was a prospective laboratory study of healthy adult volunteers to determine total cervical motion in the horizontal, coronal, and sagittal planes in both seated and supine positions. Goniometric techniques were used to measure head and neck movement after marking anatomic landmarks. Ranges of motion were compared with a one-way analysis of variance (ANOVA). A Bonferroni correction was applied for multiple comparisons, setting significance at p <or= 0.004. RESULTS: Twenty-five subjects (11 men; 14 women) completed the study. The subject pool represented a wide range of morphometrics. For most measurements, the XCollar permitted 10-15 millimeters of movement when applied without manual cervical stabilization. This was less than the movement permitted by both comparison collars. On average, the XCollar permitted less than 10 millimeters of movement in the sagittal and horizontal planes when the subject was in the seated position. CONCLUSIONS: The XCollar provided superior cervical stabilization without augmentation by manual stabilization in healthy adult volunteers in both the seated and supine positions when compared with other one-piece and two-piece rigid cervical collars. Although maximal stabilization was achieved only after the subjects were secured to a long spine board with a cervical immobilization device, the XCollar can provide an acceptable alternative to manual cervical stabilization in situations where the number of patients exceeds the number of EMS providers available to provide care.

Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations.
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