The L&S is preferable to the LR when possible for minimizing unwanted C-spine motion. There is little overall difference between HS and TS in a cooperative patient. When a patient is confused, the HS is much worse than the TS at minimizing C-spine motion.
Objectives: To compare paramedics' ability to minimize cervical spine motion during patient transfer onto a vacuum mattress with two stabilization techniques (Head Squeeze vs. Trap Squeeze) and two transfer methods (log roll with one assistant (LR 2 ) vs. 3 assistants (LR 4 )).Methods: We used a cross-over design to minimize bias. Each lead paramedic performed 10 LR 2 transfers and 10 LR 4 transfers . For each of the 10 LR 2 and 10 LR 4 transfers, the lead paramedic stabilized the cervical spine using the Head Squeeze technique five times and the Trap Squeeze technique five times. We randomized the order of the stabilization techniques and LR 2 / LR 4 across lead paramedics to avoid a practice or fatigue effect with repeated trials. We measured relative cervical spine motion between the head and trunk using Inertial Measurement Units placed on the forehead and sternum.Results: On average, total motion was 3.9° less with three assistants compared to one assistant (p=0.0002), and 2.8° less with the Trap Squeeze compared to the Head Squeeze (p=0.002). There was no interaction between the transfer method and stabilization technique. When examining specific motions in the six directions, the Trap Squeeze generally produced less lateral flexion and rotation motion but allowed more extension. Examining within paramedic differences, some paramedics were clearly more proficient with the Trap Squeeze technique and others were clearly more proficient with the Head Squeeze technique.Conclusion: Paramedics performing a log roll with three assistants created less motion compared to a log roll with only one assistant, and using the Trap Squeeze stabilization technique resulted in less motion than the Head Squeeze technique. However, the clinical relevance of the magnitude remains unclear. However, large individual differences suggest future paramedic training should incorporate both best evidence practice as well as recognition that there may be individual differences between paramedics.
Context: Health care providers must be prepared to manage all potential spine injuries as if they are unstable. Therefore, most sport teams devote resources to training for sideline cervical spine (C-spine) emergencies.Objective: To determine (1) how accurately rescuers and simulated patients can assess motion during C-spine stabilization practice and (2) whether providing performance feedback to rescuers influences their choice of stabilization technique.Design: Crossover study. Setting: Training studio. Patients or Other Participants: Athletic trainers, athletic therapists, and physiotherapists experienced at managing suspected C-spine injuries.Intervention(s): Twelve lead rescuers (at the patient's head) performed both the head-squeeze and trap-squeeze C-spine stabilization maneuvers during 4 test scenarios: lift-and-slide and log-roll placement on a spine board and confused patient trying to sit up or rotate the head. Main Outcome Measure(s):Interrater reliability between rescuer and simulated patient quality scores for subjective evaluation of C-spine stabilization during trials (O=best, 10 = worst), correlation between rescuers' quality scores and objective measures of motion with inertial measurement units, and frequency of change in preference for the head-squeeze versus trap-squeeze maneuver.Results: Although the weighted K value for interrater reliability was acceptable (0.71-0.74), scores varied by 2 points or more between rescuers and simulated patients for approximately 10% to 15% of trials. Rescuers' scores correlated with objective measures, but variability was large: 38% of trials scored as 0 or 1 by the rescuer involved more than 10°of motion in at least 1 direction. Feedback did not affect the preference for the lift-and-slide placement. For the log-roll placement, 6 of 8 participants who preferred the head squeeze at baseline preferred the trap squeeze after feedback. For the confused patient, 5 of 5 participants initially preferred the head squeeze but preferred the trap squeeze after feedback.Conclusions: Rescuers and simulated patients could not adequately assess performance during C-spine stabilization maneuvers without objective measures. Providing immediate feedback in this context is a promising tool for changing behavior preferences and improving training.Key Words: head squeeze, trap squeeze, spine board placement, head motion, inertial measurements, self-reports, training, feedback, spine injuries, spine immobilization, neck injuries Key Points• Properly stabilizing an injured cervical spine is an essential skill for sports medicine professionals.• In the absence of objective measures, neither lead rescuers nor simulated patients were able to accurately characterize the performance of cervical spine stabilization maneuvers.• Immediate, objective feedback during training may provide rescuers with practical suggestions for improving their skills in cervical stabilization.
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