Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction

Swartz, Erik E.; Tucker, William S.; Nowak, Matthew G.; Roberto, Jason; Hollingworth, Amy; Decoster, Laura C.; Trimarco, Thomas W; Mihalik, Jason P.

doi:10.1080/10903127.2018.1431341

Cited by 26 publications

(12 citation statements)

References 14 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

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“…A avaliação da Circulação com controle da hemorragia obriga à consideração do volume sanguíneo, débito cardíaco e perda de sangue e à abordagem sistematizada para a ressuscitação indicada e consequente estabilização hemodinâmica (2,4,10,12,(17)(18) . A circulação assume-se como um tipo de função com as características específicas: circulação do sangue através do sistema cardiovascular (coração e vasos sanguíneos centrais e periféricos) (10) espinhal, e à semelhança das avaliações anteriores, definir e redefinir intervenções para otimização da oxigenação, perfusão cerebral e prevenção de lesão secundária (2,4,10,12,(17)(18)(19)(20) (Figura 5).…”

Section: (Figura 3)unclassified

Intervenções De Enfermagem Pré-Hospitalar: Revisão Narrativa

Mota

Cunha

Santos

et al. 2020

revenf

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Objetivo: Construir algoritmos de intervenção de enfermagem pré-hospitalar a vítimas de trauma. Metodologia: Revisão Narrativa da Literatura, entre 2008 e 2019, nas principais bases de dados. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. A construção dos algoritmos resultou do processo interpretativo da revisão narrativa por três peritos na área. Utilizou-se o modelo teórico de Virgínia Henderson. Resultados: Obtiveram-se 17 documentos, seis foram incluídos no desenvolvimento dos metaparadigmas Saúde, Pessoa e Ambiente e 16 para a elaboração e construção de Algoritmos de avaliação, diagnóstico e intervenções de enfermagem às vítimas de trauma. Conclusões: A revisão possibilitou a operacionalização do modelo teórico de Henderson para a assistência pré-hospitalar permitindo a criação de algoritmos orientadores da prática de enfermagem.

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“…The best form of spinal motion restriction uses a spine board, head blocks and immobilisation straps with and without a cervical collar [23]. However, evidence not only shows the benefits of spinal immobilisation but also reports adverse effects such as raised intracranial pressure, pain and discomfort, pressure ulcers, difficulties in airway management, restriction of respiration and dural sac compression [24][25][26][27][28][29][30][31][32]. This is especially true for the cervical spine which is particularly susceptible to secondary injury during transportation due to its inferior stability and accounts for > 29% of all spinal cord injuries [33,34].…”

Section: Why Are Cervical Collars Recommended or Not?mentioning

confidence: 99%

Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review

Hawkridge

Ahmed

2020

Eur J Trauma Emerg Surg

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Purpose Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The aim of this systematic review was to determine whether the use of spinal collars in the pre-hospital trauma patient was recommended by published literature. Methods A systematic search of the literature was conducted between 1990 and 2020, screening PubMed, Medline, Science Direct and Google Scholar. The consequent findings were then qualitatively synthesised with the aim of effectively evaluating the evidence to resolve the discrepancy between current practice and literature. Results Of the nine eligible studies, six deemed that spinal collars should not be used in pre-hospital trauma patients with the remaining three reporting uncertainty if spinal collars were best practice. Our results suggest that there is a discrepancy between current guidance and practice in that although the guidelines recommend the use of spinal collars in the pre-hospital setting the majority of the studies were against the use of spinal collars. Importantly, none of the studies reported any benefits of spinal collars. Conclusion Our study shows a disparity between current guidelines and the published literature and warrants further direct research to obtain a more comprehensive view of the use of spinal collars in a pre-hospital setting.

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Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction

Cited by 26 publications

References 14 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

Intervenções De Enfermagem Pré-Hospitalar: Revisão Narrativa

Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review

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