Biomechanical analysis of spinal immobilisation during prehospital extrication: a proof of concept study

Dixon, Mark; O'Halloran, Joseph; Cummins, Niamh M.

doi:10.1136/emermed-2013-202500

Cited by 35 publications

(32 citation statements)

References 12 publications

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“…According to our results, especially in case of a suggested cervical spinal injury, professional guided self-extrication seems to be the best option. These findings were supported by other studies that favoured self-extrication in hemodynamically stable patients [1] . According to our data, applying a cervical collar to the patient will additionally reduce cervical spinal motion.…”

Section: Discussionsupporting

confidence: 87%

“…The test person was instructed by one emergency medical care provider on how to perform self-extrication from the car. The given instructions have been described in the literature previously [1] . This intervention was performed with and without immobilizing the test person's cervical spine in a cervical collar (Ambu Perfit ACE®, Ballerup, Denmark; Fig.…”

Section: Interventionmentioning

confidence: 99%

“…The measuring methods used in the current study have already been used successfully to measure spinal movements in the context of ergonomic-physiological workplace studies, in which a deviation of 5 °to the neutral position of the spine could be specified [ 14 , 28 , 29 , 30 ]. In extrication tests, Dixon et al demonstrated a cervical spine movement of 6.6 °when the subject gets self-extracted, but a cervical spine movement of up to 26.1 °in traditional extrication procedures, but used other measuring procedures [1] .…”

Section: Rapid Extrication With a Slide Board And Rescue Boamentioning

confidence: 99%

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An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures

Häske

Schier

Weerts

et al. 2020

Injury

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Objectives: The extrication of patients following a road traffic collision is among the basic procedures in emergency medicine. Thus, extrication is a frequently performed procedure by most of the emergency medical services worldwide. The appropriate extrication procedure depends on the patient's current condition and accompanying injuries. A rapid extrication should be performed within a few minutes, and the cervical spine (at least) should be immobilized. To our knowledge, the scientific literature and current guidelines do not offer detailed recommendations on the extrication of injured patients. Thus, the aim of the current study is to compare the effectiveness of spinal stabilization during various out-of-hospital extrication procedures. Methods: This is an explorative, biomechanical analysis of spine motion during different extrication procedures on an example patient. Movement of the cervical spine was measured using a wireless human motion tracker. Movement of the thoracic and lumbar spine was quantified with 12 strain gauge sensors, which were positioned paravertebrally on both sites along the thoracic and lumbar spine. To interpret angular movement, a motionscore was developed based on newly defined axioms on the biomechanics of the injured spine. Results: Self-extrication showed the least spinal movement (overall motionscore sum = 667). Movement in the cervical spine could further be reduced by applying a cervical collar. The extrication by a rescue boa showed comparable results in overall spinal movement compared to the traditional extrication via spineboard (overall motionscore sum = 1862vs. 1743). Especially in the cervical spine, the spinal movement was reduced (motionscore sum = 339 vs. 595). However, the thoracic spine movement was increased (motionscore sum = 812 vs. 432). Conclusion: In case of a suspected cervical spine injury, guided self-extrication seems to be the best option. If the patient is not able to perform self-extrication, using a rescue boa might reduce cervical spinal movement compared to the traditional extrication procedure. Since promising results are shown in the case of extrication using a patient transfer sheet that has already been placed below the driver, future developments should focus on novel vehicle seats that already include an extrication device.

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Section: Discussionsupporting

confidence: 87%

Section: Interventionmentioning

confidence: 99%

Section: Rapid Extrication With a Slide Board And Rescue Boamentioning

confidence: 99%

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An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures

Häske

Schier

Weerts

et al. 2020

Injury

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“…Recently, there is a lot of debate and research ongoing in the call for alternative spinal motion restriction. There are many side effects known of spinal immobilisation, and researchers recently came up with evidence that cervical spine movement was up to four times as high during extrication by EMS as by controlled self-extrication [35]. To reduce the adverse effects caused by spinal immobilisation, the National Association of EMS physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACS-COT) have published a position paper in 2013.…”

Section: Discussionmentioning

confidence: 99%

The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study

Oosterwold

Sagel²,

Grunsven³

et al. 2016

Eur J Trauma Emerg Surg

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BackgroundPre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Second, we assessed the choices made by EMS staff regarding spinal immobilisation techniques and reasons for immobilisation. Third, we researched the possible adverse effects of immobilisation.DesignA retrospective observational study in a cohort of blunt trauma patients.Study methodData of blunt trauma patients with suspected spinal column injuries were collected from one EMS organisation between January 2008 and January 2013. Coded data and free text notes were analysed.ResultsA total of 1082 patients were included in this study. Spinal immobilisation was applied in 96.3 % of the patients based on valid pre-hospital criteria. In 2.1 % of the patients immobilisation was not based on valid criteria. Data of 1.6 % patients were missing. Main reasons for spinal immobilisation were posterior midline spinal tenderness (37.2 % of patients) and painful distracting injuries (13.5 % of patients). Spinal cord injury (SCI) was suspected in 5.7 % of the patients with posterior midline spinal tenderness. A total of 15.8 % patients were immobilised using non-standard methods. The reason for departure from the standard method was explained for 3 % of these patients. Reported adverse effects included pain (n = 10, 0.9 %,); shortness of breath (n = 3, 0.3 %); combativeness or anxiety (n = 6, 0.6 %); and worsening of pain when supine (n = 1, 0.1 %).Conclusion/recommendationSpinal immobilisation was applied in 96.3 % of all included patients based on pre-hospital criteria. We found that consensus among EMS staff on how to interpret the criterion ‘distracting injury’ was lacking. Furthermore, the adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed.

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“… 8–11 A proof-of-concept study undertaken by the authors demonstrated that up to four times more cervical spine movement occurs when traditional EMS rescue equipment (rigid collar, long spinal board (LSB) and short extrication jacket (SEJ)) is used in comparison to haemodynamically stable patients self-extricating under paramedic instructions. 12 The primary aim of this study was to build on these findings by increasing the sample size and including a range of male and female participants of variable age, height and mass to represent the general adult population of potential RTC patients.…”

Section: Introductionmentioning

confidence: 99%

Confirmation of suboptimal protocols in spinal immobilisation?

et al. 2015

Self Cite

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BackgroundSpinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication.ObjectiveThe objective of this study was to establish, using biomechanical analysis which technique provides the minimal deviation of the cervical spine from the neutral in-line position during extrication from a vehicle in a larger sample of variable age, height and mass.MethodsA crew of two paramedics and four fire-fighters extricated 16 immobilised participants from a vehicle using six techniques for each participant. Participants were marked with biomechanical sensors and relative movement between the sensors was captured via high-speed infrared motion analysis cameras. A three-dimensional mathematical model was developed and a repeated-measures analysis of variance was used to compare movement across extrication techniques.ResultsControlled self-extrication without a collar resulted in a mean movement of 13.33° from the neutral in-line position of the cervical spine compared to a mean movement of 18.84° during one of the equipment-aided extrications. Two equipment-aided techniques had significantly higher movement (p<0.05) than other techniques. Both height (p=0.003) and mass (p=0.02) of the participants were significant independent predictors of movement.ConclusionsThese data support the findings of the proof of concept study, for haemodynamically stable patients controlled self-extrication causes less movement of the cervical spine than extrications performed using traditional prehospital rescue equipment.

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Biomechanical analysis of spinal immobilisation during prehospital extrication: a proof of concept study

Cited by 35 publications

References 12 publications

An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures

An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures

The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study

Confirmation of suboptimal protocols in spinal immobilisation?

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