Can a Rescuer or Simulated Patient Accurately Assess Motion During Cervical Spine Stabilization Practice Sessions?

Abstract

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.

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

“…Previous investigations have noted that IMUs can provide near perfect resolution of orientation; however, this generally has been established under ideal conditions (that is, with negligible external acceleration) and/or using IMUs that house additional sensors (for example, magnetometers and gyroscopes) 20 32 , 33 The variations (error) reported here are slightly larger than those reported previously, 32 but they may be more indicative of the variation encountered during actual human movements, and they also provide a potential alternate method of quantifying orientation in SI.…”

Sports prehospital-immediate care and spinal injury: not a car crash in sight

“…It involves simply kneeling or lying behind the casualty and placing a hand over either side of the head to protect the region from movement or accidental contact. The ‘trap squeeze9’ is similar but involves placing the hands either side of the root of the neck and gripping the trapezius so that the head lies between the forearms. A log roll10 involves a controlled manoeuvre to keep the cervical spine in line while rolling the casualty onto their side to allow positioning on a spinal device.…”

Quantitative Approach Based on Wearable Inertial Sensors to Assess and Identify Motion and Errors in Techniques Used during Training of Transfers of Simulated c-Spine-Injured Patients

“…Feedback on the quality of the stabilization manoeuvre is subjectively given by the simulated patient and/or the expert. Considering the proven limited ability of rescuers and simulated patients to adequately judge the performance of stabilization manoeuvres [ 10 ], the demonstrated variability in stabilization performance between rescuers [ 9 , 11 – 13 ], and the described complexity of the manoeuvre [ 9 ], there is a critical need to develop objective and meaningful feedback measures for c-spine stabilization techniques during training scenarios.…”

“…Inertial systems are a portable, flexible, and relatively low-cost alternative that is not affected by visual occlusions, offering new possibilities for in-context measurement of kinematic features [ 14 ]. AHRS have already been used successfully to assess the performance of different c-spine stabilization techniques [ 10 – 12 ]. Furthermore, the interest of trainers and trainees to use such technology to provide visual objective feedback was also explored by our team in a nursing context and shown to be very promising [ 15 ].…”