Community Implementation of a Prehospital Spinal Immobilization Guideline

Rhodes, Whitney Jones; Steinbruner, David; Finck, Lani; Flarity, Kathleen

doi:10.1080/10903127.2016.1194932

Cited by 8 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One possible explanation is that SMR has done more than simply provide alternative assessment and treatment options: in considering the limitations of past practice, it has also shifted baseline assumptions of potential harms and benefits of treatment – implicitly granting permission for more widespread practice change. This view corresponds with earlier opinions of SI as over-used, un-necessary, or sub-optimal, [ 1 , 17 , 18 ] and respondents to this survey described exactly this shift in practice in terms of “less fear in the workplace…towards not utilizing SMR” and a move away from “gross over-treatment”. Whether this shift can be described as adequate correction or over-compensation remains to be seen.…”

Section: Discussionsupporting

confidence: 86%

“…First, the connection between the views of frontline providers and patterns of treatment has not been widely researched. Some studies have reported feelings of skepticism towards the value of SI or SMR among EMS personnel in a variety of settings, [ 1 , 17 , 18 ] and others have described differences in treatment before and after the transition to SMR, [ 19 , 45 ] but the relationship between provider beliefs and treatment patterns deserves more exploration [ 46 ]. In the service being surveyed, there has been a decreasing trend in the number of treatments over the last decade [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Major changes over the last decade in the standard of care for treating potential spine injuries in the prehospital setting have been described as a paradigm shift [ 1 ]. These changes have occurred across international jurisdictions, and new options for treatment allow greater flexibility than previous guidelines [ 2 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent survey from Norway evaluated the use of a new national prehospital spinal treatment guideline, but was focused on implementation, not attitudes towards practice [ 16 ]. Other available research shows that emergency medical technicians (EMTs) in the United States believed that the prior practice of spinal immobilization (SI) was generally over-used, and that those with advanced life support (ALS) qualifications in particular viewed it as often unnecessary or not optimal in certain cases [ 1 , 17 , 18 ]. Limited research on SMR across countries demonstrates that EMTs and paramedics feel empowered and positive towards what are seen as progressive advances [ 1 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

2022

View full text Add to dashboard Cite

Background The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics’ attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. Methods This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss’ kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. Results Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics’ estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents’ composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21–4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09–0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. Conclusion Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

2022

View full text Add to dashboard Cite

show abstract

“…For example, Adelgais et al described how organisational and technical barriers impeded implementation of prehospital pain management guidelines [ 35 ]. Motivation of personnel and intensive education are associated with successful implementation [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services

Ångerman

Kirves

Nurmi

2023

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process. Methods The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records. Results During the study period (2012–2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25–42] vs. 29 [IQR 21–39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7–77.8%) to 97.6% (95% CI 96.7–98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0–73.9%) to 93.4% (95% CI 92.3–94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6–88.9%) to 98.5% (95% CI 97.7–99.0%), respectively. Deterioration in compliance indicators was not observed. Conclusions We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.

show abstract

Prehospital Predictors of Traumatic Spinal Cord Injury in Victoria, Australia

Smith

Stoelwinder

Middleton

et al. 2017

Prehospital Emergency Care

View full text Add to dashboard Cite

This study identified several predictors of TSCI including meeting AV Potential Major Trauma criteria, male gender, presence of neurological deficit, presence of an altered state of consciousness, high falls (> 3 meters), diving, or motorcycle or bicycle collisions. Most of these predictors are included in NEXUS and/or CCR criteria, however, Potential Major Trauma criteria have not previously been linked to the presence of TSCI. Therefore, Emergency Medical Systems are encouraged to integrate similar Potential Major Trauma criteria into their guidelines and protocols to further improve the provider's accuracy in identifying TSCI and to be more selective in their spinal immobilization, thereby reducing unwarranted adverse effects of this practice.

show abstract

Community Implementation of a Prehospital Spinal Immobilization Guideline

Cited by 8 publications

References 21 publications

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services

Prehospital Predictors of Traumatic Spinal Cord Injury in Victoria, Australia

Contact Info

Product

Resources

About