Confirmation of suboptimal protocols in spinal immobilisation?

Dixon, Mark; O'Halloran, Joseph; Hannigan, Ailish; Keenan, Scott; Cummins, Niamh M.

doi:10.1136/emermed-2014-204553

Cited by 37 publications

(52 citation statements)

References 25 publications

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“…Shafer and Naunheim, in 2009, demonstrated how volunteers stabilised only with a rigid collar who exited a vehicle on their own volition, generated less spinal motion than when extricated using traditional assisted longboard techniques [145]. More recently, Dixon et al, in a biomechanical study on healthy volunteers found that controlled self-extrication without collar generated less movement in the cervical spine when compared to equipment aided extrication techniques [146]. …”

Section: Resultsmentioning

confidence: 99%

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

Kornhall

Jørgensen

Brommeland

et al. 2017

Scand J Trauma Resusc Emerg Med

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The traditional prehospital management of trauma victims with potential spinal injury has become increasingly questioned as authors and clinicians have raised concerns about over-triage and harm. In order to address these concerns, the Norwegian National Competence Service for Traumatology commissioned a faculty to provide a national guideline for pre-hospital spinal stabilisation. This work is based on a systematic review of available literature and a standardised consensus process. The faculty recommends a selective approach to spinal stabilisation as well as the implementation of triaging tools based on clinical findings. A strategy of minimal handling should be observed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0345-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

Kornhall

Jørgensen

Brommeland

et al. 2017

Scand J Trauma Resusc Emerg Med

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show abstract

“…The ScopRev also identified a narrative review of cervical spine motion during vehicle extrication. 223 This review included 1 small series using high-speed infrared motion-detection cameras 224 that measured less cervical spine motion in conscious injured adults who self-extricated without a cervical collar compared with cervical spine motion during extrication with traditional equipment, including a cervical collar (mean movement 13.33 AE 2.67 from the neutral inline position compared with 18.84 AE 3.46 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

2020 International Consensus on First Aid Science With Treatment Recommendations

Singletary¹,

Zideman²,

Bendall³

et al. 2020

Resuscitation

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This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science WithTreatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates.As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

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“…Previous researchers have concluded that self-extrication is associated with smaller movements at the cervical spine than other methods of extrication, which normally involve being physically lifted from the vehicle by rescue service personnel on to a board or a scoop [ 23 , 24 ]. Trapped casualties have an excess mortality, and many of the injuries they suffer are time critical [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Where collars were required, Laerdal Stiff Neck collars were used, and these were fitted by a member of the study team trained in their use in accordance with manufacturer guidance. The verbal instructions for extrication were taken from the work of Dixon et al and can be found in Table 1 ; these instructions were delivered by a trained member of the study team [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision - a biomechanical study using healthy volunteers

Nutbeam

Fenwick

May

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Motor vehicle collisions account for 1.3 million deaths and 50 million serious injuries worldwide each year. However, the majority of people involved in such incidents are uninjured or have injuries which do not prevent them exiting the vehicle. Self-extrication is the process by which a casualty is instructed to leave their vehicle and completes this with minimal or no assistance. Self-extrication may offer a number of patient and system-wide benefits. The efficacy of routine cervical collar application for this group is unclear and previous studies have demonstrated inconsistent results. It is unknown whether scripted instructions given to casualties on how to exit the vehicle would offer any additional utility. The aim of this study was to evaluate the effect of cervical collars and instructions on spinal movements during self-extrication from a vehicle, using novel motion tracking technology. Methods Biomechanical data on extrications were collected using Inertial Measurement Units on 10 healthy volunteers. The different extrication types examined were: i) No instructions and no cervical collar, ii) No instructions, with cervical collar, iii) With instructions and no collar, and iv) With instructions and with collar. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement, mean, standard deviation and confidence intervals are reported for each extrication type. Results Data were recorded for 392 extrications. The smallest cervical spine movements were recorded when a collar was applied and no instructions were given: mean 6.9 mm AP and 4.4 mm LAT. This also produced the smallest movements at the lumbar spine with a mean of 122 mm AP and 72.5 mm LAT. The largest overall movements were seen in the cervical spine AP when no instructions and no collar were used (28.3 mm). For cervical spine lateral movements, no collar but with instructions produced the greatest movement (18.5 mm). For the lumbar spine, the greatest movement was recorded when instructions were given and no collar was used (153.5 mm AP, 101.1 mm LAT). Conclusions Across all participants, the most frequently occurring extrication method associated with the least movement was no instructions, with a cervical collar in situ.

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Confirmation of suboptimal protocols in spinal immobilisation?

Cited by 37 publications

References 25 publications

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

2020 International Consensus on First Aid Science With Treatment Recommendations

The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision - a biomechanical study using healthy volunteers

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