Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Stevens, Andrew C.; Trammell, Terry R.; Billows, Geoff L.; Ladd, Lauren M.; Olinger, Michael

doi:10.1016/j.jemermed.2014.06.049

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…Authors have argued that spinal movement within the normal range of motion requires so little energy, of many magnitudes less than the energy at the initial impact, that it is highly unlikely to cause further injury. Furthermore, the alert victim’s own muscular tone will suffice to protect the spine from further injury [41, 68, 144]. In 2013, the British Faculty of Pre-Hospital care acknowledged this in a statement recommending that the fully alert patient a potential spinal injury who is without distracting injury, should be allowed to self-extricate without external stabilisation [2].…”

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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“…Mindennek ellenére az utóbbi években egyre többször merült fel a kérdés, hogy biztosan a jelenleg használt eszközök a legmegfelelőbbek a traumás betegek ellátására? Ezek káros hatásaira egyre több a tudományos bizonyíték [7,8], melyek között megjelenik a fájdalom [9], az emelkedő intracraniális nyomás (ICP) [10], a megnyúlt kórházi tartózkodási/ápolási idő [11], a radiológiai vizsgálatok számának növekedése [12][13][14], a nehezített fi zikális vizsgálat [9], a növekvő helyszíni ellátási idő [10,15], a nehezített légútbiztosítás [16] és az idős betegek esetén a csigolyatörés elmozdulása [17].…”

Section: Bevezetésunclassified

gerincsérültek rögzítése-merre tovább

Bánfai-Csonka

Bánfai

2021

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traumás gerincvelő sérülések előfordulása viszonylag alacsony, azonban nem elhanyagolható kórkép, hiszen visszafordíthatatlan következményekkel járhat, ha nem ismerjük fel időben. Már az 1960-as évektől kezdve számos országban a gerincsérültek ellátásának protokollja tartalmazza a merev nyakrögzítő gallér és a gerinchordágy (board) használatát, azonban ezen eszközök alkalmazásának hatékonysága már többször felmerült kérdésként, azonban magas evidenciával bíró tanulmányok hiányában mégsem változtattak érdemben az ellátási protokollokon. Jelen közleményünk célja, hogy felhívja a figyelmet ezen eszközök használatának esetleges hátrányaira, veszélyeire, mindezt egy dán szisztematikus összefoglaló közlemény alapján. Ezen szakirodalmi áttekintés alapján a „Danish National Board of Health” új ajánlást fogalmazott meg, mely nem a baleseti mechanizmus alapján dönt a gerinc rögzítéséről és annak módjáról, hanem a klinikai/fizikális vizsgálatok eredményei alapján. Hazánkban is fontos lenne ezen irányelvek átgondolása és egyesítése mind prehospitális, mind pedig hospitális szempontból.

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“…Orthotic devices may be used as well but are not mandatory considering data now shows that the proposed bene ts of full immobilization do not always outweigh the related risks (10,(15)(16)(17)(18)(19). Spinal immobilization with a CC may lead to serious complications such as pressure ulcers, airway di culties, increased intracranial pressure, increased imaging and radiation exposure (14,(20)(21)(22)(23)(24)(25)(26)(27); neurologic aggravations in ankylosing spondylitis (28,29) and elderly patients (30,31); and increased mortality in penetrating trauma patients (18,32). Moreover, CCs installation requires precious time as well as winter clothing and helmet removal, inducing higher risks of CCs inappropriate use, victim cold exposure, and other hazardous events (33).…”

Section: Introductionmentioning

confidence: 99%

Removal of the Cervical Spine Collar from Alpine Extrication and Evacuation Skiing Rescue Spinal Motion Restriction Protocols: A Biomechanical Controlled Study in Real-Life Mountain Conditions with a High-Fidelity Mannequin

Grenier

Despatis

Lebel

et al. 2021

Preprint

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Background: Alpine skiing rescues are unique because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims’ extrication (EX) and downhill evacuation (DE). Current pre-hospital guidelines recommend the application of full spinal immobilization using various orthotic devices such as cervical collars (CC) when mobilizing and transfer+ring a victim with a suspected spine injury. The biomechanical benefits of applying CC in terms of spinal motion restriction during simulated alpine rescue are undocumented. Methods: Observational design of CSM measurement on a high-fidelity simulation mannequin with a motion sensors-instrumented cervical spine during simulated alpine skiing EX and DE. A total of 32 EXs and 4 DEs on different slope conditions were performed by six experienced active ski patrollers at a Canadian ski resort. The primary outcome was the 3D excursion vector (PeakΔθ) of the mannequin’s head. The secondary objectives were the time to extrication completion (tEX) depending on CC use and to identify which EX event is more likely to induce CSM. Results: PeakΔθ recorded during flat terrain EX using CC was 11.71° +/- 3.61° compared to 16.00° +/- 7.93° using MILS, and 18.29° +/- 9.78° for CC versus 17.90° +/- 4.16° using MILS on a steep slope. PeakΔθ with CC or using MILS during EXs were equivalent according to a 10 degrees non-inferiority hypothesis testing. Time to extrication completion (tEX) was significantly higher using CC as opposed to MILS for both flat and steep terrain conditions (100.6s vs. 219.2s and 106.2s vs. 268.8s longer respectively, 95% confidence interval). During DEs, CSM with and without CC across all terrain conditions were negligible (<5°). Task analysis during EX showed that when CC is used, its installation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM. Conclusion: For experienced ski patrollers, the biomechanical benefits of motion restriction provided by CC over MILS during alpine skiing rescues were found to be at best marginal and CC use negatively affected rescue time. Systematic use of CC during alpine rescue should be reconsidered.

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Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Cited by 7 publications

References 29 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

gerincsérültek rögzítése-merre tovább

Removal of the Cervical Spine Collar from Alpine Extrication and Evacuation Skiing Rescue Spinal Motion Restriction Protocols: A Biomechanical Controlled Study in Real-Life Mountain Conditions with a High-Fidelity Mannequin

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