The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization

Hamilton, Robert S.; Pons, Peter T.

doi:10.1016/s0736-4679(96)00170-9

Cited by 62 publications

(48 citation statements)

References 13 publications

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“…no extra motion control by adding a collar to a spine board with head blocks, 72 a collar and spine board provide more immobilization than a collar alone, 73,74 a collar and a vacuum mattress offer greater stability and comfort than a collar and a spine board, 75,76 immobilization provided by the short board is superior to collars and not augmented by adding collars, 77,78 sandbags, collar, and tape is the most effective measure for motion control (the use of sandbags is limited though because of practical concerns), 55 a board, collar, and towels/foam wedges is the most stable immobilization, 79,80 and allowing an individual to exit a car under his own volition with a collar in place may result in the least amount of movement of the cervical spine. 81 Altogether, whereas any form of immobilization is superior to no immobilization, no available method is optimal, and there is no solid evidence to support the commonly accepted treatment standards of today.…”

Section: How Effective Are Cervical Collars?mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

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The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

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Section: How Effective Are Cervical Collars?mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

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“…12 Vacuum splints (small cushions) were originally developed in 1970 for use during surgery 13 and peripheral fractures, 14,15 and later enlarged to allow stabilization of the entire patient. In general, a vacuum mattresses is associated with 30%-85% reduced motion compared to a spine board in simulated experiments, 16,17 and provide for more patient comfort. 12,18 The two main methods of transferring a patient onto a stable surface are the log roll (LR) and the lift-and slide.…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Motion during Transfer and Stabilization Techniques

Shrier¹,

Boissy²,

Lebel³

et al. 2014

Prehospital Emergency Care

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Objectives: To compare paramedics' ability to minimize cervical spine motion during patient transfer onto a vacuum mattress with two stabilization techniques (Head Squeeze vs. Trap Squeeze) and two transfer methods (log roll with one assistant (LR 2 ) vs. 3 assistants (LR 4 )).Methods: We used a cross-over design to minimize bias. Each lead paramedic performed 10 LR 2 transfers and 10 LR 4 transfers . For each of the 10 LR 2 and 10 LR 4 transfers, the lead paramedic stabilized the cervical spine using the Head Squeeze technique five times and the Trap Squeeze technique five times. We randomized the order of the stabilization techniques and LR 2 / LR 4 across lead paramedics to avoid a practice or fatigue effect with repeated trials. We measured relative cervical spine motion between the head and trunk using Inertial Measurement Units placed on the forehead and sternum.Results: On average, total motion was 3.9° less with three assistants compared to one assistant (p=0.0002), and 2.8° less with the Trap Squeeze compared to the Head Squeeze (p=0.002). There was no interaction between the transfer method and stabilization technique. When examining specific motions in the six directions, the Trap Squeeze generally produced less lateral flexion and rotation motion but allowed more extension. Examining within paramedic differences, some paramedics were clearly more proficient with the Trap Squeeze technique and others were clearly more proficient with the Head Squeeze technique.Conclusion: Paramedics performing a log roll with three assistants created less motion compared to a log roll with only one assistant, and using the Trap Squeeze stabilization technique resulted in less motion than the Head Squeeze technique. However, the clinical relevance of the magnitude remains unclear. However, large individual differences suggest future paramedic training should incorporate both best evidence practice as well as recognition that there may be individual differences between paramedics.

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“…For the same outcome, we also identified very-low-quality evidence (downgraded for indirectness) from 13 nonrandomized studies [140][141][142][143][144][145][146][147][148][149][150][151][152] Seven additional studies [153][154][155][156][157][158][159] were not included in the final analysis because they were missing data (mean and/or SD of intervention and control group not reported).…”

Section: (Semi)rigid Collar (I) Compared With No Collar (C)mentioning

confidence: 99%

“…For the important outcome of patient comfort, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 nonrandomized study 158 with 26 healthy volunteers, showing no change in patient comfort score.…”

Section: (Semi)rigid Collar (I) Compared With No Collar (C)mentioning

confidence: 99%

Part 9: First Aid

Em¹,

Da²,

Buck³

et al. 2015

Circulation

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and curriculum development, and a specialist in first aid evidence evaluation methodology and guideline development.The task force convened in June 2013 to review the topics and questions that were evaluated in 2005 and 2010, past research questions formulated in the PICO style (population, intervention, comparator, outcomes) that were never completed, and the new questions that had been submitted since 2010 to the task force, and a priority list created. Topics were reviewed for areas of controversy, known additional new science, and subject matter not previously evaluated. Task force members created a priority list for review, and the top 10 priority-ranked PICO questions were assigned. After the successful commencement of the workflow, the task force co-chairs added a further 12 PICO questions, including 5 new questions, 1 derived question, and 6 that had been previously reviewed. Selected PICO questions that had been previously reviewed were, in some cases, reworded to facilitate literature searches, and outcomes were decided upon by group consensus.Evidence reviewers were recruited through a call for volunteers distributed by ILCOR to stakeholder organizations around the world. More than 30 individual reviewers were assigned to topics, usually by preference or expertise, but avoiding any direct conflicts of interest. In general, 2 evidence reviewers were assigned to each PICO, supervised by a member of the task force designated as the task force question owner. Evidence reviewers included physicians with diverse specialties including emergency medicine, EMS, wilderness medicine, critical care, cardiology, occupational medicine, toxicology, anesthesia, pediatric emergency medicine, public health, and epidemiology, as well as paramedics, nurse practitioners and first aid education specialists with experience in guideline and curriculum development, and professional evidence evaluation and methodology experts. The Evidence Evaluation ProcessFor the 2015 international evidence evaluation process, the AHA developed a new Web-based information and documentation platform, the Systematic Evidence Evaluation and Review System (SEERS), to support the ILCOR systematic reviews and to capture the data in reusable formats. This Webbased system facilitated structured reviews in a consistent format that would support the ultimate development of science summaries and evidence-based treatment recommendations.Each task force performed a detailed systematic review based on the recommendations of the Institute of Medicine of the National Academies, 1 using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 After identifying and prioritizing the PICO questions to be addressed, 3 and with the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evalu...

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The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization

Cited by 62 publications

References 13 publications

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Cervical Spine Motion during Transfer and Stabilization Techniques

Part 9: First Aid

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