This paper sought to compare the functionality of a standard cervical collar compared to an improvised one. The researchers took 24~healthy volunteers aged between 25 and 45~years. While seated, they applied, in a random order, either the improvised collar or a standard collar. The improvised collar was fashioned from a rolled-up fleece jumper according to a method commonly taught on wilderness medicine courses. Head movement was then measured with a handheld goniometer to judge maximal neck flexion/extension, rotation and lateral flexion. Repeated measurements were taken for each participant with each collar type (three measurements per movement type). Participants were also asked to rate their comfort levels on a scale of 1 to 5.
The results failed to demonstrate a statistically significant difference in terms of neck movement between the two collars. The fleece collar was however found to be more comfortable than the standard collar (P<0.001). This study appears to suggest that an improvised collar of this type may be non-inferior to a standard collar in uninjured and awake casualties. The increased comfort values may also suggest a decreased likelihood of secondary injuries, such as pressure sores from an improvised collar.
Clinical decision tools have been developed to reduce the number of negative computerised tomography (CT) scans following traumatic brain injury. Though these have proven effective, no study has compared the various tools available. In this study, a retrospective review was undertaken for patients who had attended a single emergency department with a documented head injury in 2017. The Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), the National Emergency X-Radiography Utilization Study II (NEXUS II), the National Institute for Health and Care Excellence (NICE) guideline and the Scandinavian Neurotrauma Committee (SNC) guideline were analysed, and applied to the cohort of 1353 patients.
The findings suggest that application of the NICE and SNC~tools could have reduced the number of CT~scans when compared with current management. Both tools would have missed some intracranial haemorrhage (17 for NICE and 9 for SNC), although none of these required any neurosurgical intervention. Interestingly, the other tools would have increased the number of CT~scans in this setting, which seems to defeat the objective of the tool. The tools are designed for in-hospital use and of relevance to any paramedic working in that setting.
This interesting prospective multi-centre cohort study sought to examine the effect of prehospital critical care on survival following out-of-hospital cardiac arrest (OHCA) when compared with routine advanced life support (ALS) care. The study included two ambulance services and six prehospital critical care services in the UK, and studied adult patients with non-traumatic OHCA treated by either prehospital critical care teams or ALS paramedics. The primary outcome measure was survival-to-hospital discharge, and the secondary outcome measure, survival-to-hospital admission.
The study comprised 658~patients with OHCA receiving prehospital critical care and 1847~patients receiving ALS care. The rate of survival-to-hospital discharge was 11.9% in both groups, while survival-to-hospital admission was 34.4% and 27.7% in the prehospital critical care and ALS group, respectively. The results show that those who received critical care were more likely to survive to hospital but, disappointingly, critical care was not associated with an improvement in survival to discharge. The findings remained consistent across various subgroups.
The findings could be due to the time it took for the critical care team to arrive at the scene but provision of prehospital critical care for OHCA is unlikely to be cost-effective in its current configuration.