References

Spine and spinal cord trauma, 8th edn. Chicago (IL)2009

Spinal injury and spinal cord injury.Bridgwater: Class Professional Publishing; 2019

Clemency BM, Natalzia P, Innes J A change from a spinal immobilization to a spinal motion restriction protocol was not associated with an increase in disabling spinal cord injuries. Prehosp Disaster Med. 2021; 36:(6)708-712 https://doi.org/10.1017/S1049023X21001187

Considine J, Botti M, Thomas S. Do knowledge and experience have specific roles in triage decision-making?. Acad Emerg Med. 2007; 14:(8)722-726 https://doi.org/10.1197/j.aem.2007.04.015

Cowley A, Nelson M, Hall C, Goodwin S, Kumar DS, Moore F. Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust. Br Paramed J. 2022; 7:(3)59-67 https://doi.org/10.29045/14784726.2022.12.7.3.59

Diaz C. Diagnosis and treatment of spinal cord injuries.Forest Hills (NY): Foster Academics; 2019

Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005; 46:(2)123-131 https://doi.org/10.1016/j.annemergmed.2005.02.004

Ebben RH, Vloet LC, Schalk DM, Mintjes-de Groot JA, van Achterberg T. An exploration of factors influencing ambulance and emergency nurses' protocol adherence in the Netherlands. J Emerg Nurs. 2014; 40:(2)124-130 https://doi.org/10.1016/j.jen.2012.09.008

Eldridge LA, Piatt JA, Agley J, Gerke S. Relationship between substance use and the onset of spinal cord injuries: a medical chart review. Top Spinal Cord Inj Rehabil. 2019; 25:(4)316-321 https://doi.org/10.1310/sci2504-316

Ellis J, Courson R, Daniels B. Spinal trauma. Curr Rev Musculoskelet Med. 2014; 7:(4)381-386 https://doi.org/10.1007/s12178-014-9235-x

FutureQuals. FAQ level 4 diploma for associate ambulance practitioners. 2023. https//www.futurequals.com/qualifications/level-4-diploma-associate-ambulance-practitioner/ (accessed 26 April 2023)

Garrison A, Clifford K, Gleason SF, Tun CG, Brown R, Garshick E. Alcohol use associated with cervical spinal cord injury. J Spinal Cord Med. 2004; 27:(2)111-115 https://doi.org/10.1080/10790268.2004.11753740

Geduld C, Muller H, Saunders CJ. Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers. Afr J Emerg Med. 2022; 12:(4)393-405 https://doi.org/10.1016/j.afjem.2022.08.005

Häske D, Lefering R, Stock JP, Kreinest M Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures. Eur J Trauma Emerg Surg. 2022; 48:(3)1975-1983 https://doi.org/10.1007/s00068-020-01515-w

Hawkridge K, Ahmed I, Ahmed Z. Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. Eur J Trauma Emerg Surg. 2022; 48:(1)647-657 https://doi.org/10.1007/s00068-020-01576-x

Health and Care Professions Council. HCPC increases the education threshold for paramedics. 2021. https//www.hcpc-uk.org/news-and-events/news/2021/hcpc-increases-the-education-threshold-for-paramedics/ (accessed 18 April 2023)

Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000; 343:(2)94-99 https://doi.org/10.1056/NEJM200007133430203

Kreinest M, Goller S, Gliwitzky B Expertise of German paramedics concerning the prehospital treatment of patients with spinal trauma. Eur J Trauma Emerg Surg. 2017; 43:(3)371-376 https://doi.org/10.1007/s00068-016-0682-5

McDaid D, Park AL, Gall A, Purcell M, Bacon M. Understanding and modelling the economic impact of spinal cord injuries in the United Kingdom. Spinal Cord. 2019; 57:(9)778-788 https://doi.org/10.1038/s41393-019-0285-1

Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin CW. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ. 2012; 184:(16)E867-E876 https://doi.org/10.1503/cmaj.120675

Myers LA, Russi CS, Hankins DG, Berns KS, Zietlow SP. Efficacy and compliance of a prehospital spinal immobilization guideline. Int J Emerg Med. 2009; 2:(1)13-17 https://doi.org/10.1007/s12245-009-0082-2

National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. 2016. https//www.nice.org.uk/guidance/ng41 (accessed 18 April 2023)

O'Hara R, Johnson M, Siriwardena AN A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Serv Res Policy. 2015; 20:45-53 https://doi.org/10.1177/1355819614558472

Oosterwold JT, Sagel DC, van Grunsven PM, Holla M, de Man-van Ginkel J, Berben S. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study. Eur J Trauma Emerg Surg. 2017; 43:(4)513-524 https://doi.org/10.1007/s00068-016-0688-z

Ryan L, Halliwell D. Paramedic decision making—how is it done?. J Para Pract. 2012; 4:(6)343-351 https://doi.org/10.12968/jpar.2012.4.6.343

Sebastian RJ, Miller K, Langdorf MI, Johnson D. EMS adherence to a pre-hospital cervical spine clearance protocol. Cal J Emerg Med. 2001; 2:(4)44-46

Stiell IG, Wells GA, Vandemheen KL The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA. 2001; 286:(15)1841-1848 https://doi.org/10.1001/jama.286.15.1841

Stroud MW, Bombardier CH, Dyer JR, Rimmele CT, Esselman PC. Preinjury alcohol and drug use among persons with spinal cord injury: implications for rehabilitation. J Spinal Cord Med. 2011; 34:(5)461-472 https://doi.org/10.1179/2045772311Y.0000000033

Vaillancourt C, Stiell IG, Beaudoin T The out-of-hospital validation of the Canadian c-spine rule by paramedics. Ann Emerg Med. 2009; 54:(5)663-671.e1 https://doi.org/10.1016/j.annemergmed.2009.03.008

Vaillancourt C, Charette M, Sinclair J Implementation of the modified Canadian c-spine rule by paramedics. Ann Emerg Med. 2023; 81:(2)187-196 https://doi.org/10.1016/j.annemergmed.2022.08.441

World Health Organization. Spinal cord injury. Key facts. 2013. https//www.who.int/news-room/fact-sheets/detail/spinal-cord-injury (accessed 18 April 2023)

trauma

How paramedics apply the spinal immobilisation algorithm in trauma patients

02 May 2023
Features
02 May 2023
Volume 15 · Issue 5

Abstract

Background:

Validated criteria are included in the algorithm used in the UK prehospital setting to safely reduce the number of traumatically injured patients requiring full spinal immobilisation. The criteria improve the sensitivity in selecting patients with spinal injuries but evidence how UK ambulance clinicians apply them is sparse.

Aims:

This study aimed to identify the knowledge levels and the use of the spinal immobilisation algorithm by ambulance clinicians.

Methods:

A quantitative survey used a convenience sample of all frontline clinicians in London Ambulance Service NHS Trust.

Findings:

The algorithm is not routinely used when assessing traumatically injured patients at risk of spinal injury; recognition of the algorithm inclusion criteria is poor, especially regarding patients under the influence of drugs or alcohol. There is a belief that too many patients are immobilised unnecessarily.

Conclusion:

Research is required on how ambulance clinicians use checklists and paramedic education on spinal immobilisation rules requires review.

In the UK, there are approximately 1200 spinal injuries per year (McDaid et al, 2019). The majority are caused by road traffic collisions, falls from height or violence (World Health Organization (WHO), 2013). Of these injuries, about 50% occur in the cervical spine, 37% in the thoracic spine and 11% in the lumbar spine.

Damage to the spinal cord can cause a temporary or permanent loss of function that can be complete or incomplete depending upon the extent of cord injury (Diaz, 2019). Spinal cord injury often results in the loss or impairment of motor and/or sensory function, as well as of autonomic function and bladder and bowel control (WHO, 2013).

Prevention of movement of an unstable spine causing secondary injury to the spinal cord led to the process of immobilising all suspected spinal injuries in the 1960s (Ellis et al, 2014). The practice became widespread across Europe and North America with spinal immobilisation being included in the Advanced Trauma Life Support guidelines, which were considered the standard of care (American College of Surgeons, 2009). Spinal immobilisation involves maintaining the person in a neutral alignment while positioning them on an orthopaedic scoop stretcher, maintaining the head and neck alignment manually until a semi-rigid collar is applied, then using head blocks to restrict movement. The patient is then secured to the stretcher with straps (Association of Ambulance Chief Executives (AACE), 2019).

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Spinal
Immobilisation
Algorithm
Alcohol
Drugs