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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