① The Pros And Cons Of Spinal Imobilization
However, in the case of significant blunt trauma the restrictions continue to be indicated in the following situations: Low GCS or evidence of alcohol Population Pollution Essay drug intoxication. Therefore, the onus remains upon pre-hospital professionals to stay up-to-date on Police Deviance Summary latest pre-hospital best practices. Acta Anaesthesiol Scand. There is The Pros And Cons Of Spinal Imobilization growing body of evidence and concern that field The Pros And Cons Of Spinal Imobilization has lead to the overuse of spinal immobilization methods and that some patients are potentially coming to The Pros And Cons Of Spinal Imobilization    . SI is also thought to reduce the risk of The Pros And Cons Of Spinal Imobilization spinal injuries by limiting movement of bony fragments The Magnus Effect Experiment unstable displaced fractures from causing further cord damage. Hauswald M, Braude D. The majority were aware of the reasoning for using immobilisation after trauma with a perception of The Pros And Cons Of Spinal Imobilization of The Pros And Cons Of Spinal Imobilization spine and to avoid further damage. That means you 'll get a good night The Pros And Cons Of Spinal Imobilization rest.
SPINAL IMMOBILIZATION SUPINE PATIENT RC Health Services
The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. One hundred and fourteen patients were eligible for inclusion based on the patient charts.
Nearly half of the awake trauma patients had no memory of being immobilised. Spinal immobilisation of blunt trauma victims with potential spinal cord injury has been considered standard of care for several decades. Inadequate management of spinal injury may cause neurological deficits and spinal stabilisation has therefore been considered crucial for preventing such secondary injuries [ 1 , 2 ]. Many researchers have, however, raised concerns about immobilisation and questioned its efficacy, the risk of over-triage and potential harmful effects as the evidence of the benefits of spinal immobilisation has been limited [ 1 , 2 ]. Furthermore, several studies have identified complications related to immobilisation, such as tissue ischemia, pressure ulcers and decreased lung volumes [ 3 , 4 , 5 ].
These complications have, however, been measured objectively without accounting for the subjective experience secondary thereto, such as possible pressure, discomfort and dyspnoea related to being immobilised. The objective of this study was therefore to evaluate the patient experience of spinal immobilisation following trauma through a semi-structured interview. We conducted a single-centre, semi-structured interview study of patients, who had been immobilised for spinal protection with a cervical collar and a spine board after trauma. Patient informed consent was obtained prior to inclusion. The Danish Data Protection Agency approved the data management. We included adult trauma patients who had been immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre.
Only awake and alert trauma patients, who recalled being immobilised and were able to speak Danish, were included. The ambulance personnel at scene, which includes a paramedic and their assistant, carried out the immobilisation of the trauma patients. In addition, in most cases a physician staffed mobile emergency care unit or a helicopter was also involved in the prehospital treatment of the patient [ 6 ]. Primarily, the patients were immobilised prehospitally with a spine board, cervical collar and head blocks.
Upon arrival at the trauma centre, they were in most cases transferred from the spine board to a Trauma Transfer — still wearing the cervical collar and logrolled. In some cases, patients were on a scoop stretcher or a vacuum mattress and then transferred to the Trauma Transfer upon arrival. In case the extent of immobilisation could not be clearly determined based on the patient charts, confirmation of immobilisation was sought through a detailed description by the patient if possible. The interview guide was developed based on a review of studies on potential complications and disadvantages related to immobilisation with a cervical collar and a spine board as well as through a discussion among the research team.
The interview covered the following topics: general experiences of being immobilised with a cervical collar and a spine board including experiences with the application of the immobilisation, knowledge of the use of immobilisation and experiences of disadvantages related to being immobilised. Interviews were transcribed as close to verbatim as possible to a paper edition of the case report form during the interview and subsequently transferred to an electronic version of the case report form in Research Electronic Data Capture REDCap for later analysis [ 7 ]. Patient demographics were obtained through patient charts. If the collar was not removed in the trauma bay, total time with cervical collar was defined from application to time of interview.
A two-sided t-test was used to test any significance between age and injury severity score ISS , respectively, and the reporting of discomfort related to being immobilised. We screened patients between April 14th, , and August 31st, , with an end of follow-up on September 30th, We were unable to get in contact with eleven patients, three patients refused to participate and two did not return the consent form and were therefore excluded. The majority were aware of the reasoning for using immobilisation after trauma with a perception of protection of the spine and to avoid further damage. The median ISS was lower amongst patients who experienced discomfort in relation to the immobilisation compared to patients who did not experience discomfort 5 IQR: 2—12 versus 9 IQR: 5— There was, however, no significant difference between the two groups p -value 0.
In this semi-structured interview, we found that nearly half of the awake trauma patients, otherwise eligible, had no memory of being immobilised. The strengths of this study include the prospective design with a detailed questionnaire. Our study also has some limitations. The study was single-centred and based on a selected population of patients suspected of having severe injuries. This may have reduced the generalizability of our findings, as it could be argued that the possible seriousness of the trauma could have overshadowed the discomfort and even have induced a sense of protection related to being immobilised.
Furthermore, nearly half of the patients had no memory of being immobilised, which could be contributed to the selected trauma population. Our direct access to a CT scanner in the trauma bay allowed for quick clarification of whether the immobilisation was still required. The duration of the immobilisation could therefore be shorter than at other facilities and thus may have affected our findings as one could imagine the reporting of discomfort, pain and pressure related to the immobilisation could increase with the time being immobilised.
We also limited our study by only including patients who were able to recall being immobilised. Even though they did not remember the immobilisation, they could have experienced discomfort or anxiety during the time being immobilised, being potential cases of denial. Furthermore, we cannot exclude that some of the patients, with no memory of the immobilisation, later would have been able to recall the immobilisation. In case the actual immobilisation could not be clearly determined based on the patient charts, the patients in question were asked for a description of their immobilisation if possible to ensure eligibility.
This could have led to inclusion of patients who did not fulfil the inclusion criteria of being fully immobilised with a cervical collar and a spine board, although we find this risk minimal. Furthermore, there were two protocols violations, as interviews were not conducted within the predetermined timeframe. The effect of these, if any, is thought to be marginal. Finally, when conducting an interview there is a risk that the interviewer affects or influences the answers depending on their questioning techniques. Negative experiences could be underreported when health care personnel interview patients.
Such a large swing in practice guidelines may have created confusion during this transition. But like the transition from dial-up to highspeed internet, a new era is here. Carefully review local guidelines and make sure you are adequately trained before applying them. Washington, DC: U. Government Printing Office, National Registry of Emergency Medical Technicians. Spinal Immobilization Supine patient. National Association of EMTs. Prehospital Trauma Life Support, 6th Edition. Mosby Publishing: Prehospital spine immobilization for penetrating trauma—review and recommendations from the Prehospital Trauma Life Support Executive Committee.
J Trauma, ; —9. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med, ; 5: —9. Respiratory effects of spinal immobilization. Preh Emerg Care, ; 3: — Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med, ; —8. J Trauma, ; An EMS provider since , Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly.