Abstract
BackgroundPre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Second, we assessed the choices made by EMS staff regarding spinal immobilisation techniques and reasons for immobilisation. Third, we researched the possible adverse effects of immobilisation.DesignA retrospective observational study in a cohort of blunt trauma patients.Study methodData of blunt trauma patients with suspected spinal column injuries were collected from one EMS organisation between January 2008 and January 2013. Coded data and free text notes were analysed.ResultsA total of 1082 patients were included in this study. Spinal immobilisation was applied in 96.3 % of the patients based on valid pre-hospital criteria. In 2.1 % of the patients immobilisation was not based on valid criteria. Data of 1.6 % patients were missing. Main reasons for spinal immobilisation were posterior midline spinal tenderness (37.2 % of patients) and painful distracting injuries (13.5 % of patients). Spinal cord injury (SCI) was suspected in 5.7 % of the patients with posterior midline spinal tenderness. A total of 15.8 % patients were immobilised using non-standard methods. The reason for departure from the standard method was explained for 3 % of these patients. Reported adverse effects included pain (n = 10, 0.9 %,); shortness of breath (n = 3, 0.3 %); combativeness or anxiety (n = 6, 0.6 %); and worsening of pain when supine (n = 1, 0.1 %).Conclusion/recommendationSpinal immobilisation was applied in 96.3 % of all included patients based on pre-hospital criteria. We found that consensus among EMS staff on how to interpret the criterion ‘distracting injury’ was lacking. Furthermore, the adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed.
Highlights
Patients who have suffered blunt trauma resulting in spinal column injuries, such as spinal fractures or dislocations, are at risk of developing iatrogenic spinal cord injury (SCI) due to physical movement or manipulation [1,2,3,4,5].SCI is defined as a traumatic injury to the spinal cord that results in loss of motor and/or sensory functions [6]
After every patient transport the emergency medical services (EMS) staff fills in a datasheet, which is added to the electronic patient record (EPR) of the EMS VRGZ
Suspicion of spinal column injuries was documented in 37.2 % of the patients and in 5.7 % of the patients EMS staff reported symptoms of SCI
Summary
Patients who have suffered blunt trauma resulting in spinal column injuries, such as spinal fractures or dislocations, are at risk of developing iatrogenic spinal cord injury (SCI) due to physical movement or manipulation [1,2,3,4,5].SCI is defined as a traumatic injury to the spinal cord that results in loss of motor and/or sensory functions [6]. It has been postulated that spinal immobilisation by emergency medical services (EMS) is required for all patients with suspected vertebral column injuries to prevent SCI after blunt trauma [1]. Departure from the guidelines is allowed, in case of neck muscle spasms, increased pain, increase of neurological deficits, signs of increased intracranial pressure (ICP) or combativeness/resistance of the patient [11] In these situations, the EMS staff can opt for a rigid collar only or head blocks with spine board only. We determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Keywords Blunt trauma · Pre-hospital · Spinal column injury · Spinal immobilisation · Emergency medical services · Retrospective observational study
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