Abstract
BackgroundSpinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board.MethodsMedical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis.ResultsUnder ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6–273.2 s) and 83.4 s (95 % CI 77.5–89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0–400.6 s) and 112.6 s (95 % CI 102.6–122.6 s), respectively (p < 0.01).ConclusionsSpinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress.We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.
Highlights
Spinal stabilisation is recommended for prehospital trauma treatment
The number of stabilisations performed on a vacuum mattress (VM) respectively on an long spine board (LSB) under ideal and realistic conditions was comparable (p = 0.83) but differs slightly since a few stabilisation procedures turned out to be not in accordance with the study protocol in the subsequent video analysis and were excluded
The Norwegian guideline on spinal stabilisation recommends a selective approach to spinal stabilisation and recommends a strategy of minimal handling [3]. Irrespective of that both guidelines clearly recommend minimal spinal stabilisation in patients with critical ABCD-problems [5] respectively time-critical threat to life [3]. Matching to these recommendations this study demonstrated that a significant amount of time can be saved by using an LSB if SS is indicated and if rapid action is essential in ABCDE-unstable trauma patients who are in extremis
Summary
Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. A weak recommendation has been made that ABCDEstable trauma patients with risk of a secondary spinal cord injury should undergo spinal stabilisation on a vacuum mattress instead on a hard backboard. This recommendation is based on the possible development of discomfort, pain and pressure ulcers as well as on the questionable efficacy according restriction of lateral movement if patients are transported on a hard backboard [5]. The evidence for this recommendation is very low mostly due to the fact that the data were extrapolated from either cadaver studies or studies with healthy volunteers [6]
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