Spinal Motion Restriction Bibliography 1
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EMS Spinal Precautions and the Use of the Long Backboard
EMS SPINAL PRECAUTIONS AND THE USE OF THE LONG BACKBOARD – RESOURCE DOCUMENT TO THE POSITION STATEMENT OF THE NATIONAL ASSOCIATION OF EMS PHYSICIANS AND THE AMERICAN COLLEGE OF SURGEONS COMMITTEE ON TRAUMA Chelsea C. White IV, MD, EMT-P, Robert M. Domeier, MD, Michael G. Millin, MD, MPH, and the Standards and Clinical Practice Committee, National Association of EMS Physicians ABSTRACT designed to guide practitioners in understanding of the new position statement. Each item in the position Field spinal immobilization using a backboard and cervical is quoted and followed by a discussion and a review collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a com- of the literature. ponent of field spinal immobilization despite lack of effi- cacy evidence. While the backboard is a useful spinal protec- • “Long backboards are commonly used to attempt tion tool during extrication, use of backboards is not without to provide rigid spinal immobilization among EMS risk, as they have been shown to cause respiratory compro- trauma patients. However, the benefit of long back- mise, pain, and pressure sores. Backboards also alter a pa- boards is largely unproven.” tient’s physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains HISTORY OF THE BACKBOARD unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the Na- Field spinal immobilization using a cervical collar and tional Association of EMS Physicians (NAEMSP) and Amer- a backboard has been standard practice for patients ican College of Surgeons Committee on Trauma (ACS-COT) with suspected spine injury since the 1960s. -
Pre-Hospital Spinal Injury Management – PHECC Position Paper Mission Statement
Pre-hospital spinal injury management – PHECC position paper Mission Statement “The Pre-Hospital Emergency Care Council protects the public by independently specifying, reviewing, maintaining and monitoring standards of excellence for the safe provision of quality pre-hospital emergency care” ©Pre-Hospital Emergency Care Council Published by: Pre-Hospital Emergency Care Council June 2016 2nd Floor, Beech House, Millennium Park, Osberstown, Naas, Co. Kildare, W91 TK7N, Ireland. T: + 353 (0)45 882042 F: + 353 (0)45 882089 E: [email protected] W: www.phecc.ie Version History (Please visit the PHECC website to confirm current version.) STN024 Pre-hospital spinal injury management – PHECC position paper Version Date Details 1 June 2016 New Standard approved by Council Pre-hospital spinal injury management – PHECC position paper Introduction The Pre-Hospital Emergency Care Council (PHECC) has a unique position internationally in pre-hospital emergency care as it sets not only practitioner standards but also responder standards. This paper will therefore refer to both practitioner and responder in relation to pre-hospital spinal injury management. A one-day seminar to present current practice (Ireland, UK and USA) and current research in spinal injury management was held in June 2015. The seminar was targeted at Council and Committee members of PHECC and also PHECC facilitators, tutors and assistant tutors. Fifty-five people attended the seminar; see Appendix 1 for details. The position papers on pre-hospital spinal injury management in both the UK and USA (Connor, Greaves et al. 2013) (White, Domeier et al. 2014) were used as primary discussion documents for seminar attendees. Both papers question the continued use of protocols for immobilisation of every trauma patient and in particular the use of a long board for other than extrication. -
Protocols, Most Care Is Done by Standing Order Within Your Scope of Practice
ABDOMINAL PAIN 12/03/2013 Follow Assessment, General Procedures Protocol EMR • Assess and support ABCs • Position of comfort • Supine if: • Trauma • Hypotension • Syncope • NPO • Monitor vital signs • Oxygen indicated for: • Unstable vitals • Severity of pain • Suspected GI bleed EMT • 12-lead – See ECG/12 Lead A-EMT • IV – NS with standard tubing • Titrate fluid to patient’s needs – See Shock Protocol EMT-I/ • Cardiac monitoring PARAMEDIC • Pain management – See Acute Pain Management Protocol ACUTE NAUSEA AND VOMITING 12/03/2013 Follow Assessment, General Procedures Protocol Every effort should be made to transport patients that: • Have been vomiting > 6 hours • Show significant signs of dehydration (e.g. tachycardia, hypotension) • Significant abdominal pain • Patients at the extremes of age <5 or >55 • Patients with cardiac history • Patients with a chronic medical condition are especially vulnerable to serious problems associated with prolonged vomiting EMR/EMT • Assess and support ABCs • Position of comfort • Monitor vital signs • Administer oxygen if indicated • Use caution when using a mask EMT • Consider obtaining 12 Lead - See ECG/12 Lead • Check CBG A-EMT • IV – NS with standard tubing • Fluid challenge, titrate fluid to patient’s needs– See Shock Protocol EMT-I • Zofran PARAMEDIC • Inapsine (2nd Line) • Compazine (2nd Line) • Phenergan (2nd Line) ACUTE PAIN MANAGEMENT 02/03/2020 Follow Assessment, General Procedures Protocol Consider administering analgesic medication in the management of any acutely painful condition relating to either trauma or medical causes. The single most reliable indicator of the existence/intensity of acute pain is the patient’s self-report. Most people who suffer pain show it, either by verbal complaint or nonverbal behaviors. -
Spinal Care REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: September 15, 2020
Title: Spinal Care REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: September 15, 2020 SPINAL CARE I. PATIENT CARE GOALS 1. Select patients for whom spinal motion restriction (SMR) is indicated. 2. Minimize secondary injury to spine in patients who have, or may have, an unstable spinal injury. 3. Minimize patient morbidity from the use of immobilization devices. 4. Spinal Motion Restriction (SMR) is defined as attempting to maintain the head, neck, and torso in anatomic alignment and independent from device use. II. PATIENT MANAGEMENT A. Assessment 1. Assess the scene to determine the mechanism of injury. a. High risk mechanisms: i. Motor vehicle crashes (including automobiles, all-terrain vehicles, and snowmobiles) ii. Axial loading injuries to the spine (large load falls vertically on the head or a patient lands on top of their head) iii. Falls greater than 10 feet 2. Assess the patient in the position found for findings associated with spine injury: a. Altered Mental Status b. Neurologic deficits c. Neck or back pain or tenderness d. Any evidence of intoxication e. Other severe injuries, particularly associated torso injuries B. Treatment and Interventions 1. Place patient in cervical collar and initiate Spinal Motion Restriction (SMR) if there are any of the following: a. Patient complains of midline neck or spine pain b. Any midline neck or spine tenderness with palpation c. Any abnormal mental status (including extreme agitation) d. Focal or neurologic deficit e. Any evidence of alcohol or drug intoxication f. Another severe or painful distracting injury is present 1 Title: Spinal Care REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: September 15, 2020 g. -
Patient Journey
ACCIDENT PATIENT WALKS INTO ED C-SPINE CLEARED AND COLLAR REMOVED AMBULANCE EMERGENCY DEPARTMENT ON SITE SPINAL UNIT - TRACTION MANUAL IN-LINE CERVICAL COLLAR EXTRICATION PATIENT MOVED ONTO LOAD INTO TRANSPORT TO HANDOVER TO TRANSFER ONTO EXAMINATION BY NURSE HALO FIXATION SURGERY TRAUMA HEAD BLOCKS WAIT RADIOLOGY DIAGNOSIS SOFT TISSUE DAMAGE PATIENT MOVED ON GARDNER-WELLS FORCE APPLIED COLLAR MIGHT TRACTION HOME Event Event Event Event Event STABILISATION FETCHED & APPLIED (RTC) SPINAL BOARD/SCOOP AMBULANCE HOSPITAL ED ED STAFF TROLLEY / DOCTOR SPINAL UNIT TRACTION BED TONGS APPLIED BE REMOVED HALO BRACE WORN 8-12 WEEKS HALO BRACE TRANSFER PATIENT PLACED ON SURGERY COLLAR WORN FOR The patient strapped to a spinal The paramedics will always One paramedic will hold A KED Extrication device Long spine (rescue) boards FITTED REMOVED TO OR OPERATING TABLE PERFORMED SEVERAL WEEKS The patient, still board will be placed on a firm trolley. The patient will be placed The patient will be moved attempt to place the head in the patients head while the is often used to stabilise are valuable primarily for The patient will be placed The clinician will need access to the Depending on the condition 4 images are taken to clear the HALO FIXATION Normally Garners-Wells tongs Once the tongs are in strapped to a spinal A log roll and initial examination of in traction for short term onto a traction bed using Guidelines say that neutral alignment to alleviate other applies a collar. the patient during extrication from vehicles. flat on a spinal board posterior cervical spine to check for of the patient he/she may C-spine: will be used. -
Accepted Manuscript
Accepted Manuscript The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation Thomas Adam Purvis, Brian Carlin, Peter Driscoll PII: S0735-6757(17)30063-3 DOI: doi: 10.1016/j.ajem.2017.01.045 Reference: YAJEM 56444 To appear in: Received date: 14 October 2016 Revised date: 3 January 2017 Accepted date: 23 January 2017 Please cite this article as: Thomas Adam Purvis, Brian Carlin, Peter Driscoll , The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Yajem(2017), doi: 10.1016/j.ajem.2017.01.045 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ACCEPTED MANUSCRIPT MANUSCRIPT TITLE PAGE TITLE: The Definite Risks and Questionable Benefits of Liberal Pre-Hospital Spinal Immobilization. CORRESPONDING AUTHOR DETAILS Full name: Mr Thomas Adam Purvis Postal address: 23 Lyndhurst Gardens, Belfast, BT13 3PH email: [email protected] Telephone number: +447887563863 CO-AUTHOR DETAILS Full name: Mr Brian Carlin Department: Pre-hospital Care Institution: Royal -
Head to Toe Critical Care Assessment for the Trauma Patient
Head to Toe Assessment for the Trauma Patient St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Objectives 1. Learn Focused Trauma Assessment 2. Learn Frequently Seen Trauma Injuries 3. Appropriate Nursing Care for Trauma Patients St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Prior to Arrival • Ensure staff have received available details of the case • Notify the entire responding Trauma team • Assign tasks as appropriate for Trauma resuscitation • Gather, check and prepare equipment • Prepare Trauma room • Don PPE (personal protective equipment) • MIVT way to obtain history: Mechanism of injury Injuries sustained Vital signs Treatment given Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey • Begins immediately on patient’s arrival • Collection of information of injury event and past medical history depend on severity of condition • Conducted in Emergency Room simultaneously with resuscitation • Focuses on detecting life threatening injuries • Assessment of ABC’s Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey Components Airway with simultaneous c-spine protection and Alertness Breathing and ventilation Circulation and Control of hemorrhage Disability – Neurological: Glasgow Coma Scale [GCS] or Alert, Voice, Pain, Unresponsive [AVPU] Exposure and Environmental Controls Full set of vital signs and Family presence Get resuscitation adjuncts (labs, monitoring, naso/oro gastric tube, oxygenation and pain) -
Blast Injury REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: July 1, 2021
Title: Blast Injury REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: July 1, 2021 BLAST INJURY I. PATIENT CARE GOALS 1. Maintain patient and provider safety by identifying ongoing threats at the scene of an explosion. 2. Identify multi-system injuries, which may result from a blast, including possible toxic contamination. 3. Prioritize treatment of multi-system injuries to minimize patient morbidity. II. PATIENT MANAGEMENT A. Assessment 1. Hemorrhage Control: a. Assess for and stop severe hemorrhage [per Extremity Trauma/External Hemorrhage Management protocol]. 2. Airway: a. Assess airway patency. b. Consider possible thermal or chemical burns to airway. 3. Breathing: a. Evaluate adequacy of respiratory effort, oxygenation, quality of lung sounds, and chest wall integrity. b. Consider possible pneumothorax or tension pneumothorax (as a result of penetrating/blunt trauma or barotrauma). 4. Circulation: a. Look for evidence of external hemorrhage. b. Assess blood pressure, pulse, skin color/character, and distal capillary refill for signs of shock. 5. Disability: a. Assess patient responsiveness (AVPU) and level of consciousness (GCS). b. Assess pupils. c. Assess gross motor movement and sensation of extremities. 1 Title: Blast Injury REGION 11 Section: Trauma CHICAGO EMS SYSTEM Approved: EMS Medical Directors Consortium PROTOCOL Effective: July 1, 2021 6. Exposure: a. Rapid evaluation of entire skin surface, including back (log roll), to identify blunt or penetrating injuries. B. Treatment and Interventions 1. Hemorrhage Control: a. Control any severe external hemorrhage (per Extremity Trauma/External Hemorrhage Management protocol). 2. Airway: a. Secure airway, utilizing airway maneuvers, airway adjuncts, supraglottic device, or endotracheal tube (per Advanced Airway Management protocol). -
Newsletter for REACT Staff and Friends
A quarterly newsletter for REACT staff and friends NewsletterREACT Summer 2019 REACT Night Out: REACT hosted a free 2 hour CEU offering at Kishwaukee Community College on March 27. Attendees learned about emergency/complicated childbirth, as well as care of the infant. If you missed this offering, never fear. REACT will be offering another educational topic and opportunity as well as community events this summer. Follow us on Facebook (facebook.com/Mercyhealth.MPESC/.) for topics, dates and locations. If you are interested in having REACT present an educational topic to your department, please contact David Uly, Regional Business Development Manager ([email protected]) or Lois Hinton, RN ([email protected]). Congratulations! Customer survey drawing When REACT transports a patient, we are very interested in what you have to say about our service and how we can improve it. The avenue we use to get that information is our RSQ911 survey. Each quarter a submission is drawn for a prize. Thank you to everyone who provided feedback through our surveys. Your insight helps to improve our services to you. We would like to congratulate our latest winner – Michelle Walker from Freeport Hospital. Congratulations! Follow us on Facebook Mercyhealth.MPESC or visit mercyems.org To Backboard or Not to Backboard Debra Webb, RN, CFRN, PHRN How do we protect our patients in the field? • It has been reported that transferring patients In 2014, the National Association of EMS Physicians with spinal cord injuries within the first 8 to 24 (NAEMSP) released new recommendations of full spinal hours to a spinal cord injury unit while providing immobilization. -
The Russell Extrication Device (RED)
Paraplegia 28 (1990) 151-157 0031-1758/90/002&-0151 $10.00 © 1990 International Medical Society of Paraplegia Paraplegia A New Device for the Care of Acute Spinal Injuries: The Russell Extrication Device (RED) A. J. Cohen, MB, BS, (Hons) UNSW,I R. G. Bosshard, IngDip (EPF), MSc, mME, IEEE,z J. D. Yeo, AO, MB, MS, DPRM, FRACS, FACRM3 IChief Medical Officer, Sydney SLSAA Helicopter Rescue Service, 2Spinal Research Unit, 3Director, Spinal Injuries Unit, Royal North Shore Hospital, Sydney, Australia. Summary The Russell extrication device (RED) is a new product designed for use in stabilising patients with an acute spinal vertebral and/or cord injury. An analysis was made over a I-year period of 64 patients transported utilising the RED by the Surf Life Saving Association of Australia Sydney Helicopter Rescue Service. There were three times as many males as females; and 70% of those injured were below 30 years of age. Primary 'scene' responses accounted for just under half of all transports. Cervical injuries represent 30% of requests for helicopter transfer. In this study no patient suffered deterioration in neurological status during the entire transfer process (including application and removal of the device). The RED has advantages for use over other currently available devices. Key words: Spinal injury; Immobilisation; Extrication; Patient transportation; Heli copter transport; Emergency Medical Services (EMS). The Russell extrication device (RED) (Figure) was introduced into service with the Surf Life Saving Association of Australia Sydney Helicopter Rescue Service (HRS) in November 1986. This Service has been operational for 15 years, the first aeromedical helicopter service in Australia, and is part of an Australia-wide network covering every state. -
Early Acute Management in Adults with Spinal Cord Injury: a Clinical Practice Guideline for Health-Care Professionals
SPINAL CORD MEDICINE EARLY ACUTE EARLY MANAGEMENT Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals Administrative and financial support provided by Paralyzed Veterans of America CLINICAL PRACTICE GUIDELINE: Consortium for Spinal Cord Medicine Member Organizations American Academy of Orthopaedic Surgeons American Academy of Physical Medicine and Rehabilitation American Association of Neurological Surgeons American Association of Spinal Cord Injury Nurses American Association of Spinal Cord Injury Psychologists and Social Workers American College of Emergency Physicians American Congress of Rehabilitation Medicine American Occupational Therapy Association American Paraplegia Society American Physical Therapy Association American Psychological Association American Spinal Injury Association Association of Academic Physiatrists Association of Rehabilitation Nurses Christopher and Dana Reeve Foundation Congress of Neurological Surgeons Insurance Rehabilitation Study Group International Spinal Cord Society Paralyzed Veterans of America Society of Critical Care Medicine U. S. Department of Veterans Affairs United Spinal Association CLINICAL PRACTICE GUIDELINE Spinal Cord Medicine Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Providers Consortium for Spinal Cord Medicine Administrative and financial support provided by Paralyzed Veterans of America © Copyright 2008, Paralyzed Veterans of America No copyright ownership -
Position of Emergency Medical Technician in Rescue Team in Traffic Accidents
Case Report JOJ Nurse Health Care Volume 7 Issue 1 - March 2018 Copyright © All rights are reserved by Goran Perge DOI: 10.19080/JOJNHC.2018.07.555703 Position of Emergency Medical Technician in Rescue Team in Traffic Accidents Goran Perge*, Milan Bagic and Damir Kustric Department of Medical Emergency, Serbia Submission: January 21, 2018; Published: March 22, 2018 *Corresponding author: Goran Perge, Emergency Medical Department, Stari sor 65, Sremska Mitrovica, Serbia, Email: Abstract Play”Emergency is used in Serbia.medical It technician means that plays all procedures important roleare donein saving on the traffic scene. accidents EMT is victims.doctor’s Emergency assistant in medical some procedures teams in Serbia such asconsist endotracheal of three members: a doctor, a EMT and a driver. In accidents with one victim, each member has specific position. For treating patients system “Stay and intubation, aspiration, monitoring, immobilizing etc. Some procedures have to be done by EMT alone or with firefighter or policeman as chief time.of the team. For instance: cervical spine stabilization with collar, extremity immobilization, IV cannulation, fixation of the patient on board etc. Extraction from the wreckage is specific. EMT has to stabilize head and cervical spine and coordinate between doctor and firefighters at the same Keywords: Abbreviations: Emergency medical technician; Traffic accident; Team position EMT: Emergency Medical Technician; SpO2: Peripheral Capillary Oxygen Saturation Introduction Emergency medical teams in Serbia consist of three members: between medical and firefighters team. Next assignment for EMT of spinal board held by the driver. Right leg was stuck on gas was cervical spine. Patient was in a specific position: laid on part a doctor, a EMT and a driver.