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. There is now increasing evidence that effective resuscitation has been associated with spinal immobilization is not only unnecessary, but may the most improved patient outcomes. be harmful. • Use of selective spinal immobilization: Spinal immobilization dates back to the early 1960s. It • Blunt trauma with altered level of was reported at that time that patients were suffering consciousness, spinal pain and\or paralysis due to improper prehospital handling and tenderness failure in detecting spinal injuries in trauma patients. • Patients unable to communicate. The theory then was that by extricating and moving • Neurological complaints such as patients onto spinal boards, EMS providers were numbness, tingling, hypersensitivity causing “secondary trauma”, so spinal protocols were • Drug or alcohol intoxication put into place as a preventive measure. • Distracting injury • Patients that would not require spinal By 2001, the use of spinal board management rose immobilization: dramatically. It was noted there were minimal studies • Normal level of consciousness, GCS 15 done to determine patient outcomes with the use • No tenderness or pain of spinal immobilization. Whereas there are several • No deformity studies on siting the risks involved with the use of • No distracting injuries spinal immobilization. One study showed an increase in • No neurological complaints patient disability after the use of spinal immobilization, • No intoxication especially in the penetrating trauma patient. The study • American College of Emergency also demonstrated that spinal immobilization increases Physicians (Prehospital Trauma Life transport times and interferes with resuscitative Support Committee) recommended no measures. spinal immobilization in patients with Other patient risks include: penetrating neck trauma • Increased pain to one or more sites, especially Spinal precautions can be maintained by application of a headaches, pain to occipital area and to the rigid cervical collar and securing the patient firmly to the lumbosacral area EMS stretcher: • Soft tissue injuries and pressure sores. • Increased exposure to radiation and increased • Patients found ambulatory at the scene cost due to additional testing done for evaluating • Patients being transported for a the areas with additional pain protracted time, interfacility transfers • Patients for whom a backboard is not Spinal immobilization has also been linked with indicated respiratory compromise due to constriction of the chest Although more studies need to be done, we can wall because the patient is lying flat. confidently use selective spinal immobilization protocols and limit future unnecessary patient complications. References: 1. White CC, Domeier RM, Millin MG. 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. Prehosp Emerg Care. 2014;18(2):306-314. 2. Geisler WO, Wynne-Jones M, Jousse AT. Early management of patients with trauma to the spinal cord. Med Serv J Can. 1966;22(7):512–523. 3. Farrington JD. Death in a ditch. Bulletin of the American College of Surgeons. 1967;52(3):121-130. 4. Farrington JD. Extrication of victims- surgical principles. J Trauma. 1968;8(4):493-512. 5. Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebrae. J Trauma. 1977;17(2):126-133. 6. Soderstrom CA, Brumback RJ. Early care of the patient with cervical spine injury. Orthop Clin North Am. 1986;17(1):3-13. 7. McHugh TP, Taylor JP. Unnecessary out-of-hospital use of full spinal immobilization. Acad Emerg Med. 1998;5(3):278-280. 8. Kwan I, Bunn F, Roberts I. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001;(2):CD002803. 9. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31(6):531-540. 10. Conrad BP, Rechtine G, Weight M, Clarke J, Horodyski M. Motion in the unstable cervical spine during hospital bed transfers. J Trauma. 2010;69,432-436. 11. Horodyski M, DiPaola CP, Conrad BP, Rechtine GR. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41(5):513-519. 12. Hughes SJ. How effective is the Newport/Aspen collar? A prospective radiographic evaluation in healthy adult volunteers. J Trauma. 1998;45(2):374-378. 13. Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phil Pa 1976). 1999;24(17):1839-1844. 14. Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS. Cervical spine motion during extrication. J Emerg Med. 2013;44(1):122-127. 15. Dixon M, O’Halloran J, Cummins NM. Biomechanical analysis of spinal immobilization during prehospital extrication—a proof of concept study. Emerg Med J. 2014;31(9):745-749. 16. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214-219. 17. Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010;68(1):115-120. Predesignated Landing Zones Anthony (Tony) Rehberg, BSN, CFRN, EMT-P a landing area. These sites provide a quickly controllable area to be utilized for helicopter EMS operations. As you respond to the scene you know the intersection well—limited access with long transport time to an The FAA publishes an Advisory Circular, AC No:150/5390-2b appropriate hospital. Multiple accidents in the past allow Heliport Design. This publication outlines the requirements you to predict that there are bound to be severe injuries for helipad construction. This would be the reference for to any involved victims. Nearly all providers can name the those considering a permanent landing spot. locations this scenario is bound to play out. There are many Most of the time predesignated landing sites can following resources available through mutual aid, including additional the recommended landing zone selection process that is ambulances, MD-1 or REACT. Each will present different presented in our helicopter safety course. Pick an area that options for incident command when utilized. is easily accessible for responding vehicles. Select a level Once on scene incident command has many responsibilities, surface of at least 100'x100'. Ideally a prepared surface is not the least of which is the safety of all responders involved. best, but groomed grass works well too. The area around Coordination of responding resources is complex requiring should be free of obstructions such as light poles, wires, management of police, EMS, extrication and fire services signs and posts. Any antennas within a half mile should be and the ever-present public. When you add to that the noted. Remember that antennas less than 200 feet tall do needed manpower and space need for helicopter EMS not require lights and will be a hazard at night. The location operations, there will be times that use of a predesignated can be plotted by road intersection or GPS coordinates. This landing zone makes perfect sense. information should be readily available in the requesting Developing a plan for a designated landing area is a simple agency’s preplan file for relay to our dispatch when REACT is option that is often overlooked. Several communities that requested to respond to this landing zone. REACT serves have taken the step to create a sufficient Most agencies can easily preplan a couple landing zones landing area to relieve the impact of the helicopter landing in a few hours. Once established a periodic review should at a scene. These landing areas can take several forms. be planned to assure the surrounding area remains clear of Pecatonica and Stillman Valley have, at the site of their fire obstructions and hazards. Anyone wishing assistance with stations, a designated, lighted helipad that appears on FAA planning or review of a potential landing area can contact Aviation maps. Other towns have designated the community REACT at (815) 971-4110. baseball/football field, park, church or business parking lot as References 1. Doc. No. AC No:150/5390-2b Heliport Design. 2. Physician’s Guide To Helicopter EMS Use in Virginia [PPT]. (n.d.).