> -----Original Message-----
> From: Ian Todd [mailto:[log in to unmask]]
> Sent: Wednesday, 21 November 2001 20:26
> To: [log in to unmask]
> Subject: C-Spine immobilisation
>
> Vikki
>
> Ambulance Services are, by nature, a cautious lot. The
> following article will explain who is immobilised out
> of hospital and why :
The reference provided by Ian Todd was to Marsden AK. (1998). Joint position
statement on spinal immobilisation and extrication. Pre-Hospital Immediate
Care, 2(3):169-72.
This position paper produced by the Royal College of Surgeons of Edinburgh
and Joint Royal Colleges Ambulance Service Liaison Committee lists criteria
for prehospital spinal immobilisation which includes "Where the mechanism of
injury raises the possibility of spinal damage" (p. 169).
Unfortunately this recommendation tends to encourage immobilisation where it
might otherwise have been safely omitted, particularly when the policy
further states "It should be emphasised that with any suspicion of spinal
injury, the default position should be the application of a collar and
spinal board" (p. 170). The decision to immobilise is subsequently driven by
fear of sanctions for non-compliance, rather than any analysis of risk vs
benefit to the patient.
Hankins et al (2001) provide a useful discussion of the implications of
unnecessary immobilisation, which included examination of health and
financial implications. When examining the sensitivity of "mechanism of
injury" as a predictor of spinal injury, the authors cite a study involving
6,500 patients that concluded that "mechanism of injury had no impact on the
ability to predict spinal injury using other standard clinical criteria"
(Domeier et al 1999). Is it time to abandon the reliance on the very
subjective assessment of "mechanism of injury", and instead focus on
clinical assessment and the use of more sensitive immobilisation criteria?
Incidentally, the question that triggered this thread is covered quite
nicely in the following paper, which employed a literature review to
conclude that "the spinal board should be removed in all patients soon after
arrival in accident and emergency departments, ideally after the primary
survey and resuscitation phases" (Vickery 2001).
Refs
Hankins DG. Rivera-Rivera EJ. Ornato JP. Swor RA. Blackwell T. Domeier RM.
(2001). Spinal immobilization in the field: clinical clearance criteria and
implementation. Prehospital Emergency Care. 5(1):88-93.
Vickery D. (2001). The use of the spinal board after the pre-hospital phase
of trauma management. Emerg Med J. 18(1):51-4.
Bill Lord
School of Public Health
Charles Sturt University
Australia
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