I've not come across this practice in Scotland (using stiffneck to maintain
head movement in cardiac arrest).
The first thing I would say, bearing in mind that most intubated transports
in the UK are due to cardiac arrest, is: "I don't believe in transportation
of pulseless patients".
The movement makes CPR impossible and dangerous (even single handed
over-the-head, been there done that), and means that there is less control
of the ET tube (lack of hands).
If you can't get the pulse back on scene, then the survival stats are zero
(paeds, drownings, penetrating trauma, ODs excepted - but how many of them
require intubation prior to movement to the ambulance?). If necessary bring
the skills to the patient (BASICS/HEMS).
Secondly,
If the patient has a pulse but is apnoeic and intubated, then there is
little need for the 'mad dash down stairs to ambulance then GLF' approach.
In which case a well secured ET tube in a patient strapped to a rescue board
or trolley should be maintainable, and should be checked carefully after
each movement of the patient.
The last thing I would say is: "What is the evidence that a stiffneck
reduces dislodgment of the ET tube?". Instead, if extrication is a real
problem - eg: poor access - I'd consider a combitube rather than an ET tube
as it is less likely to dislodge.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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