Fred

>>Can anyone help with research or reference to this, I believe that I
identified a dangerous practice, only to be told butt out, if has been
stipulated by the medical director as okay.<<

This sort of knee-jerk comment implies the person felt threatened or intimidated by the question. As one of the relatively limited pool of UK ambulance "medical directors", I would be rather concerned if my thoughts were being wielded in this way!

>>Can you perform a jaw thrust from BEHIND, in an unconscious casualty, who is
sitting in a car seat,(head slumped) with only one person which would be
sitting in the rear seat and trying to manage a casualthy's airway (given
trauma involved form RTA's & C spine control) and trying to maintain netural
alinement,<<

There is no research based in the prehospital environment on this topic, only educated opinion. Current thinking suggests that the head needs bringing towards the neutral position to have any chance of either assessing or opening the airway. The ambulance crews are asked to do this unless there is a physical obstruction to the movement, increasing pain or altered sensation in a limb. In an unconscious patient, only the first would apply.

It is not really possible to assess the airway properly from behind. Once assessed, circumstances will dictate how much access can be given to manage the airway and c-spine and whether this can be done from the front, the rear or both.

>>My views are, IF you can get the head in natural alignment??, you would be
pushing the whole head forward by trying to extend the lower jaw. and may
compound  a C-spine injury plus unable to tell if the airway is managed,
cause you still unable to check it from behind.<<

The aim is an open airway. If an adjunct is tolerated then the jaw thrust might not be necessary. If it is needed then I would suggest "any port in a storm". There are firefighters trying to use cutting equipment, an oxygen supply, monitoring and a continual assessment of the other components of the primary survey to be considered. The ideal would be one pair of hands for the c-spine and another for the airway drawing the lax mandible forward. Being prescriptive about where the hands will be placed may feel intellectually right but may not be deliverable within the resources available.

Perhaps video fluoroscopy of the lateral c-spine in a semi-recumbant unconscious subject while the movement is applied would answer the question. Add in an unstable spinal fracture to truly assess the risk to the spinal canal. Until we get this we are all simply expressing opinion.

Prehospital care is often about educated compromises and is circumstance and environment specific. An open airway and a c-spine in neutral with minimal movement ... I'll take it any way it comes.

Darren

South Manchester
(& Associate Medical Director, GMAS)