Evaluation of the safety of C-spine clearance by paramedics: design and methodology.
BMC Emergency Medicine · 2011-02-01 · Study protocol
Abstract
BACKGROUND: Canadian Emergency Medical Services annually transport 1.3 million patients with potential neck injuries to local emergency departments. Less than 1% of those patients have a c-spine fracture and even less (0.5%) have a spinal cord injury. Most injuries occur before the arrival of paramedics, not during transport to the hospital, yet most patients are transported in ambulances immobilized. They stay fully immobilized until a bed is available, or until physician assessment and/or X-rays are complete. The prolonged immobilization is often unnecessary and adds to the burden of already overtaxed emergency medical services systems and crowded emergency departments. METHODS/DESIGN: The goal of this study is to evaluate the safety and potential impact of an active strategy that allows paramedics to assess very low-risk trauma patients using a validated clinical decision rule, the Canadian C-Spine Rule, in order to determine the need for immobilization during transport to the emergency department.This cohort study will be conducted in Ottawa, Canada with one emergency medical service. Paramedics with this service participated in an earlier validation study of the Canadian C-Spine Rule. Three thousand consecutive, alert, stable adult trauma patients with a potential c-spine injury will be enrolled in the study and evaluated using the Canadian C-Spine Rule to determine the need for immobilization. The outcomes that will be assessed include measures of safety (numbers of missed fractures and serious adverse outcomes), measures of clinical impact (proportion of patients transported without immobilization, key time intervals) and performance of the Rule. DISCUSSION: Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Time intervals · Spinal motion restriction · Paramedics & EMTs
Related articles
- Comparison of different techniques for prehospital cervical spine immobilization: Biomechanical measurements with a wireless motion capture system. (PLoS One, 2023)
- Evaluating soft collars in pre-hospital cervical spine immobilisation: A cohort study on neurological outcomes, patient comfort and paramedic perspectives. (Emerg Med Australas, 2024)
- Implementation of the Modified Canadian C-Spine Rule by Paramedics. (Ann Emerg Med, 2023)
- Pragmatic Strategy Empowering Paramedics to Assess Low-Risk Trauma Patients With the Canadian C-Spine Rule and Selectively Transport Them Without Immobilization: Protocol for a Stepped-Wedge Cluster Randomized Trial. (JMIR Res Protoc, 2020)
- Prehospital clinical clearance of the cervical spine: a prospective study. (Am Surg, 2013)
- Value of prehospital assessment of spine fracture by paramedics. (Eur J Trauma Emerg Surg, 2018)