NEW SPINAL PRECAUTION STANDARDS

Transcription

1 NEW SPINAL PRECAUTION STANDARDS July 31, 2015 Dane Van Horn B.S., CCEMT-P Field Supervisor - Life EMS Ambulance

2 Disclosure I have no relevant financial relationships or conflicts of interest to disclose

3 Objectives Overview 1. Research 2. Indications for Spinal Immobilization 3. "Nexus Exam" Spinal Assessment process. 4. General Guidelines 5. Special Considerations

4 Why Are We Changing?

5 What is the research consensus? Early studies demonstrated that spinal immobilization has little to no effect on neurologic function, or that its effect is uncertain. 1, 2 As studies progressed, was discovered that spinal immobilization may actually be contributing to pt. morbidity and mortality. 3

6 Does spinal immobilization help? Probably Not! - Increases pain 4, 5, 6 - Contributes to airway compromise 8, 9 - Increases mortality of those suffering from penetrating trauma 10, 11, 12 - May actually cause MORE movement of the neck and spine 7, 13, 14

7 Spinal Injury Assessment Changes highlighted in Red

8 New Spinal Injury Assessment Criteria Positive Mechanism + - Altered Mental Status - Use of Intoxicants - Significant painful distracting injury - Motor and/or sensory deficit - Spine pain and/or tenderness

9 KCEMS Spinal Assessment Procedure

10 New General Guidelines

11 General Guidelines - New Protocols The following apply to all patients with a Positive Spinal Assessment Long backboard or equivalent only required for extrication and movement to cot*.

12 Long Backboard Only for patients with Neuro-Deficits Only required for extrication and movement to the cot*. Can be removed afterward*. * The NATA recommends leaving patients with neurodeficits on the backboard for transport. 15

13 6+ Lift Technique Recommended by the NATA in place of log-roll 1 person at head 6+ rescuers equally distributed along body

14 General Guidelines - New Protocols The following apply to all patients with a Positive Spinal Assessment Patients, who are stable, alert, and without neurological deficit should be allowed to selfextricate to cot after placing a c-collar.

15 Self-Extrication Procedure Do not have neuro deficits. Can move themselves to stretcher after c- collar placement. Limit spinal movement during process.

16 Procedure After Removal of Extrication Device Place patient supine or in position of comfort. Head/neck should be padded to prevent excessive movement.

17 General Guidelines - New Protocols The following apply to all patients with a Positive Spinal Assessment Ambulatory patients with positive spinal assessment should have a c- collar placed and be moved directly to cot while limiting spinal movement.

18 New Special Considerations

19 New Special Considerations You may forgo immobilizing combative/agitated patients If c-spine is hampering airway management, airway comes first. NATA recommends removal of protective athletic equipment prior to transport. 15

20 Communication The Nata recommends each athletic program have an Emergency Action Plan (EAP) developed in conjunction with local EMS. 15 The EAP establishes a plan to integrate athletic team, EMS and hospitals to facilitate fast and efficient care.

21 The Take Home Message New perception of spinal precautions. Spinal immobilization still exists: o In a collar, on the cot o Backboard generally for movement only As always, use clinical judgment. Be aware of your local protocols.

22 Thank you! bronsonhealth.com

23 References 1) Huaswald M, Ong G, et al. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad. Emerg. Med Mar;5(3): ) Kwan I, Bunn F, Roberts IG. Spinal immobilization for trauma patients. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD DOI: / CD ) Abram S, Bulstrode C. Routine spinal immobilization in trauma patients: what are the advantages and disadvantages? Surgeon Aug;8(4): ) Chan D, Goldberg R, et al. The effect of spinal immobilization on healthy volunteers. Annals of Emergency Medicine. Vol 23, Issue Jan; ) Chan D, Goldberg, RM, et al. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med May-Jun;14(3): ) Lerner EB, Billittier AJ 4th, et al. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care Apr-Jun: 2(2): ) Dixon M, O Halloran J, et al. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Emerg Med J Sep;31(9):745-9.

24 References continued 8) Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Annals of Emergency Medicine Sep;17(9): ) Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth Sep;95(3): Epub 2005 Jul 8. 10) Stuke L, Pons P, et al. Prehospital spine immobilization for penetrating trauma-review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma Sep;71(3): ) Haut ER, Kalish BT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma Jan;68(1):115-20; discussion ) Vanderlan WB, Tew BE, et al. Increased risk of death with cervical spine immobilization in penetrating cervical trauma. Injury Aug;40(8): ) Del Rossi G, Rechtine GR, et al. Is sub-occipital padding necessary to maintain optimal alignment of the unstable spine in the prehospital setting? A preliminary report. J Emerg Med Sep;45(3): ) Engsberg JR, Standeven JW, et al. Cervical spine motion during extrication. J Emerg Med Jan;44(1): ) "NATA Releases Executive Summary of Appropriate Care of the Spine Injured Athlete Inter-Association Consensus Statement." National Athletic Trainers' Association. N.p., 24 June Web. 24 July 2015.