Immobilizing the spine New national approach
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1 NORWEGIAN NATIONAL ADVISORY UNIT ON TRAUMA Immobilizing the spine New national approach Torben Wisborg, MD, PhD Director Norwegian National Advisory Unit on Trauma Professor, University of Tromsø Consultant anaesthetist, Hammerfest Hospital, NORWAY
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3 Conflict of interest Director Norwegian National Advisory Unit on Trauma Governmental knowledge center No COI declared
4 NORWEGIAN NATIONAL ADVISORY UNIT ON TRAUMA Norwegian National Advisory Unit on Trauma
5 Inauguration May 2013
6 Purpose «To coordinate trauma systems on a regional and national level. The activities should be in collaboration with National Advisory Unit on Prehopital Emergency Medicine (NAKOS).»
7 Employees
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11 National aim Each inhabitant should have equal access to health care independent of diagnosis, place of living, personal economy, gender, ethnical background and individual circumstances of life
12 Protection of the spine - historical background 80 ies: A in ATLS primary survey rigid cervical collar ATLS 9th Edition 2012: protection of cervical spine - undefined 2013: rigid cervical collar back again igjen
13 Clinical criteria Mechanism of injury Clinical criteria
14 Minor traffic collision, brand new police car vs. civilian car. Head light in police car destroyed. Due to smoke from the other car the driver of that was offered a seat in the police car. When the rescue service arrived the «patient» complained of neck tenderness. The roof of the police car was removed, the patient extricated on spine board with full immobilization. The police car condemned, at the cost of 500,000 SEK.
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17 And so the rigid cervical collar is laid to rest in the Emergency Medical Service of Bergen, Norway
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19 Spinal stabilization the challenge Increasingly different procedures
20 Pro s and con s Protection against secondary injuries Acts as a warning sign Airway obstruction Aspiration risk Pressure ulcers Increased intracranial pressure Time consuming
21 Spinal injuries Incidence in blunt trauma: % Cervical 50% Thoracic 20% Thoraco/lumbar 20% Lumbo/sacral 10% Traumatic brain injury 25 % traumatic brain injury 5% spinal injury Spinal injury
22 The task Reach consensus on a national procedure/guideline for spinal stabilization Based on best available evidence Use AGREE methodology based on the «Appraisal of Guidelines for Research and Evaluation» From site of injury until spine clearance
23 The task force Multiprofessional Geographical, (gender), profession and medical specialty balanced composition National credibility Co-operation with the Norwegian Knowledge Centre for the Health Sciences
24 Literature review Scoping search Guidelines Systematic reviews Medline / Embase Search concluded: March 2015
25 Scoping search National and international guidelines Guidelines International Network database (G-I-N), National Guideline Clearinghouse, National Institutes of Health Consensus Development Program, National Institute for Health and Care Excellence (NICE) References BMJ: Best Practice, Up to Date, McMaster Systematic reviews Cochrane Library
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27 Systematic reviews Search in Cochrane Library Dec Reviews and other rewiews 100 hits 1 systematic review included Trials 1,188 hits none included
28 Extended search March 2015 Mesh term Wounds and Injuries Medline, Embase from 2010 until March ,441 hits (titles & abstracts) 16 primary studies and 5 systematic reviews included
29 Research based knowledge consensus Context Knowledge based procedure Experience & user participation
30 Trauma patient Critically injured patient? RF < 10 eller > 30 and/or HR>120 and/or Lack of radial pulse NO Y E S Immediate transport prioritized Stabilization of spine results in unnecessary delay: Manual stabilization of neck and tranportation supine or in lateral trauma position One or more: Spinal pain and/or GCS < 15 and/or Intoxicated and/or Neurological signs and/or Distracting pain NO (all items) Y E S Spinal stabilization: Cervical (one or several): Collar Head blocks Continuous manual neck stabilization Thoracic or lumbar: Vacuum matress Stretcher/scoop with straps Isolated penetrating injury No spinal stabilization
31 Implementation?
32 NORWEGIAN NATIONAL ADVISORY UNIT ON TRAUMA Thanks for your attention
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