Backboard time for patients receiving spinal immobilization by emergency medical services

Springer Science and Business Media LLC - Tập 6 - Trang 1-3 - 2013
Derek R Cooney1, Harry Wallus1, Michael Asaly2, Susan Wojcik1
1Department of Emergency Medicine, SUNY Upstate Medical University, EMSTAT Center, Syracuse, USA
2SUNY Upstate Medical University, Syracuse, USA

Tóm tắt

Use of backboards as part of routine trauma care has recently come into question because of the lack of data to support their effectiveness. Multiple authors have noted the potential harm associated with backboard use, including iatrogenic pain, skin ulceration, increased use of radiographic studies, aspiration and respiratory compromise. An observational study was performed at a level 1 academic trauma center to determine the total and interval backboard times for patients arriving via emergency medical services (EMS). Patients were directly observed. Transport time was recorded as an estimate of initiation of backboard use; arrival time, nurse report time and time of removal from the backboard were all recorded. National Emergency Department Overcrowding Study (NEDOCS) score, Emergency Severity Index (ESI) and demographic information were recorded for each patient encounter. Forty-six patients were followed. The mean total backboard time was 54 min (SD ±65). The mean EMS interval was 33 min (SD ±64), and the mean ED interval was 21 min (SD ±15). The ED backboard interval trended inversely to ESI (1 = 5 min, 2 = 10 min, 3 = 25 min, 4 = 26 min, 5 = 32 min). Patients had a mean total backboard time of around an hour. The mean EMS interval was greater than the mean ED interval. Further study with a larger sample directed to establishing associated factors and to target possible reduction strategies is warranted.

Tài liệu tham khảo

Ahn H, Singh J, Nathens A, MacDonald RD, Travers A, Tallon J, Fehlings MG, Yee A: Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011,28(8):1341–1361. 10.1089/neu.2009.1168 Vickery D: The use of the spinal board after the pre-hospital phase of trauma management. Emerg Med J 2001,18(1):51–54. 10.1136/emj.18.1.51 Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC: Spine immobilization in penetrating trauma: more harm than good? J Trauma 2010,68(1):115–120. 10.1097/TA.0b013e3181c9ee58 Hunt K, Hallworth S, Smith M: The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia 2001,56(6):511–513. 10.1046/j.1365-2044.2001.02053.x Johnson DR, Hauswald M, Stockhoff C: Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. Am J Emerg Med 1996,14(4):369–372. 10.1016/S0735-6757(96)90051-0 Lerner EB, Billittier AJ 4th, Moscati RM: The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care 1998,2(2):112–116. 10.1080/10903129808958853 March JA, Ausband SC, Brown LH: Changes in physical examination caused by use of spinal immobilization. Prehosp Emerg Care 2002,6(4):421–424. 10.1080/10903120290938067 Lerner EB, Moscati R: Duration of patient immobilization in the ED. Am J Emerg Med 2000,18(1):28–30. 10.1016/S0735-6757(00)90043-3 Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM: Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care 1997,1(1):11–15. 10.1080/10903129708958777 Muhr MD, Seabrook DL, Wittwer LK: Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care 1999,3(1):1–6. 10.1080/10903129908958895 Sahni R, Menegazzi JJ, Mosesso VN Jr: Paramedic evaluation of clinical indicators of cervical spinal injury. Prehosp Emerg Care 1997,1(1):16–18. 10.1080/10903129708958778 Stroh G, Braude D: Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med 2001,37(6):609–615. 10.1067/mem.2001.114409 Vaillancourt C, Charette M, Kasaboski A, Maloney J, Wells GA, Stiell IG: Evaluation of the safety of C-spine clearance by paramedics: design and methodology. BMC Emerg Med 2011, 11: 1. 10.1186/1471-227X-11-1