Aeromedical Use of Spinal Clearance Protocol

 

 
 
 

Keith Wesley, MD, FACEP | | Monday, October 27, 2008


Review of: Werman HA, White LJ, Herron H, et al: "Clinical Clearance of Spinal Immobilization in the Air Medical Environment: A Feasibility Study." Journal of Trauma. 64(6):1539-1542, 2008.

The Science

The researchers decided to use this flight program in Akron, Ohio to examine the feasibility of using what they term a "spinal clearance" protocol to determine if they could either remove the patients from spinal immobilization prior to transport or avoid spinal immobilization. They did not actually change their practice for this study. They transported 329 patients who were immobilized and performed the clearance assessment while en route to the trauma center.

They utilized the most common set of what I call "selective spinal" immobilization criteria that includes the absence of all of the following clinical findings: (1) abnormal level of consciousness; (2) evidence of intoxication; (3) distracting painful injury; (4) spinal tenderness or pain or (5) abnormal neurologic examination.

Only 40 of their patients met the criteria for non-immobilization. However, four of these were found to have spinal fractures. One of these four was unstable. Of the patients who didn't qualify for non-immobilization, 49 (15%) had spinal fractures with 12 being considered unstable.

The authors concluded spinal clearance wasn't appropriate for air medical services.

The Street

Selective spinal immobilization continues to be a controversial issue. Although the emergency department data strongly supports it, only a handful of prehospital studies examine its safety in the hands of EMS. The problem for EMS studies is that the incidence of spinal injury is relatively low; and therefore these studies require large numbers of participants to determine the specificity (few false negative) and sensitivity (few false positives). Of the two, specificity is the most clinically important as the consequences of missing a spinal injury could be significant.

A further analysis of the patients transported by this air medical service reveals almost half of their patients had a Glasgow Coma Scale less than 15 (not alert), and 38% were hypotensive. Although the majority of their patients who met the criteria for not being immobilized didn't have what you and I would consider being significant distracting injuries, they did have a high incidence of thoracic and abdominal trauma. The average Injury Severity Score (ISS) was 12.6 where 16 is major trauma.

Therefore, the take-home message, at least from this study, is that patients who meet your service's criteria for air medical evacuation should have spinal immobilization since this group of patients may have occult injuries that disqualify them from routine use of selective spinal immobilization protocols.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Head and Spinal Injuries, Operations and Protcols, Research

 
What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Simulation-Based Assessment Facilitates Learning & Enhances Clinical Judgment

Simulation is an educational tool that can be used to develop and refine clinical skills of the student in a controlled environment before they progress to becoming practicing clinicians.
More >

Multimedia Thumb

REMSA Programs Helps Reduce Hospital Visits

Community paramedic effort goes into service.
Watch It >


Multimedia Thumb

City Official Challenges San Francisco Fire Chief

Ambulance response times among problems noted by city supervisor.
Watch It >


Multimedia Thumb

Texas Ambulance Crash

Victoria ambulance collides with civilian vehicle.
Watch It >


Multimedia Thumb

Colorado Medics Ditch Pants for Kilts

“Real men do wear kilts.”
Watch It >


Multimedia Thumb

CO Leak at Illinois School

Girard incident sends over 130 to hospitals.
More >


Multimedia Thumb

Hands On September 2014

Who gets thumbs up this month?
More >


Multimedia Thumb

NYC Sept. 11 Anniversary

View images from the ceremony at Ground Zero.
More >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


More Product Videos >