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McDonald N, Kriellaars D, Pryce RT. Patterns of change in prehospital spinal motion restriction: A retrospective database review. Acad Emerg Med 2023; 30:698-708. [PMID: 36734048 DOI: 10.1111/acem.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute management of trauma patients with potential spine injuries has evolved from uniform spinal immobilization (SI) to spinal motion restriction (SMR). Little research exists describing how these changes have been implemented. This study aims to describe and analyze the practice of SMR in one emergency medical services (EMS) agency over the time frame of SMR adoption. METHODS This was a retrospective database review of electronic patient care reports from 2009 to 2020. The effects of key practice changes (revised documentation and a collar-only treatment option) were analyzed in an interrupted time series using the rate of SI/SMR as the primary outcome. Secondary outcomes included patient age, sex, acuity, mechanism of injury, treatment provided, cervical collar size, and positioning. These were assessed for changes from year to year by Poisson regression. Associations between patient and treatment characteristics were investigated with binomial logistic regression. RESULTS There were 25,747 instances of SI/SMR included. Among all patients, the median age was 40 (interquartile range 24-56), 58% (14,970) were male, and 20% (5062) were high-acuity. The rate of SI/SMR declined from 31.2 to 12.7 treatments per 100 trauma calls per month. The proportion of high-acuity patients increased by 9.6% per year on average (95% CI 8.7%-10.0%). When first available, collar-only treatment was provided to 47% of patients, rising by 6.3% per year (95% CI 3.2%-9.5%) to 60% in 2020. Collar-only treatment (compared to board-and-collar) was more likely to be applied to low-acuity patients (as compared to high): odds ratio 3.01 (95% CI 2.64-3.43). CONCLUSIONS This study shows decreasing SI/SMR treatment and changing patient and practice characteristics. These patterns of care cannot be attributed solely to formal protocol changes. Similar patterns and their possible explanations should be investigated elsewhere.
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Affiliation(s)
- Neil McDonald
- Applied Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology, University of Winnipeg, Winnipeg, Manitoba, Canada
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Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system. J Trauma Acute Care Surg 2022; 93:806-812. [PMID: 35234714 DOI: 10.1097/ta.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Universal spinal immobilization has been the standard of prehospital trauma care since the 1960s. Selective immobilization has been shown to be safe and effective for emergency medical services use, but it is unclear whether such protocols reduce unnecessary and potentially harmful immobilization practices. This study evaluated the impact of a selective spinal immobilization protocol on practice patterns in a regional trauma system. METHODS All encounters for traumatic injury in the Tidewater Emergency Medical Services region from 2010 to 2016 were extracted from the Virginia Pre-Hospital Information Bridge. An interrupted time series analysis was used to assess practice change after system-wide protocol implementation in 2013. Intravenous access was used as a nonequivalent outcome measure in the absence of an appropriate control group. RESULTS A total of 63,981 encounters were analyzed. At baseline, 16.7% of patients underwent full immobilization. The preprotocol slope was slightly positive (0.2% per month; 95% confidence interval, 0.1-0.2%). Slope and level changes after protocol implementation did not differ from those observed for intravenous access (-0.4% vs. -0.4% per month [ p = 0.4917] and -1.6% vs. -1.1% [ p = 0.1202], respectively). Cervical spinal immobilization became more common over the postimplementation period (0.1% per month; 95% confidence interval, 0.1-0.1%). Rates of immobilization for isolated penetrating trauma remained unchanged. CONCLUSION Implementation of a selective spinal immobilization protocol did not reduce prehospital immobilization rates in a regional trauma system. Given the entrenched nature of immobilization practices, more intensive education and training strategies are needed. Efforts should prioritize eliminating immobilization for isolated penetrating trauma given its association with increased mortality. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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McDonald N, Kriellaars D, Pryce RT. Paramedic attitudes towards prehospital spinal care: a cross-sectional survey. BMC Emerg Med 2022; 22:162. [PMID: 36123619 PMCID: PMC9487099 DOI: 10.1186/s12873-022-00717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics' attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. METHODS This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss' kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. RESULTS Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics' estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents' composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21-4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09-0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. CONCLUSION Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.
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Affiliation(s)
- Neil McDonald
- Applied Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,Winnipeg Fire Paramedic Service, 2546 McPhillips St, Winnipeg, Manitoba, R2P 2T2, Canada.
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences University of Manitoba, 771 Mc Dermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology University of Winnipeg, 400 Spence St, Winnipeg, Manitoba, R3B 2E9, Canada
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Santos Júnior H, Giacon-Arruda BCC, Larrosa S, Andrade ARD, Teston EF, Ferreira Júnior MA. Extrication techniques of entrapped car crash victims: a scoping review. Rev Esc Enferm USP 2021; 55:e20210064. [PMID: 34807225 DOI: 10.1590/1980-220x-reeusp-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to summarize the extrication techniques of entrapped car crash victims with potential spinal injury. METHOD a literature review study, of scoping review type, using the MEDLINE/PubMed, CINAHL, Scopus, Science Direct, Web of Science, Cochrane Library and gray literature data sources, without time frame, with studies that addressed extricating techniques extrication of entrapped car crash victims. RESULTS a total of 33 studies were included that enabled identifying and summarizing the different types of extrication and respective devices for extrication of entrapped car crash victims, indicated according to injury assessment and the victim's clinical condition. All pointed to the need for techniques to maintain neutral alignment and prevent spine twists. CONCLUSION this study indicated that injury assessment with an emphasis on the victim's clinical condition provides a coherent decision-making regarding the technique and device to be used. However, carrying out other comparative studies between existing techniques may help in the decision-making process more assertively.
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Affiliation(s)
- Hamilton Santos Júnior
- Universidade Federal de Mato Grosso do Sul, Instituto Integrado de Saúde, Programa de Pós-Graduação em Enfermagem, Campo Grande, MS, Brazil
| | | | - Sarah Larrosa
- Universidade Federal de Mato Grosso do Sul, Instituto Integrado de Saúde, Curso de Enfermagem, Campo Grande, MS, Brazil
| | - André Rodrigues de Andrade
- Corpo de Bombeiros Militar do Distrito Federal, Grupamento de Atendimento de Emergência Pré-Hospitalar, Brasília, DF, Brazil
| | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul, Instituto Integrado de Saúde, Programa de Pós-Graduação em Enfermagem, Campo Grande, MS, Brazil
| | - Marcos Antonio Ferreira Júnior
- Universidade Federal de Mato Grosso do Sul, Instituto Integrado de Saúde, Programa de Pós-Graduação em Enfermagem, Campo Grande, MS, Brazil
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Long B, Koyfman A, Gottlieb M. Utility of Spinal Immobilization in Patients With Penetrating Trauma. Acad Emerg Med 2020; 27:69-70. [PMID: 31495007 DOI: 10.1111/acem.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine Brooke Army Medical Center Fort Sam Houston TX
| | - Alex Koyfman
- Department of Emergency Medicine The University of Texas Southwestern Medical Center Dallas TX
| | - Michael Gottlieb
- Department of Emergency Medicine Rush University Medical Center Chicago IL
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Coggins A, Ebrahimi N, Kemp U, O'Shea K, Fusi M, Murphy M. A prospective evaluation of cervical spine immobilisation in low-risk trauma patients at a tertiary Emergency Department. Australas Emerg Care 2019; 22:69-75. [PMID: 31053486 DOI: 10.1016/j.auec.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the Emergency Department cervical spine immobilisation precautions are frequently used. There is controversy in regard to the balance of risks and benefits of routine immobilisation in conscious patients. METHODS A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives were to investigate current practices and rate of concordance with established international guidelines. A provider survey focused on current knowledge, skills and attitudes and was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally, clinical data were collected on a cohort of immobilised trauma patients. Demographic data were analysed using SPSS and content analysis was completed by manifest coding. RESULTS The response rate to the survey was 85.2%. Interdisciplinary providers included nurses (n=46), doctors (n=68) and paramedics (n=41). Content analysis revealed a range of themes for improving care. Themes identified included improved application of guidelines, tailored use of equipment in low-risk patients, improved access to radiology results, and staff education. The series of five case vignettes provided to participants revealed a high level of variance in intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls (40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54 (77.8%). CONCLUSIONS Despite widespread dissemination of guidelines, observed approaches to patient immobilisation appear to be highly variable in this trauma centre. Reducing variation for low-risk patients is likely to improve the patient journey and minimise the risk of prolonged immobilisation. Further assessment of the causes of variation could define goals for targeted translational change.
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Affiliation(s)
- Andrew Coggins
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia.
| | - Nargus Ebrahimi
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Ursula Kemp
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Kelly O'Shea
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | | | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
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Kreinest M, Goller S, Rauch G, Gliwitzky B, Frank C, Matschke S, Wölfl CG, Münzberg M. [Parameters influencing the preclinical application of cervical collars]. Unfallchirurg 2019; 120:675-682. [PMID: 27357352 DOI: 10.1007/s00113-016-0207-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The application of cervical collars is a standard procedure in emergency care of trauma patients. It is often observed that the application of cervical collars is performed incorrectly, which may lead to reduced immobilization of the cervical spine. OBJECTIVES The objective of this study was to analyze the practical skills of professional emergency care providers concerning the application of cervical collars. MATERIALS AND METHODS Emergency care professionals (n = 104) were asked to apply a cervical collar to a training doll. Each performance step was assessed separately. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. RESULTS The study participants included professional rescue personnel and emergency physicians. The average occupational experience of all study participants in out-of-hospital emergency care was 11.1 ± 8.9 years. Most participants had already received training on trauma care (61 %) and felt "very confident" in handling a cervical collar (84 %). The application of the cervical collar was performed correctly in 11 % of the performances. The most common error was incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and possible parameters of influence, such as working experience in emergency care or participation in trauma courses. CONCLUSIONS Despite pronounced subjective confidence regarding the application of cervical collars, this study shows that there are general deficits in the practical skills of applying cervical collars. Therefore, a critical assessment of the current training contents on the subject of trauma care must be demanded.
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Affiliation(s)
- M Kreinest
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - S Goller
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - B Gliwitzky
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - C Frank
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Mittelbaden, Baden-Baden, Deutschland
| | - S Matschke
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - C G Wölfl
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - M Münzberg
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland.
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Prehospital care of spinal injuries: a historical quest for reasoning and evidence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2999-3006. [PMID: 30220041 DOI: 10.1007/s00586-018-5762-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization. METHODS An extensive search throughout historical literature and recent evidence based studies was conducted. RESULTS The history of treating spinal injuries dates back to prehistoric times. Descriptions of prehospital spinal immobilization are more recent and span two distinct periods. First documentation of its use comes from the early 19th century, when prehospital trauma care was introduced on the battlefields of the Napoleonic wars. The advent of radiology gradually helped to clarify the underlying pathology. In recent decades, adoption of advanced trauma life support has elevated in-hospital trauma-care to an high standard. Practice of in-hospital spine immobilization in case of suspected injury has also been implemented as standard-care in prehospital setting. Evidence for and against prehospital immobilization is equally divided in recent evidence-based studies. In addition, recent studies have shown negative side-effects of immobilisation in penetrating injuries. CONCLUSION Although widely implementation of spinal immobilization to prevent spinal cord injury in both penetrating and blunt injury, it cannot be explained historically. Furthermore, there is no high-level scientific evidence to support or reject immobilisation in blunt injury. Since evidence in favour and against prehospital immobilization is equally divided, the present situation appears to have reached something of a deadlock. These slides can be retrieved under Electronic Supplementary Material.
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Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg 2018; 84:736-744. [DOI: 10.1097/ta.0000000000001764] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Jones Rhodes W, Steinbruner D, Finck L, Flarity K. Community Implementation of a Prehospital Spinal Immobilization Guideline. PREHOSP EMERG CARE 2016; 20:792-797. [DOI: 10.1080/10903127.2016.1194932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Expertise of German paramedics concerning the prehospital treatment of patients with spinal trauma. Eur J Trauma Emerg Surg 2016; 43:371-376. [PMID: 27173645 DOI: 10.1007/s00068-016-0682-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/02/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Spinal immobilization is a standard procedure in emergency medicine. Increasing awareness of complications associated with immobilization of trauma patients leads to controversial discussions in the literature. Current guidelines require to include considerations of accident mechanism, an assessment of the patient's condition and an examination of the spine in the decision-making process if immobilization of the spine should be performed. This requires sound knowledge of assessing these parameters. The aim of the current study is to analyze German paramedics' subjective uncertainty in terms of their prehospital assessment and treatment of patients suffering from spine injuries. METHODS Over a period of 17 months participants in a trauma course were asked to complete a standardized anonymous questionnaire about subjective uncertainty of prehospital assessment and management of spinal trauma before participation in that course. Questions about the frequency of application of different immobilization tools and skills training on spinal immobilization were also asked. RESULTS A total of 465 paramedics were surveyed. The participants did not indicate any uncertainty about the prehospital diagnosis and treatment of spinal injuries. The feeling of confidence was significantly greater in participants who had already attended another course on structured trauma care before. The participants agreed with the statements that standardized algorithms facilitate teamwork and that there is a need for a protocol for the prehospital treatment of spinal injuries. CONCLUSIONS Paramedics do not feel uncertain about the prehospital assessment and treatment of spinal injuries. The feeling of confidence in participants who had already attended a course on the treatment of trauma patients before was significantly higher.
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Clemency BM, Bart JA, Malhotra A, Klun T, Campanella V, Lindstrom HA. Patients Immobilized with a Long Spine Board Rarely Have Unstable Thoracolumbar Injuries. PREHOSP EMERG CARE 2016; 20:266-72. [DOI: 10.3109/10903127.2015.1086845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Kreinest M, Goller S, Rauch G, Frank C, Gliwitzky B, Wölfl CG, Matschke S, Münzberg M. Application of Cervical Collars - An Analysis of Practical Skills of Professional Emergency Medical Care Providers. PLoS One 2015; 10:e0143409. [PMID: 26587650 PMCID: PMC4654515 DOI: 10.1371/journal.pone.0143409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background/Objective The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars. Material and Methods Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. Results The test subjects included professional rescue personnel (80.8%) and emergency physicians (12.5%). The average occupational experience of all study participants in pre-clinical emergency care was 11.1±8.9 years. Most study participants had already attended a certified training on trauma care (61%) and felt "very confident" in handling a cervical collar (84%). 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses. Conclusion Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded.
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Affiliation(s)
- Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopedics, Ludwigshafen, Germany
- PHTLS Europe Research Group, Offenbach/Queich, Germany
| | - Sarah Goller
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopedics, Ludwigshafen, Germany
- PHTLS Europe Research Group, Offenbach/Queich, Germany
| | - Geraldine Rauch
- University of Heidelberg, Institute for Medical Biometry and Informatics, Heidelberg, Germany
| | - Christian Frank
- PHTLS Europe Research Group, Offenbach/Queich, Germany
- Mittelbaden Clinic, Department for Orthopedic and Trauma Surgery, Baden-Baden, Germany
| | | | - Christoph G. Wölfl
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopedics, Ludwigshafen, Germany
- PHTLS Europe Research Group, Offenbach/Queich, Germany
| | - Stefan Matschke
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopedics, Ludwigshafen, Germany
| | - Matthias Münzberg
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopedics, Ludwigshafen, Germany
- PHTLS Europe Research Group, Offenbach/Queich, Germany
- * E-mail:
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