Comparison of different techniques for prehospital cervical spine immobilization: Biomechanical measurements with a wireless motion capture system

BACKGROUND

Various rescue techniques are used for the prehospital transport of trauma patients. This study compares different techniques in terms of immobilization of the cervical spine and the rescue time.

METHODS

A wireless motion capture system (Xsens Technologies, Enschede, The Netherlands) was used to record motion in three-dimensional space and the rescue time in a standardized environment. Immobilization was performed by applying different techniques through different teams of trained paramedics and physicians. All tests were performed on the set course, starting with the test person lying on the floor and ending with the test person lying on an ambulance cot ready to be loaded into an ambulance. Six different settings for rescue techniques were examined: rescue sheet with/without rigid cervical collar (P1S1, P1S0), vacuum mattress and scoop stretcher with/without rigid cervical collar (P2S1, P2S0), and long spinal board with/without rigid cervical collar (P3S1, P3S0). Four time intervals were defined: the time interval in which the rigid cervical collar is applied (T0), the time interval in which the test person is positioned on rescue sheet, vacuum mattress and scoop stretcher, or long spinal board (T1), the time interval in which the test person is carried to the ambulance cot (T2), and the time interval in which the ambulance cot is rolled to the ambulance (T3). An ANOVA was performed to compare the different techniques.

RESULTS

During the simulated extrication procedures, a rigid cervical collar provided biomechanical stability at all angles with hardly any loss of time (mean angle ranges during T1: axial rotation P1S0 vs P1S1 p<0.0001, P2S0 vs P2S1 p<0.0001, P3S0 vs P3S1 p<0.0001; lateral bending P1S0 vs P1S1 p = 0.0263, P2S0 vs P2S1 p<0.0001, P3S0 vs P3S1 p<0.0001; flexion/extension P1S0 vs P1S1 p = 0.0023, P2S0 vs P2S1 p<0.0001). Of the three techniques examined, the scoop stretcher and vacuum mattress were best for reducing lateral bending in the frontal plane (mean angle ranges during T1: P2S1 vs P3S1 p = 0.0333; P2S0 vs P3S0 p = 0.0123) as well as flexion and extension in the sagittal plane (mean angle ranges during T2: P1S1 vs P2S1 p<0.0001; P1S0 vs P2S0 p<0.0001). On the other hand, the rescue sheet was clearly superior in terms of time (total duration P1S0 vs P2S0 p<0.001, P1S1 vs P2S1 p<0.001, P1S0 vs P3S0 p<0.001, P1S1 vs P3S1 p<0.001) but was always associated with significantly larger angular ranges of the cervical spine during the procedure. Therefore, the choice of technique depends on various factors such as the rescue time, the available personnel, as well as the severity of the suspected instability.

How to deliver an effective primary survey report for the trauma CT: A radiological and surgical perspective

Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention.

In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report.

We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment.