title: Out-of-hospital cervical spine clearance: agreement between emergency medical technicians and emergency physicians.
abstract: OBJECTIVE
  Determine the level of agreement between emergency medical technicians (EMTs) and emergency physicians (EPs) when applying an existing emergency medical services/fire department protocol for out-of-hospital clinical cervical spine injury (CSI) clearance in blunt trauma patients.
  
  
  METHODS
  Prospective observational study of consecutive blunt trauma patients transported by emergency medical services/fire department during a 3-month study period. The setting was an urban Level I trauma center. Measurement of interrater agreement (kappa) was determined.
  
  
  RESULTS
  Mean age of the 190 patients was 34+/-19 years (range, 6 -98 years). Fifty-nine percent of the patients were male. One hundred forty-six patients (77%) were immobilized by EMTs; 17 of these patients were clinically cleared by EPs. Forty-four patients (23%) were clinically cleared by EMTs and presented without CSI precautions; of these, 61% (27 of 44) were immobilized by EPs and 57% (25 of 44) had cervical spine radiographs obtained. Overall, 141 patients (74%) required radiographic clearance. CSI were detected in five patients (2.6%); all five were immobilized in the out-of-hospital setting. Overall disagreement between EMTs and EPs regarding out-of-hospital CSI clearance occurred in 44 patients (23%) (kappa=0.29; 95% confidence interval, 0.15-0.43; p < 0.01).
  
  
  CONCLUSIONS
  Significant disagreement in clinical CSI clearance exists between EMTs and EPs. Further research and education is recommended before widespread implementation of this practice.
authors.affiliation: Department of Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Meldon
authors.forename: T A
authors.initials: TA
authors.lastname: Brant
authors.forename: R K
authors.initials: RK
authors.lastname: Cydulka
authors.forename: T E
authors.initials: TE
authors.lastname: Collins
authors.forename: B R
authors.initials: BR
authors.lastname: Shade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002574:Cervical Vertebrae / Q000293:injuries* / Q000503:physiopathology; D002648:Child; D002985:Clinical Protocols; D004634:Emergency Medical Technicians; D004635:Emergency Medicine; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011446:Prospective Studies; D013124:Spinal Injuries / Q000175:diagnosis* / Q000503:physiopathology