title: Prehospital clearance of the cervical spine: does it need to be a pain in the neck?
abstract: Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations.
authors.affiliation: Emergency Department, Basingstoke & North Hampshire Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK. bruce.armstrong@bnhft.nhs.uk
authors.forename: B P
authors.initials: BP
authors.lastname: Armstrong
authors.forename: H K
authors.initials: HK
authors.lastname: Simpson
authors.forename: R
authors.initials: R
authors.lastname: Crouch
authors.forename: C D
authors.initials: CD
authors.lastname: Deakin
mesh_terms: D000465:Algorithms; D000553:Ambulatory Care / Q000379:methods*; D002574:Cervical Vertebrae / Q000293:injuries*; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008485:Medical Audit / Q000379:methods; D010351:Patient Discharge