title: Specialisation of spinal services: consequences for cervical trauma management in the district hospital.
abstract: BACKGROUND
  Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre.
  
  
  METHODS
  The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma.
  
  
  RESULTS
  The response rate was 51/70 (73%). Nineteen of the hospitals (37%) did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 - 50%) were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization.
  
  
  CONCLUSIONS
  The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency.
authors.affiliation: Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK. ulfinr@yahoo.com.
authors.forename: Ulfin
authors.initials: U
authors.lastname: Rethnam
authors.forename: James
authors.initials: J
authors.lastname: Cordell-Smith
authors.forename: Amit
authors.initials: A
authors.lastname: Sinha