title: Confirmation of suboptimal protocols in spinal immobilisation?
abstract: BACKGROUND
  Spinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication.
  
  
  OBJECTIVE
  The objective of this study was to establish, using biomechanical analysis which technique provides the minimal deviation of the cervical spine from the neutral in-line position during extrication from a vehicle in a larger sample of variable age, height and mass.
  
  
  METHODS
  A crew of two paramedics and four fire-fighters extricated 16 immobilised participants from a vehicle using six techniques for each participant. Participants were marked with biomechanical sensors and relative movement between the sensors was captured via high-speed infrared motion analysis cameras. A three-dimensional mathematical model was developed and a repeated-measures analysis of variance was used to compare movement across extrication techniques.
  
  
  RESULTS
  Controlled self-extrication without a collar resulted in a mean movement of 13.33° from the neutral in-line position of the cervical spine compared to a mean movement of 18.84° during one of the equipment-aided extrications. Two equipment-aided techniques had significantly higher movement (p<0.05) than other techniques. Both height (p=0.003) and mass (p=0.02) of the participants were significant independent predictors of movement.
  
  
  CONCLUSIONS
  These data support the findings of the proof of concept study, for haemodynamically stable patients controlled self-extrication causes less movement of the cervical spine than extrications performed using traditional prehospital rescue equipment.
authors.affiliation: Paramedic Studies Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Dixon
authors.affiliation: Physical Education and Sport Sciences Department, University of Limerick, Limerick, Ireland Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: O'Halloran
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Ailish
authors.initials: A
authors.lastname: Hannigan
authors.affiliation: Fire and Rescue Service, Limerick City and County Council, Limerick, Ireland.
authors.forename: Scott
authors.initials: S
authors.lastname: Keenan
authors.affiliation: Centre for Prehospital Research, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Cummins
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001835:Body Weight; D002574:Cervical Vertebrae; D003430:Cross-Sectional Studies; D005260:Female; D019416:Head Movements; D006801:Humans; D021621:Imaging, Three-Dimensional; D007103:Immobilization / Q000379:methods*; D008297:Male; D013119:Spinal Cord Injuries / Q000517:prevention & control*; D055815:Young Adult
keywords: Trauma; emergency department; first responders; prehospital care; spinal