title: Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers.
abstract: BACKGROUND
  In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel.
  
  
  METHODS
  A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol.
  
  
  RESULTS
  Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol.
  
  
  CONCLUSIONS
  Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support.
  
  
  CONCLUSIONS
  The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular.
authors.affiliation: BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.|PHTLS Europe Research Group, Offenbach/Queich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kreinest
authors.affiliation: PHTLS Europe Research Group, Offenbach/Queich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gliwitzky
authors.affiliation: University of Heidelberg, Institute for Medical Biometry and Informatics, Heidelberg, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Schüler
authors.affiliation: BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grützner
authors.affiliation: BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. matthias.muenzberg@bgu-ludwigshafen.de.|PHTLS Europe Research Group, Offenbach/Queich, Germany. matthias.muenzberg@bgu-ludwigshafen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Münzberg
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D003657:Decision Making; D004632:Emergency Medical Services / Q000639:trends*; D005858:Germany; D006801:Humans; D007103:Immobilization / Q000592:standards*; D017410:Practice Guidelines as Topic; D013124:Spinal Injuries / Q000628:therapy*
keywords: Algorithm; Cervical; Emergency; Immobilization; Out-of-hospital; Protocol; Spine