Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 3/2017

01-06-2017 | Original Article

Expertise of German paramedics concerning the prehospital treatment of patients with spinal trauma

Authors: M. Kreinest, S. Goller, B. Gliwitzky, P. A. Grützner, M. Küffer, D. Häske, V. Papathanassiou, M. Münzberg

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2017

Login to get access

Abstract

Purpose

Spinal immobilization is a standard procedure in emergency medicine. Increasing awareness of complications associated with immobilization of trauma patients leads to controversial discussions in the literature. Current guidelines require to include considerations of accident mechanism, an assessment of the patient’s condition and an examination of the spine in the decision-making process if immobilization of the spine should be performed. This requires sound knowledge of assessing these parameters. The aim of the current study is to analyze German paramedics’ subjective uncertainty in terms of their prehospital assessment and treatment of patients suffering from spine injuries.

Methods

Over a period of 17 months participants in a trauma course were asked to complete a standardized anonymous questionnaire about subjective uncertainty of prehospital assessment and management of spinal trauma before participation in that course. Questions about the frequency of application of different immobilization tools and skills training on spinal immobilization were also asked.

Results

A total of 465 paramedics were surveyed. The participants did not indicate any uncertainty about the prehospital diagnosis and treatment of spinal injuries. The feeling of confidence was significantly greater in participants who had already attended another course on structured trauma care before. The participants agreed with the statements that standardized algorithms facilitate teamwork and that there is a need for a protocol for the prehospital treatment of spinal injuries.

Conclusions

Paramedics do not feel uncertain about the prehospital assessment and treatment of spinal injuries. The feeling of confidence in participants who had already attended a course on the treatment of trauma patients before was significantly higher.
Literature
1.
go back to reference Abram S, Bulstrode C. Routine spinal immobilization in trauma patients: what are the advantages and disadvantages? Surg J R Coll Surg Edinb Irel. 2010;8:218–22. Abram S, Bulstrode C. Routine spinal immobilization in trauma patients: what are the advantages and disadvantages? Surg J R Coll Surg Edinb Irel. 2010;8:218–22.
2.
go back to reference Ali J, Cohen R, Adam R, et al. Teaching effectiveness of the advanced trauma life support program as demonstrated by an objective structured clinical examination for practicing physicians. World journal of surgery. 1996;20:1121–5 (discussion 1125–1126).CrossRefPubMed Ali J, Cohen R, Adam R, et al. Teaching effectiveness of the advanced trauma life support program as demonstrated by an objective structured clinical examination for practicing physicians. World journal of surgery. 1996;20:1121–5 (discussion 1125–1126).CrossRefPubMed
3.
go back to reference Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17:915–8.CrossRefPubMed Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17:915–8.CrossRefPubMed
4.
go back to reference Ben-Galim P, Dreiangel N, Mattox KL, et al. Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010;69:447–50.CrossRefPubMed Ben-Galim P, Dreiangel N, Mattox KL, et al. Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010;69:447–50.CrossRefPubMed
5.
go back to reference Bortz J. Statistik: Für Human- und Sozialwissenschaftler. Berlin: Springer; 2005. Bortz J. Statistik: Für Human- und Sozialwissenschaftler. Berlin: Springer; 2005.
6.
go back to reference Bouland AJ, Jenkins JL, Levy MJ. Assessing attitudes toward spinal immobilization. J Emerg Med. 2013;45:e117–25.CrossRefPubMed Bouland AJ, Jenkins JL, Levy MJ. Assessing attitudes toward spinal immobilization. J Emerg Med. 2013;45:e117–25.CrossRefPubMed
7.
go back to reference Clarke A, James S, Ahuja S. Ankylosing spondylitis: inadvertent application of a rigid collar after cervical fracture, leading to neurological complications and death. Acta Orthop Belg. 2010;76:413–5.PubMed Clarke A, James S, Ahuja S. Ankylosing spondylitis: inadvertent application of a rigid collar after cervical fracture, leading to neurological complications and death. Acta Orthop Belg. 2010;76:413–5.PubMed
8.
go back to reference Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med. 1991;17:504–5.CrossRefPubMed Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med. 1991;17:504–5.CrossRefPubMed
9.
go back to reference Deutsche Gesellschaft Für Unfallchirurgie (Dgu); Sektion Intensiv- & Notfallmedizin SNa-aDUG (2014) TraumaRegister DGU—Jahresbericht 2014. Deutsche Gesellschaft Für Unfallchirurgie (Dgu); Sektion Intensiv- & Notfallmedizin SNa-aDUG (2014) TraumaRegister DGU—Jahresbericht 2014.
10.
go back to reference Domeier RM, Evans RW, Swor RA, et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehospital Emerg care Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir. 1999;3:332–7. Domeier RM, Evans RW, Swor RA, et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehospital Emerg care Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir. 1999;3:332–7.
11.
go back to reference Frank CB, Wolfl CG, Hogan A, et al. PHTLS (R) (prehospital trauma life support) provider courses in Germany—who takes part and what do participants think about prehospital trauma care training? J Trauma Manag Outcomes. 2014;8:7.CrossRefPubMedPubMedCentral Frank CB, Wolfl CG, Hogan A, et al. PHTLS (R) (prehospital trauma life support) provider courses in Germany—who takes part and what do participants think about prehospital trauma care training? J Trauma Manag Outcomes. 2014;8:7.CrossRefPubMedPubMedCentral
12.
go back to reference Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344–8.CrossRefPubMed Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344–8.CrossRefPubMed
13.
go back to reference Häske D, Kreinest M, Wölfl CG et al. Bericht aus der Praxis:Strukturierte Fortbildung zur Verbesserung der Versorgungsqualität im Rettungsdienst. Einsatz-Supervision als neuer Ansatz im Bereich der Rettungsdienst-Fortbildung in Wiesbaden und im Rheingau-Taunus-Kreis? In: Zeitschrift fuer Evidenz, Fortbildung und Qualitaet im Gesundheitswesen. 2013; 107(7): 484–489. Häske D, Kreinest M, Wölfl CG et al. Bericht aus der Praxis:Strukturierte Fortbildung zur Verbesserung der Versorgungsqualität im Rettungsdienst. Einsatz-Supervision als neuer Ansatz im Bereich der Rettungsdienst-Fortbildung in Wiesbaden und im Rheingau-Taunus-Kreis? In: Zeitschrift fuer Evidenz, Fortbildung und Qualitaet im Gesundheitswesen. 2013; 107(7): 484–489.
14.
go back to reference Hasler RM, Exadaktylos AK, Bouamra O, et al. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2011;20:2174–80.CrossRef Hasler RM, Exadaktylos AK, Bouamra O, et al. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2011;20:2174–80.CrossRef
15.
go back to reference Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.CrossRefPubMed Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.CrossRefPubMed
16.
go back to reference Konrad C, Schupfer G, Wietlisbach M, et al. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesth Analg. 1998;86:635–9.CrossRefPubMed Konrad C, Schupfer G, Wietlisbach M, et al. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesth Analg. 1998;86:635–9.CrossRefPubMed
17.
go back to reference Kreinest M, Goller S, Rauch G, et al. Application of cervical collars—an analysis of practical skills of professional emergency medical care providers. PLoS One. 2015;10:e0143409.CrossRefPubMedPubMedCentral Kreinest M, Goller S, Rauch G, et al. Application of cervical collars—an analysis of practical skills of professional emergency medical care providers. PLoS One. 2015;10:e0143409.CrossRefPubMedPubMedCentral
18.
go back to reference Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92:1229–36.CrossRefPubMed Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92:1229–36.CrossRefPubMed
19.
go back to reference Mcdonald NE, Curran-Sills G, Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J EMJ. 2015. doi:10.1136/emermed-2015-204693. Mcdonald NE, Curran-Sills G, Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J EMJ. 2015. doi:10.​1136/​emermed-2015-204693.
20.
go back to reference Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72:389–91.CrossRefPubMed Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72:389–91.CrossRefPubMed
21.
go back to reference Mulcaster JT, Mills J, Hung OR, et al. Laryngoscopic intubation: learning and performance. Anesthesiology. 2003;98:23–7.CrossRefPubMed Mulcaster JT, Mills J, Hung OR, et al. Laryngoscopic intubation: learning and performance. Anesthesiology. 2003;98:23–7.CrossRefPubMed
22.
go back to reference Papadopoulos MC, Chakraborty A, Waldron G, et al. Lesson of the week: exacerbating cervical spine injury by applying a hard collar. BMJ Clin Res. 1999;319:171–2.CrossRef Papadopoulos MC, Chakraborty A, Waldron G, et al. Lesson of the week: exacerbating cervical spine injury by applying a hard collar. BMJ Clin Res. 1999;319:171–2.CrossRef
23.
go back to reference Stephan K, Huber S, Haberle S, et al. Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. Spine J Off J North Am Spine Soc. 2015;15:1994–2001CrossRef Stephan K, Huber S, Haberle S, et al. Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. Spine J Off J North Am Spine Soc. 2015;15:1994–2001CrossRef
24.
go back to reference Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–8.CrossRefPubMed Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–8.CrossRefPubMed
25.
go back to reference Sundstrom T, Asbjornsen H, Habiba S, et al. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31:531–40.CrossRefPubMedPubMedCentral Sundstrom T, Asbjornsen H, Habiba S, et al. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31:531–40.CrossRefPubMedPubMedCentral
26.
go back to reference Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72(Suppl 2):22–34.CrossRefPubMed Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72(Suppl 2):22–34.CrossRefPubMed
27.
go back to reference Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehospital Emerg Care Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir. 1999;3:347–52. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehospital Emerg Care Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir. 1999;3:347–52.
28.
go back to reference Unfallchirurgie DGF (2011) S3—Leitlinie Polytrauma/Schwerverletzten-Behandlung AWMF-Register Nr. 012/019. Unfallchirurgie DGF (2011) S3—Leitlinie Polytrauma/Schwerverletzten-Behandlung AWMF-Register Nr. 012/019.
29.
go back to reference Vaillancourt C, Charette M, Kasaboski A, et al. Evaluation of the safety of C-spine clearance by paramedics: design and methodology. BMC Emerg Med. 2011;11:1.CrossRefPubMedPubMedCentral Vaillancourt C, Charette M, Kasaboski A, et al. Evaluation of the safety of C-spine clearance by paramedics: design and methodology. BMC Emerg Med. 2011;11:1.CrossRefPubMedPubMedCentral
30.
go back to reference Vaillancourt C, Stiell IG, Beaudoin T, et al. The out-of-hospital validation of the Canadian C-spine rule by paramedics. Ann Emerg Med. 2009;54(663–671):e661. Vaillancourt C, Stiell IG, Beaudoin T, et al. The out-of-hospital validation of the Canadian C-spine rule by paramedics. Ann Emerg Med. 2009;54(663–671):e661.
31.
go back to reference Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol. 1990;155:465–72.CrossRefPubMed Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol. 1990;155:465–72.CrossRefPubMed
32.
go back to reference Woelfl CG, Guehring T, Moghaddam A, et al. PHTLS team course: a pilot project. Structured student education in prehospital care of severely injured patients. Unfallchirurg. 2012;115:243–9.CrossRefPubMed Woelfl CG, Guehring T, Moghaddam A, et al. PHTLS team course: a pilot project. Structured student education in prehospital care of severely injured patients. Unfallchirurg. 2012;115:243–9.CrossRefPubMed
33.
go back to reference Wölfl CG, Bouillon B, Lackner CK, et al. Prehospital trauma life support® (PHTLS®). Unfallchirurg. 2008;111:688–94.CrossRefPubMed Wölfl CG, Bouillon B, Lackner CK, et al. Prehospital trauma life support® (PHTLS®). Unfallchirurg. 2008;111:688–94.CrossRefPubMed
Metadata
Title
Expertise of German paramedics concerning the prehospital treatment of patients with spinal trauma
Authors
M. Kreinest
S. Goller
B. Gliwitzky
P. A. Grützner
M. Küffer
D. Häske
V. Papathanassiou
M. Münzberg
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2017
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0682-5

Other articles of this Issue 3/2017

European Journal of Trauma and Emergency Surgery 3/2017 Go to the issue