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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2011

Open Access 01-12-2011 | Study protocol

Evaluation of the safety of C-spine clearance by paramedics: design and methodology

Authors: Christian Vaillancourt, Manya Charette, Ann Kasaboski, Justin Maloney, George A Wells, Ian G Stiell

Published in: BMC Emergency Medicine | Issue 1/2011

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Abstract

Background

Canadian Emergency Medical Services annually transport 1.3 million patients with potential neck injuries to local emergency departments. Less than 1% of those patients have a c-spine fracture and even less (0.5%) have a spinal cord injury. Most injuries occur before the arrival of paramedics, not during transport to the hospital, yet most patients are transported in ambulances immobilized. They stay fully immobilized until a bed is available, or until physician assessment and/or X-rays are complete. The prolonged immobilization is often unnecessary and adds to the burden of already overtaxed emergency medical services systems and crowded emergency departments.

Methods/Design

The goal of this study is to evaluate the safety and potential impact of an active strategy that allows paramedics to assess very low-risk trauma patients using a validated clinical decision rule, the Canadian C-Spine Rule, in order to determine the need for immobilization during transport to the emergency department.
This cohort study will be conducted in Ottawa, Canada with one emergency medical service. Paramedics with this service participated in an earlier validation study of the Canadian C-Spine Rule. Three thousand consecutive, alert, stable adult trauma patients with a potential c-spine injury will be enrolled in the study and evaluated using the Canadian C-Spine Rule to determine the need for immobilization. The outcomes that will be assessed include measures of safety (numbers of missed fractures and serious adverse outcomes), measures of clinical impact (proportion of patients transported without immobilization, key time intervals) and performance of the Rule.

Discussion

Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.

Trial Registration

ClinicalTrials.gov NCT01188447
Appendix
Available only for authorised users
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Metadata
Title
Evaluation of the safety of C-spine clearance by paramedics: design and methodology
Authors
Christian Vaillancourt
Manya Charette
Ann Kasaboski
Justin Maloney
George A Wells
Ian G Stiell
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2011
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/1471-227X-11-1

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