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Paramedic Documentation of Indicators for Cervical Spine Injury

Published online by Cambridge University Press:  28 June 2012

Andre M. Pennardt  and
Wm. John Zehner Jr.
Andre M. Pennardt
Affiliation:
Department of Emergency Medicine, SUNY Health Science Center, Syracuse, N.Y.
Wm. John Zehner Jr.*
Affiliation:
Department of Emergency Medicine, SUNY Health Science Center, Syracuse, N.Y.
*
Department of Emergency Medicine, SUNY Health Science Center, 750 East Adams Street, Syracuse, NY 13210USA
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Abstract

Introduction:

Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should “wear that collar and be strapped to that board.” Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.

Hypothesis:

Algorithms exist for physicians to “clear” the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.

Methods:

A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.

Results:

All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).

Conclusion:

Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

Keywords

algorithmcervical spinedocumentationemergency medical servicesimmobilizationparamedicprehospitaltrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 1 , March 1994 , pp. 40 - 43
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

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