This document discusses selective spinal motion restriction (SSMR) and alternatives to traditional full spinal immobilization. It notes the risks of long spine boards and rigid cervical collars, including increased pain, pressure sores, and raised intracranial pressure. Current research supports SSMR, using assessment to determine who needs restriction and allowing removal of extrication devices when possible. For transport, soft restraints like vacuum mattresses are recommended over rigid devices when spinal motion restriction alone is needed. The document outlines indications for SSMR including altered mental status, neck/back pain, and distracting injuries. Innovative solutions discussed include soft foam collars and adjustable collars that reduce risks compared to traditional rigid devices.
Scene size-up is the first step of trauma assessment and involves evaluating scene safety, initial triage needs, additional resource requirements, and mechanism of injury. Understanding the mechanism, such as in motor vehicle collisions, falls, or penetrating injuries, allows providers to anticipate potential injuries based on the forces involved. Proper scene size-up is critical for effective trauma management and patient care.
- EMS is a system comprised of various components including public access to 911, EMS response, clinical care, medical control, legislation/regulation, evaluation/quality improvement, transport to hospitals, and prevention/public education.
- As an AEMT, you are an important part of the EMS system and will provide emergency medical care to sick and injured patients within your authorized scope of practice under the supervision of a medical director. Your role involves professional conduct, effective patient interaction, and following legal and regulatory requirements.
The document provides guidelines for cervical spine immobilization including:
- Proper techniques for applying cervical spine immobilization and the criteria for when to immobilize a patient.
- Spinal immobilization should be provided if there is any reasonable possibility of a spinal or head injury.
- The algorithm outlines the steps for manually stabilizing the cervical spine, logrolling a supine patient onto a backboard, and fully immobilizing standing or seated patients.
Spinal immobilization, Treatment or Torture?Luke Winkelman
This document discusses the history and evidence surrounding spinal immobilization practices in EMS. It begins with a brief history of spinal motion restriction from the 1960s to present. It then discusses the anatomy of the spine, costs of spinal cord injuries, and mechanisms of injury that could cause spinal injuries. The majority of the document questions the evidence and potential harms of traditional spinal immobilization using backboards and cervical collars. It presents research showing low rates of spinal injuries from blunt trauma and questions whether immobilization benefits outweigh risks like respiratory compromise, pressure ulcers, and delayed treatment. Alternative approaches adopted by some agencies are presented, as well as calls from organizations to use immobilization more judiciously.
1. The document discusses different types and purposes of triage. Triage is used to prioritize patient treatment during mass casualty events based on urgency of conditions. It aims to allocate patients to the most appropriate care provider and area to maximize lives saved.
2. Primary triage is done in the field to classify patients into categories of urgent need. Secondary triage in the ED further evaluates patients and assigns color codes. Tertiary triage by specialists determines who needs emergency surgery or ICU care.
3. The triage process involves classifying patients into categories of red (most urgent), yellow, green, or black (deceased) based on injury severity and prognosis to direct patients to the right level
This document outlines guidelines for spinal motion restriction (SMR) for EMS providers in Connecticut. It discusses moving away from traditional spinal immobilization which was not evidence-based and could cause harm. The new SMR guidelines are based on research and focus on minimizing unnecessary immobilization. It provides objectives for EMS training and outlines the SMR assessment process to determine if a patient requires restriction of spinal motion based on their mechanism of injury, ability to be assessed, and clinical findings. It describes the SMR procedure for extrication, moving, transporting, and restricting motion of patients who require SMR. The goal is to appropriately care for patients while reducing risks from traditional immobilization techniques.
The document provides an overview of key topics from a chapter on prehospital emergency care, including anatomical terms, body positions, anatomical planes and landmarks, body cavities, and the musculoskeletal system. It describes anatomical structures like the skull, spinal column, and skeletal system. Case studies and review questions are presented to help reinforce the material.
This chapter discusses the history and development of Emergency Medical Services (EMS) systems. It covers the roles of various EMS personnel like EMTs, paramedics, and medical directors. The chapter also addresses important topics like quality improvement, medical research, ethics, and evidence-based practice within EMS. Overall, the chapter provides an overview of the key aspects of EMS systems and the roles and responsibilities of EMS professionals.
Scene size-up is the first step of trauma assessment and involves evaluating scene safety, initial triage needs, additional resource requirements, and mechanism of injury. Understanding the mechanism, such as in motor vehicle collisions, falls, or penetrating injuries, allows providers to anticipate potential injuries based on the forces involved. Proper scene size-up is critical for effective trauma management and patient care.
- EMS is a system comprised of various components including public access to 911, EMS response, clinical care, medical control, legislation/regulation, evaluation/quality improvement, transport to hospitals, and prevention/public education.
- As an AEMT, you are an important part of the EMS system and will provide emergency medical care to sick and injured patients within your authorized scope of practice under the supervision of a medical director. Your role involves professional conduct, effective patient interaction, and following legal and regulatory requirements.
The document provides guidelines for cervical spine immobilization including:
- Proper techniques for applying cervical spine immobilization and the criteria for when to immobilize a patient.
- Spinal immobilization should be provided if there is any reasonable possibility of a spinal or head injury.
- The algorithm outlines the steps for manually stabilizing the cervical spine, logrolling a supine patient onto a backboard, and fully immobilizing standing or seated patients.
Spinal immobilization, Treatment or Torture?Luke Winkelman
This document discusses the history and evidence surrounding spinal immobilization practices in EMS. It begins with a brief history of spinal motion restriction from the 1960s to present. It then discusses the anatomy of the spine, costs of spinal cord injuries, and mechanisms of injury that could cause spinal injuries. The majority of the document questions the evidence and potential harms of traditional spinal immobilization using backboards and cervical collars. It presents research showing low rates of spinal injuries from blunt trauma and questions whether immobilization benefits outweigh risks like respiratory compromise, pressure ulcers, and delayed treatment. Alternative approaches adopted by some agencies are presented, as well as calls from organizations to use immobilization more judiciously.
1. The document discusses different types and purposes of triage. Triage is used to prioritize patient treatment during mass casualty events based on urgency of conditions. It aims to allocate patients to the most appropriate care provider and area to maximize lives saved.
2. Primary triage is done in the field to classify patients into categories of urgent need. Secondary triage in the ED further evaluates patients and assigns color codes. Tertiary triage by specialists determines who needs emergency surgery or ICU care.
3. The triage process involves classifying patients into categories of red (most urgent), yellow, green, or black (deceased) based on injury severity and prognosis to direct patients to the right level
This document outlines guidelines for spinal motion restriction (SMR) for EMS providers in Connecticut. It discusses moving away from traditional spinal immobilization which was not evidence-based and could cause harm. The new SMR guidelines are based on research and focus on minimizing unnecessary immobilization. It provides objectives for EMS training and outlines the SMR assessment process to determine if a patient requires restriction of spinal motion based on their mechanism of injury, ability to be assessed, and clinical findings. It describes the SMR procedure for extrication, moving, transporting, and restricting motion of patients who require SMR. The goal is to appropriately care for patients while reducing risks from traditional immobilization techniques.
The document provides an overview of key topics from a chapter on prehospital emergency care, including anatomical terms, body positions, anatomical planes and landmarks, body cavities, and the musculoskeletal system. It describes anatomical structures like the skull, spinal column, and skeletal system. Case studies and review questions are presented to help reinforce the material.
This chapter discusses the history and development of Emergency Medical Services (EMS) systems. It covers the roles of various EMS personnel like EMTs, paramedics, and medical directors. The chapter also addresses important topics like quality improvement, medical research, ethics, and evidence-based practice within EMS. Overall, the chapter provides an overview of the key aspects of EMS systems and the roles and responsibilities of EMS professionals.
Scene assessment involves evaluating safety, pre-arrival information, arrival on scene, available resources, and mechanism of injury. The primary assessment evaluates airway, breathing, circulation, disability, and environment/exposure to identify life-threatening conditions. This assessment determines if the patient is sick, not yet sick, or not sick. Based on these assessments, the responder decides if immediate transport is needed, if further assessment is required, how to package the patient, the transport method, and receiving facility.
This document discusses scene safety for emergency medical technicians. It emphasizes that scene safety is the top priority when responding to any call. EMTs must assess hazards such as environmental conditions, hazardous materials, potential for violence, and vehicle collisions before providing care to patients. The document provides guidance on identifying hazards, requesting assistance if a scene is unsafe, and techniques for providing care while protecting oneself and patients from risks.
The document provides guidance on performing an initial patient assessment for EMTs. It describes evaluating the scene for safety, determining the mechanism of injury or nature of illness, and performing an initial assessment of the patient's airway, breathing, circulation, mental status and skin signs. The assessment may be followed by a more focused physical exam and history gathering for medical versus trauma patients. Key steps include maintaining spinal immobilization if needed, assessing vital signs, and identifying any life-threatening conditions requiring immediate treatment.
An EMT typically works 24-hour shifts for an average of 50 hours per week. They must be ready to respond to emergency dispatch calls to aid those in need. At the scene, the EMT identifies the person requiring aid. EMTs work in nursing homes, hospitals, and other facilities in 12-hour day and night shifts under all weather conditions. They may have to travel long distances on foot to reach some patients. While rewarding, the job has long hours and can be emotionally difficult due to the trauma EMTs witness.
The document provides an overview of the emergency medical services (EMS) system and the roles within it. It discusses the timeline of EMS developing from Civil War medical care, the different models of EMS systems, and levels of training including emergency medical responders. Emergency medical responders are the first to arrive on scene and provide initial care like assessing the patient, providing basic life support, and safely moving the patient. Research and new technology help improve patient care standards and guidelines within the EMS system.
Tactical Combat Casualty Care Update: 2015Tetiana Botsva
The document provides an update on Tactical Combat Casualty Care (TCCC). It discusses that coalition forces currently have the best trauma care and evacuation system in history. However, 87% of combat fatalities still occur in the pre-hospital phase before reaching the hospital. TCCC aims to ensure casualties survive to reach the hospital where they can benefit from definitive care. The document reviews changes and advances made in TCCC over the past decade, including increased use of tourniquets, hemostatic dressings, and fluid resuscitation with blood products. It emphasizes that further efforts are needed to fully incorporate TCCC advances across medical and operational units.
Management of polytraumatized patients focuses on organizing trauma teams and systems. The trauma team is assigned specific tasks to simultaneously address life-threatening injuries. A trauma system includes protocols like ATLS for managing multi-injured patients. ATLS emphasizes treating lethal injuries first through a primary survey addressing airway, breathing, circulation, disability and exposure. Secondary surveys then discover all other injuries to develop a definitive management plan. Proper triage also sorts patients by priority to maximize survival of the most severely injured.
The document discusses proper lifting and moving techniques for EMTs. It covers body mechanics principles like keeping weight close and lifting with legs. It describes emergency, urgent and non-urgent moves. It also lists common patient carrying devices like stretchers, chairs, boards and baskets.
Prehospital care in Malaysia - Issues and ChallengesChew Keng Sheng
The document discusses pre-hospital care in Malaysia and identifies several issues and challenges. It notes that Malaysia has a complex pre-hospital care system incorporating hospital-based, civil defense, private, volunteer-based, and other models. Key challenges include a lack of standardized training for pre-hospital providers, inconsistent communication between agencies, and limited access to care in remote areas. The document calls for addressing these challenges to improve pre-hospital care coordination and patient outcomes in Malaysia.
Trauma is a leading cause of death worldwide and in the United States. Annually in the US, trauma results in over 179,000 deaths, 60 million injuries, 40 million emergency department visits, and $684 billion in economic costs. The goals of PHTLS are to reduce mortality and morbidity from trauma through providing appropriate prehospital care. It teaches a team-based approach and emphasizes clear communication and documentation. PHTLS is based on current trauma research and aims to teach assessment and treatment principles to enhance critical thinking and patient care.
TEMS - Tactical Emergency Medical ServicesscanFOAM
A talk by Peter Anthony Berlac at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
2020 special considerations in emergent interfacility transportsRobert Cole
This document discusses special considerations for interfacility transports. It defines different types of transports including interfacility, specialty care, and levels of acuity. It discusses EMTALA requirements including conducting a medical screening exam, stabilizing patients with emergency conditions, and ensuring appropriate transfers. It notes special considerations for pregnant patients under EMTALA and requirements for qualified personnel and equipment during transfers.
Manual of common bedside surgical procedures 2edThaisa Pestana
This chapter discusses various techniques for managing the airway including:
1) Manual maneuvers like head tilt and jaw thrust to relieve mild airway obstruction.
2) Oral and nasal airway devices to relieve partial or complete upper airway obstruction.
3) Bag-mask ventilation for respiratory support.
4) Tracheal intubation, which can be done orally or nasally to secure the airway.
5) Other advanced techniques like the laryngeal mask airway, lighted stylet intubation, and cricothyroidotomy.
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
The document discusses emergency triage in a hospital emergency department. It describes triage as a process where a nurse rapidly evaluates patients upon arrival to determine the level of acuity and priority for care. The triage nurse assesses factors like chief complaint, appearance, vital signs, history and assigns the patient to one of five standardized triage levels, from level 1 being life-threatening to level 5 being non-urgent, with corresponding timeframes for clinician assessment. The primary role of the triage nurse is to make decisions about priority of care while monitoring for communicable diseases or violence.
Pre-hospital care aims to reduce morbidity and mortality for patients outside the hospital by providing immediate medical care at the scene and during transport. It involves various providers like paramedics, nurses, and doctors who are specially trained to treat patients in pre-hospital settings. The philosophy is to intervene appropriately and transport patients safely to definitive care in a timely manner. An effective pre-hospital care system requires coordination between various stakeholders including emergency responders, hospitals, and policymakers to ensure patients receive optimal care from the scene to the hospital.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
1) Spinal motion restriction (SMR) guidelines aim to minimize spinal movement to avoid aggravating injury, but should only be applied based on careful evaluation of injury mechanism and reliable patient assessment, not simply due to mechanism alone.
2) While SMR is traditionally recommended for spinal trauma patients, there is limited evidence that it improves outcomes and it can cause complications; a patient-centered approach evaluates each case individually.
3) Special situations like closed-space rescues, water incidents, or patients in protective gear may require airway access or equipment removal, which should be done while prioritizing spinal stabilization and neutral alignment.
This document discusses chest trauma and injuries. It begins with an overview of the anatomy of the chest and categories of chest injuries such as open chest injuries from penetration or closed chest injuries from blunt force. Specific injuries discussed in detail include flail chest segments, pulmonary contusions, and pneumothoraces. The document emphasizes the importance of thoroughly assessing for potential chest injuries after trauma and providing interventions to support ventilation and oxygenation such as positive pressure ventilation for serious injuries.
Scene assessment involves evaluating safety, pre-arrival information, arrival on scene, available resources, and mechanism of injury. The primary assessment evaluates airway, breathing, circulation, disability, and environment/exposure to identify life-threatening conditions. This assessment determines if the patient is sick, not yet sick, or not sick. Based on these assessments, the responder decides if immediate transport is needed, if further assessment is required, how to package the patient, the transport method, and receiving facility.
This document discusses scene safety for emergency medical technicians. It emphasizes that scene safety is the top priority when responding to any call. EMTs must assess hazards such as environmental conditions, hazardous materials, potential for violence, and vehicle collisions before providing care to patients. The document provides guidance on identifying hazards, requesting assistance if a scene is unsafe, and techniques for providing care while protecting oneself and patients from risks.
The document provides guidance on performing an initial patient assessment for EMTs. It describes evaluating the scene for safety, determining the mechanism of injury or nature of illness, and performing an initial assessment of the patient's airway, breathing, circulation, mental status and skin signs. The assessment may be followed by a more focused physical exam and history gathering for medical versus trauma patients. Key steps include maintaining spinal immobilization if needed, assessing vital signs, and identifying any life-threatening conditions requiring immediate treatment.
An EMT typically works 24-hour shifts for an average of 50 hours per week. They must be ready to respond to emergency dispatch calls to aid those in need. At the scene, the EMT identifies the person requiring aid. EMTs work in nursing homes, hospitals, and other facilities in 12-hour day and night shifts under all weather conditions. They may have to travel long distances on foot to reach some patients. While rewarding, the job has long hours and can be emotionally difficult due to the trauma EMTs witness.
The document provides an overview of the emergency medical services (EMS) system and the roles within it. It discusses the timeline of EMS developing from Civil War medical care, the different models of EMS systems, and levels of training including emergency medical responders. Emergency medical responders are the first to arrive on scene and provide initial care like assessing the patient, providing basic life support, and safely moving the patient. Research and new technology help improve patient care standards and guidelines within the EMS system.
Tactical Combat Casualty Care Update: 2015Tetiana Botsva
The document provides an update on Tactical Combat Casualty Care (TCCC). It discusses that coalition forces currently have the best trauma care and evacuation system in history. However, 87% of combat fatalities still occur in the pre-hospital phase before reaching the hospital. TCCC aims to ensure casualties survive to reach the hospital where they can benefit from definitive care. The document reviews changes and advances made in TCCC over the past decade, including increased use of tourniquets, hemostatic dressings, and fluid resuscitation with blood products. It emphasizes that further efforts are needed to fully incorporate TCCC advances across medical and operational units.
Management of polytraumatized patients focuses on organizing trauma teams and systems. The trauma team is assigned specific tasks to simultaneously address life-threatening injuries. A trauma system includes protocols like ATLS for managing multi-injured patients. ATLS emphasizes treating lethal injuries first through a primary survey addressing airway, breathing, circulation, disability and exposure. Secondary surveys then discover all other injuries to develop a definitive management plan. Proper triage also sorts patients by priority to maximize survival of the most severely injured.
The document discusses proper lifting and moving techniques for EMTs. It covers body mechanics principles like keeping weight close and lifting with legs. It describes emergency, urgent and non-urgent moves. It also lists common patient carrying devices like stretchers, chairs, boards and baskets.
Prehospital care in Malaysia - Issues and ChallengesChew Keng Sheng
The document discusses pre-hospital care in Malaysia and identifies several issues and challenges. It notes that Malaysia has a complex pre-hospital care system incorporating hospital-based, civil defense, private, volunteer-based, and other models. Key challenges include a lack of standardized training for pre-hospital providers, inconsistent communication between agencies, and limited access to care in remote areas. The document calls for addressing these challenges to improve pre-hospital care coordination and patient outcomes in Malaysia.
Trauma is a leading cause of death worldwide and in the United States. Annually in the US, trauma results in over 179,000 deaths, 60 million injuries, 40 million emergency department visits, and $684 billion in economic costs. The goals of PHTLS are to reduce mortality and morbidity from trauma through providing appropriate prehospital care. It teaches a team-based approach and emphasizes clear communication and documentation. PHTLS is based on current trauma research and aims to teach assessment and treatment principles to enhance critical thinking and patient care.
TEMS - Tactical Emergency Medical ServicesscanFOAM
A talk by Peter Anthony Berlac at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
2020 special considerations in emergent interfacility transportsRobert Cole
This document discusses special considerations for interfacility transports. It defines different types of transports including interfacility, specialty care, and levels of acuity. It discusses EMTALA requirements including conducting a medical screening exam, stabilizing patients with emergency conditions, and ensuring appropriate transfers. It notes special considerations for pregnant patients under EMTALA and requirements for qualified personnel and equipment during transfers.
Manual of common bedside surgical procedures 2edThaisa Pestana
This chapter discusses various techniques for managing the airway including:
1) Manual maneuvers like head tilt and jaw thrust to relieve mild airway obstruction.
2) Oral and nasal airway devices to relieve partial or complete upper airway obstruction.
3) Bag-mask ventilation for respiratory support.
4) Tracheal intubation, which can be done orally or nasally to secure the airway.
5) Other advanced techniques like the laryngeal mask airway, lighted stylet intubation, and cricothyroidotomy.
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
The document discusses emergency triage in a hospital emergency department. It describes triage as a process where a nurse rapidly evaluates patients upon arrival to determine the level of acuity and priority for care. The triage nurse assesses factors like chief complaint, appearance, vital signs, history and assigns the patient to one of five standardized triage levels, from level 1 being life-threatening to level 5 being non-urgent, with corresponding timeframes for clinician assessment. The primary role of the triage nurse is to make decisions about priority of care while monitoring for communicable diseases or violence.
Pre-hospital care aims to reduce morbidity and mortality for patients outside the hospital by providing immediate medical care at the scene and during transport. It involves various providers like paramedics, nurses, and doctors who are specially trained to treat patients in pre-hospital settings. The philosophy is to intervene appropriately and transport patients safely to definitive care in a timely manner. An effective pre-hospital care system requires coordination between various stakeholders including emergency responders, hospitals, and policymakers to ensure patients receive optimal care from the scene to the hospital.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
1) Spinal motion restriction (SMR) guidelines aim to minimize spinal movement to avoid aggravating injury, but should only be applied based on careful evaluation of injury mechanism and reliable patient assessment, not simply due to mechanism alone.
2) While SMR is traditionally recommended for spinal trauma patients, there is limited evidence that it improves outcomes and it can cause complications; a patient-centered approach evaluates each case individually.
3) Special situations like closed-space rescues, water incidents, or patients in protective gear may require airway access or equipment removal, which should be done while prioritizing spinal stabilization and neutral alignment.
This document discusses chest trauma and injuries. It begins with an overview of the anatomy of the chest and categories of chest injuries such as open chest injuries from penetration or closed chest injuries from blunt force. Specific injuries discussed in detail include flail chest segments, pulmonary contusions, and pneumothoraces. The document emphasizes the importance of thoroughly assessing for potential chest injuries after trauma and providing interventions to support ventilation and oxygenation such as positive pressure ventilation for serious injuries.
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
The document discusses spinal injuries and the traditional approach of fully immobilizing all suspected spinal injuries. It notes that this approach is being reevaluated as it may not be as necessary or beneficial as previously thought, as only a small percentage of immobilized casualties actually have spinal injuries. The document outlines several issues with full immobilization, such as increased risk of pressure sores and reduced respiratory function. It suggests that alternative devices like vacuum mattresses may provide sufficient immobilization without the same risks. The document advocates for a more selective approach to immobilization based on mechanism of injury and patient presentation to better balance risks of immobilization against benefits of potential spinal protection.
This document discusses the management and treatment of brain and spinal injuries. It outlines steps for treating brain injuries, including securing the airway, providing oxygen, immobilizing the spine, starting IVs, and rapid transport. It then describes different types of spinal trauma such as hyperextension, compression, rotation, lateral stress, and distraction. Examples are provided for each type. The document concludes by covering signs and symptoms of spinal injuries, immobilization devices and techniques, general treatment principles, and the possibility of future protocols that may allow for ruling out the need for full spinal immobilization.
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
This document discusses trauma triage and the Advanced Trauma Life Support (ATLS) protocol. It begins with an introduction to trauma and triage. It then covers the primary and secondary surveys in ATLS, which assess the patient's airway, breathing, circulation, disability, and exposure. The primary survey focuses on stabilization, while the secondary survey involves a full head-to-toe examination. Re-evaluation is important if the patient deteriorates. Triage on the scene uses a four-level scale to determine priority of care. Overall, the document provides an overview of trauma patient assessment and management based on the ATLS guidelines.
1. The level of amputation is selected based on factors like viability of tissues, risk of infection, and suitability for prosthesis use.
2. Lower extremity amputations are generally classified based on the level - such as transfemoral (above knee), transtibial (below knee), knee disarticulation.
3. The goal is to amputate at the lowest possible level to allow for maximum function with a prosthesis. Higher levels of amputation are associated with greater challenges to rehabilitation.
A mangled extremity refers to severe limb injury where viability is questionable. Emergent management prioritizes life-saving care. The decision to salvage or amputate is complex, considering scoring systems, nerve function, bone/joint integrity, and patient factors. If salvaged, options include debridement, fixation, flaps, and bone reconstruction. Amputation may provide better function than some salvaged limbs, especially with vascular/major injuries. The child's growth is also a key consideration.
Bilateral hip fractures are rare and usually result from high-energy trauma. This case report describes a 40-year old male who sustained simultaneous bilateral intertrochanteric hip fractures after his lower body was crushed in a motor vehicle accident. He underwent staged surgical fixation of the fractures with dynamic hip screws. Postoperative recovery was uncomplicated. While bilateral hip fractures pose risks, early surgical treatment and careful monitoring can lead to good functional outcomes even in active patients.
This document discusses the management of polytrauma patients. Polytrauma is defined as multiple injuries exceeding a certain severity threshold or involving multiple body regions. Over 1 million people die each year from traffic injuries worldwide. The management of polytrauma patients requires a multidisciplinary team approach led by a general surgeon. The team evaluates patients using scoring systems like the Injury Severity Score to predict outcomes. The evaluation involves a primary survey to address life threats and a secondary full-body examination to identify and treat all injuries.
1. Immobilize the cervical spine and obtain imaging of the full spine including CT scan of the cervical spine to evaluate for fractures or ligamentous injuries.
2. Perform neurological examination and assess for signs of spinal cord injury such as motor and sensory deficits.
3. Maintain adequate perfusion with intravenous fluids to achieve a mean arterial pressure of 85 mmHg to support cord perfusion.
4. Administer steroids such as methylprednisolone if spinal cord injury is present based on imaging and neurological exam findings.
5. Determine need for surgical stabilization and decompression depending on fracture pattern and presence
This document discusses diagnosis and treatment of acromioclavicular (AC) joint injuries. It describes the anatomy of the AC joint and classifications of injuries. For type I and II injuries, conservative treatment with slings or harnesses is recommended. Types IV, V and VI generally require surgical treatment to reduce and reconstruct injured ligaments. Recent techniques focus on arthroscopic reconstruction of the coracoclavicular ligaments and stabilization of the AC joint with suture anchors, tightropes or tendon grafts. Arthroscopy allows better visualization and less invasive reconstruction of the ligaments compared to open surgery.
Injuries to the sternoclavicular (SC) joint are uncommon and can result from direct or indirect forces. Mechanisms typically involve vehicular accidents or athletics. Assessment involves history, physical exam, and imaging like CT or MRI. Injuries are classified based on anatomy and etiology. Treatment depends on type but may involve closed reduction, bracing, or open surgery for irreducible injuries. Complications can be life-threatening if not addressed promptly and can include vascular, tracheal, or neurological issues. Careful follow-up is important to monitor for late effects.
Upper limb slabs, broad arm sling and.pptxAyalewKomande1
This document provides information on various types of upper limb splints and slints, including their indications, techniques, and complications. It discusses splinting principles and describes techniques for coaptation splints, long arm posterior splints, sugar tong splints, wrist splints, gutter splints, thumb spica splints, finger extension splints, broad arm slings, collar and cuffs. Complications of splinting like loss of reduction, sores, and neurovascular compromise are also covered. The document emphasizes immobilizing joints in positions of function and monitoring for signs of impaired circulation.
This document discusses primary trauma care and outlines the steps for assessing and managing trauma patients. It covers triaging patients, performing a primary and secondary survey, identifying life-threatening injuries, providing initial resuscitation and stabilization, and determining appropriate disposition. The primary goals are to assess and treat airway, breathing, circulation and disability issues; control hemorrhage; and identify injuries requiring surgical intervention. Proper trauma management in the first hours can significantly impact outcomes.
Clavicle fractures are common injuries, especially in young active individuals. The majority occur in the midshaft region due to its thin bone and lack of muscle protection. Treatment depends on the location and degree of displacement/shortening. Nondisplaced fractures are usually treated nonsurgically with slings or strapping. Displaced fractures may require plate fixation, intramedullary nails, or coracoclavicular ligament repair/reconstruction to achieve union and restore function. Complications can include nonunion, malunion, hardware irritation, and neurovascular injury.
1) Meniscus injuries are among the most common orthopedic injuries seen in practice, with an incidence of 61 cases per 100,000 people per year. Arthroscopic partial meniscectomy is one of the most common orthopedic procedures performed.
2) Meniscal tears can be classified based on location and pattern. Common types include bucket handle tears, longitudinal vertical tears, radial tears, and root tears. MRI is the gold standard for diagnosing meniscal tears.
3) Treatment depends on the type and location of the tear. Unstable tears or tears over 1cm are typically repaired surgically if possible. Debridement or meniscectomy is performed if the tear is not
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdfRobert Cole
(note: This presentation contained videos not included in this slide deck)
Describe the elements of Negligence
Describe the concept of vicarious liability
Describe the role of anchor bias, fatigue, anger and fear in EMS decision making
Review the case of Kyle Vess
Review the case of Paul Tarashuk
Review the case of Crystal Galloway
Introductory/onboarding training for Video Laryngeoscopy, specifically for the MacGrath VL.
NOTE: This is meant to be part of a larger educational endeavor including online, hands on, and team based training.
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...Robert Cole
This document summarizes a study examining outcomes of patients transported to the hospital with ongoing cardiopulmonary resuscitation (CPR) following out-of-hospital cardiac arrest. The study assessed 227 patients transported to three hospitals in the UK with ongoing CPR between 2016-2017. It found that 39.2% of patients met criteria for universal prehospital termination of resuscitation based on guidelines. Overall survival of patients transported with ongoing CPR was very poor, with only 3 patients (1.3%) surviving to hospital discharge and none of those meeting termination of resuscitation criteria surviving.
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdfRobert Cole
This study compared outcomes of out-of-hospital cardiac arrest (OHCA) patients who received manual chest compressions versus mechanical chest compressions delivered by a mechanical CPR device. The study took place in an EMS system that implemented a quality improvement effort to standardize their "pit crew" approach to OHCA resuscitation and establish a scripted sequence for initiating mechanical CPR. The study found that after controlling for patient characteristics, OHCA patients who received manual CPR had higher rates of return of spontaneous circulation and survival to hospital discharge compared to those receiving mechanical CPR.
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdfRobert Cole
This clinical paper compares outcomes of patients receiving ACE-CPR (which includes controlled elevation of the head and thorax during CPR using various adjunct devices) versus conventional C-CPR. Data was collected from 227 ACE-CPR patients in 6 EMS systems and compared to 5196 C-CPR patients from previous trials. Propensity score matching was used. Results found that rapid initiation of ACE-CPR (within 11 or 18 minutes) was associated with higher odds of survival to hospital discharge compared to C-CPR, as well as higher rates of ROSC and favorable neurological outcomes. The study concludes ACE-CPR may improve survival after out-of-hospital cardiac arrest when initiated
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...Robert Cole
Bag-mask ventilation (BMV) is a less complex technique than endotracheal
intubation (ETI) for airway management during the advanced cardiac life support phase of
cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest.
It has been reported as superior in terms of survival.
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdfRobert Cole
Accession Number: AD0427998
Title: CLINICAL SHOCK; A STUDY OF THE BIOCHEMICAL RESPONSE TO INJURY IN MAN
Descriptive Note: Annual progress rept. 1 Jan-31 Dec 1963
Corporate Author: MARYLAND UNIV BALTIMORE SCHOOL OF MEDICINE
Personal Author(s): Crowley, R. A.
Report Date: 1963-12-31
Pagination or Media Count: 226.0
Abstract: Traumatic shock is associated usually with severe injury and characterized principally by inability to maintain an adequate circulation. This study focuses on the total problem - the reaction of the body to injury, maintenance of life, and repair of injury. Studies currently in progress and those proposed are aimed primarily to understanding the biochemical response to injury in man. Provisions have been made for careful metabolic studies in the shocked patient without interfering with obvious life saving measures. Such extensive studies have required the assembly of a considerable staff - professional and technical - to support a C.S.U. on a 24-hour basis. Experimental problems relevant to establishment of such a unit evolved from two major factors 1 original nature of the study a scientific study of shock in man and 2 an unprecedented design of this study. Solutions to these problems are described. Since inception of the contract January, 1962, some 200 patients have been studied as they have undergone resuscitation measures. Final organization of the unit now permits more complex studies into the physio-biochemical response to injury in man.
Descriptors: *ENDOTOXIC SHOCK BACTERIA ENZYMES METABOLISM AMMONIA THERAPY HYPOXIA PHYSIOLOGY WOUNDS AND INJURIES IMMUNOLOGY CARDIOVASCULAR SYSTEM HYPOTHERMIA TOXINS AND ANTITOXINS HEMORRHAGE BLOOD COAGULATION
Subject Categories: Stress Physiology
Distribution Statement: APPROVED FOR PUBLIC RELEASE
Proposal to establish a new training center for Multi Agency EMS Training v1....Robert Cole
Vision
The Joint Emergency Medical Services training Center (JEMSTC) is a multi-use campus
and facilities dedicated to the provision of EMS and public safety education in the Ada
County-City Emergency Medical Services System. It would serve as a locus of collaboration and
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The JEMSTC would provide facilities for 24 /7 EMS education, vehicle operation, skills
practice, and credentialing. The facilities would be able to accommodate both EMS and Fire
apparatus in all climates for a diverse array of educational activities. This JEMSTC would meet
all the EMS (and related operational) training for the ACCESS system.
This document discusses thyroid storm, a life-threatening condition caused by excess thyroid hormone levels. It begins by outlining the objectives of understanding the pathophysiology of hyperthyroidism, recognizing clinical presentations of thyroid storm, and providing optimal treatment guidelines. Key points include distinguishing primary from secondary hyperthyroidism, identifying potential triggers of thyroid storm like infection or trauma, and describing the classic presentation of fever, tachycardia, and altered mental status. Treatment involves supportive care as well as inhibiting thyroid hormone synthesis with drugs, blocking hormone release with iodine, treating symptoms like tachycardia, and using steroids or plasmapheresis in refractory cases. The goal is to reduce circulating thyroid hormone levels and control
This document provides information on adrenal issues including primary and secondary adrenal failure, Cushing's syndrome, and Addisonian crisis. It discusses the pathophysiology, etiology, clinical presentation, and treatment of adrenal insufficiency and adrenal crisis. Key points include that adrenal emergencies can be fatal if not recognized and treated rapidly, and the greatest challenge is recognizing the condition given its non-specific early symptoms. Treatment involves administering stress doses of glucocorticoids intravenously or intramuscularly such as hydrocortisone, methylprednisolone, or dexamethasone.
This document provides guidance on effective medical documentation using the SOAP note format. It discusses the goals of documentation, including writing consistently, comprehensively, and in a legally defensible manner. It then covers the components of the SOAP note format, with subjective (S) covering patient-reported information, objective (O) focusing on clinical observations, assessment (A) stating the patient's conditions, and plan (P) outlining treatment. The document emphasizes writing objectively and avoiding judgment.
This document from • The Centers for Medicare & Medicaid Services shows that refusing to accept reports or parking EMS patients on the wall may be an EMTALA violation.
Hospitals and administrators do not want line EMS providers to know this, but this is ammo against abuse of EMS systems by ER Staff.
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...Robert Cole
This document discusses improving drug calculation performance among paramedics. It provides context on the author's role as an EMS educator and describes the lack of emphasis on math skills in initial and continuing paramedic education programs. The literature review examines studies showing poor math performance among healthcare providers and the relationship to medical errors. It explores strategies used in other fields to address math anxiety and improve formal math preparation as ways to enhance drug calculation skills for paramedics working in high-stress emergency environments. The goal is to identify practical instructional strategies that can help paramedics perform calculations accurately under real-world conditions.
National ems scope_of_practice_model_2019Robert Cole
This document presents the National EMS Scope of Practice Model, which is a guide for states to develop legislation, rules, and regulations regarding EMS personnel licensure and scope of practice. It defines four levels of EMS personnel - Emergency Medical Responder, Emergency Medical Technician, Advanced EMT, and Paramedic - and outlines the minimum competencies for each level. The model aims to increase uniformity in EMS across states while allowing flexibility for state implementation. It was revised in 2019 based on input from subject matter experts to reflect changes in the EMS profession.
The 2021 National EMS Education Standards were released in December 2021 as an update to the 2009 standards. They were developed by a committee consisting of representatives from NHTSA, HHRC, EMSC, and NAEMSE. The standards provide minimum competencies and content for EMR, EMT, AEMT, and Paramedic levels. Key changes in the 2021 update include integrating pediatric and geriatric topics throughout instead of isolating them, expanding EMS operations and public health sections, emphasizing medication safety, and clarifying that graduation achieves entry-level competency but not readiness for independent practice. The standards are intended to guide EMS education nationally while allowing for local flexibility.
The document provides an overview of the evolution of EMS education in the United States and summarizes the revised 2021 National EMS Education Standards. Key points include:
1) EMS education has advanced significantly since the 1960s through landmark documents and efforts to establish national standards and guidelines.
2) The revised 2021 National EMS Education Standards build upon prior versions and input from stakeholders to define the minimum competencies for each EMS licensure level based on the National EMS Scope of Practice Model and other guidance documents.
3) Notable revisions in the 2021 Standards address areas like public health, pediatrics, geriatrics, behavioral health, cultural humility, pharmacology, and EMS safety.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
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The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
2. What should my
rapper name be?
Based on what you know about me,
what should my rapper name be?
• CMXI (Roman Numerals for 911)
• METALHEADMEDIC
• M.C. NEEERRRRD
• E4MAFIA
3. Questions
and
Objectives
• What is wrong with boarding and collaring
everyone?
• Describe the adverse clinical
consequences and risks of the long
spine board and cervical collar
• What should I be doing?
• Discuss the current research and
practices for the use of selective spinal
immobilization
• Who should I be applying SSMR to?
• Describe the patients at higher risk for
actual spinal injury
• Are there any innovative solutions in SMR?
• Describe the role of soft and malleable
SMR devices in EMS
4. Some
terms…
• C-Collar – Referring to, unless
otherwise stated, a RIGID Cervical
Collar.
• Extrication Collar – C-Collar as above
• SMR – Spinal Motion Restriction
• SSMR – Selective Spinal Motion
Restriction – generically referring to
protocols that allow screening
patients and selecting who does ( and
does not) get SMR in the field.
5. What is wrong with boarding
and collaring everyone?
Describe the adverse clinical consequences and risks of the long spine board and cervical collar
6. Three main reasons why traditional SMR is
bad…
The Risks
• Increased pain and pressure sores
• Increased intercranial pressure
• Increased spinal Injury through “distraction” (separation) and
movement of vertebra
• And….little benefit
• It really does not protect the patient from injury
7. Pressure Sores
Occur quickly (30 min) in
the elderly but may occur
in as little as 2 hours in
general population.
8. 2012 Study: Application of
Cervical Collars causes more
motion in injured patients
than uninjured patients
• Cadaver Study
• Studied with and without C6-C6 injury
• Found that motion increased when there was instability (injury)
• Displaced between 3.6 and 4.4 mm
9. Rigid Cervical Collars raise ICP 5-10 mmHg
• Intercranial Pressure
• Normal: . <15 mmHg
• Mild : 20-30 mmHg
• Herniation and brain damage can still occur at
“mild levels” in head trauma
• Moderate: 30-40 mmHg
• Requires treatment in most cases
• Severe: > 40 mmHg
• Lifethreatening
• Rigid Collars were studied in closed head injury patients with
and without Increased Intercranial pressure.
• Application of a cervical collar consistently increased ICP 4-10
mmHg
• It is believed to be caused by compression of venous
structures (i.e. the Jugular veins) preventing venous outflow
from the brain.
10. 2010 Study: Extrication collars can result in
abnormal separation between vertebra
• C-Collar application resulted in 7.3 mm +/- 4.0 mm of
separation between C1 and C2 in a cadaver model.
11. What should I be doing?
Discuss the current research and practices for the use of selective spinal immobilization
12. 2017 Lit review: “The definite risks and questionable
benefits of liberal pre-hospital spinal immobilization”
• “Local oedema and hypoxia were more likely to be contributors to secondary
neurological damage” than spinal fractures.
• “No reliable sources were found proving the benefit for patient immobilisation. In
contrast there is strong evidence to show that pre-hospital spinal immobilisation
is not benign with recognised complications ranging from discomfort to
significant physiological compromise.”
• “The literature supports the Consensus Guidelines but raises the question as to
whether they go far enough”
13. 2018: Spinal Motion Restriction in the
Trauma Patient – A Joint Position Statement
• Multiple Organizations:
• The American College of Surgeons Committee on Trauma (ACS-
COT)
• American College of Emergency Physicians (ACEP),
• The National Association of EMS Physicians (NAEMSP)
• “This updated uniform guidance is intended for use by emergency
medical services (EMS) personnel, EMS medical directors, emergency
physicians, and trauma surgeons”
• Change from use of Immobilization devices to extrication devices
• Use of a LSB, Scoop, or vacuum mattress mentioned as
acceptable extrication devices.
• “transfer or extrication devices may be removed” prior to
transport by trained personnel (i.e. EMS providers) with SMR
maintained.
• Acceptable methods of SMR during transport include:
• scoop stretcher, vacuum splint, ambulance cot, or other similar
device to which a patient is safely secured.
14. Some new uses..
Alternative use for Spine Boards. (Image
source /u/Benutzerkonto, Reddit/r/EMS)
"5 Creative Uses For Backboards". EMS1.com
2015. Web. 3 Feb. 2017.
15. But not quite here yet…
"5 Creative Uses For Backboards". EMS1.com
2015. Web. 3 Feb. 2017.
16. REMEMBER: LSB are still
used for movement, CPR,
and extrication of
patients.
(But probably not like
this…)
American Academy of Orthopedic Surgeons,. Emergency
Care And Transportation Of The Sick And Injured. 1st ed.
Menasha Wisconsin: George Banta Company, 1971. Print.
17. New(er) approaches
• Assess the patient, determine if SMR is needed at all
• If the patient can ambulate on their own, let them.
• If the patient is questionable on ambulation, extricate/move them
with a scoop or LSB.
• Apply the cervical collar of choice
• Remove the extrication device
• Secure them to the orthopedic mattress on the cot
18. Is there any time we would leave the
LSB/SCOOP in place?
• Yes. Examples:
• CPR and anticipated need for CPR
• Other patient priorities (i.e. Airway Management)
• Anticipated need for further patient movement (i.e. rescue
operations)
• Goal is to minimize the time on rigid extrication devices (LSB and
scoop)
19. Who should I be applying
SSMR to?
Describe the patients at higher risk for actual spinal injury
20.
21.
22. NAEMSP Joint Position Paper
Blunt trauma
• Indications for SMR following blunt trauma
include:
• Acutely altered level of consciousness (e.g.,
GCS <15, evidence of intoxication)
• Midline neck or back pain and/or tenderness
• Focal neurologic signs and/or symptoms (e.g.
numbness or motor weakness)
• Anatomic deformity of the spine
• Distracting circumstances or injury (e.g., long bone
fracture, degloving, or crush injuries, large burns,
emotional distress, communication barrier, etc.) or
any similar injury that impairs the patient’s ability
to contribute to a reliable examination
Penetrating Trauma
• “There is no role for SMR in
penetrating trauma”
Pediatric Trauma
• “Age alone should not be a factor in decision
making for prehospital spinal care, both for the
young child and the child who can reliably provide
a history”
23.
24. MOI is back (Kind of)
•“There is insufficient evidence to support
absolute criteria for mechanism of injury
(MOI) either as an inclusion or exclusion
criteria for any spinal immobilization
consideration.
•That said, a prudent prehospital provider
should carefully evaluate the role of
mechanism of injury in the total clinical
presentation with a tendency to err on the
side of immobilization, particularly with the
frail, chronically bedridden, or extremes of
age (< 12 or >65 years of age).”
Freeway Patrol - Episode 5 –
Mechanism of Injury - YouTube
25. Canadian Rule Risk Factors
Low Risk Factors
• Simple Rear End MVC
• Sitting Position when found
• Ambulatory at any time after accident
• “Delayed” onset of pain
• Not immediate onset
Dangerous Mechanisms
• Fall from > 3 feet/5 stairs
• Axial Load to head
• Confirmed
• MVC @ “high Speed”
• 100 km/hr ( 62 mph )
• Rollover
• Hit by large vehicle
• Hit hard enough to be “pushed”
• Auto-Ped or Auto-Bike
• “Motorized Recreational Vehicles”
26. Special comment about Diving
Injuries
• Actual axial loading and spinal injuries in drowning are
exceedingly rare.
• Use of SMR in drowning can delay lifesaving efforts and
increase morbidity
• Unless there clear indication of injury to head or spine,
SMR is not indicated.
• Actual diving incident
• Shallow Water diving
• Witnessed event
33. Football and high impact athletic activities
(picture courtesy of http://www.amsvans.com/blog/paralyzed-football-player-
eric-legrand-returns-to-metlife-stadium/)
34. 2015 NATA guidelines on spinal injured
athletes • “ The athlete with a suspected spinal cord injury presents medical providers with challenges that are not
common with the general population. Equipment worn for protective purposes presents a treatment barrier
for basic or advanced life support to the airway and chest. Removal of equipment prior to transport is one of
our most important updated recommendations,”
• Recommendation 4: Protective athletic equipment should be removed prior to transport to an emergency
facility for an athlete-patient with suspected cervical spine instability.
• Recommendation 5: Equipment removal should be performed by at least three rescuers trained and
experienced with equipment removal at the earliest possible time. If fewer than three people are present,
the equipment should be removed at the earliest possible time after enough trained individuals arrive on the
scene
• Recommendation 7: A rigid cervical stabilization device should be applied to spine injured athlete-patients
prior to transport. A rigid cervical collar should be applied at the earliest and most appropriate time possible
during pre-hospital procedures. The medical team needs to continue manual in-line stabilization even after
the rigid cervical collar is applied.
• Recommendation 8: Spine injured athlete-patients should be transported using a rigid immobilization device.
• Sports medical care teams must now recognize the concepts of spinal motion restriction (SMR) as compared to spinal
immobilization. SMR implies that true spinal immobilization cannot be obtained even with the patient securely
strapped to a spine board.
• Recent literature has raised concern regarding the use of the long spine board due to potential harmful effects after
extended period of time on the board.
• However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other
immobilization device be used for transport
• - 2015 NATA recommendations
35. Bottom Line
• ON FIELD: OK to leave pads/helmet on on-field and
extricate off-field with a LSB or remove on-field at
scene of injury (depending on AT guidance)
• This limits the possibility of conflict with AT on
which approach is better since both approaches
are likely in use
• ONCE OFF THE FIELD: Remove pads and helmet for
transport (if not already removed) in accordance with
current protocols.
• Make sure you have enough hands on scene to
do so (Typically 3 or more)
• Incorporate the help of the AT as appropriate.
• LSB comes off too as appropriate.
36. GSW to head
• Incidence of Spinal Injury from isolated GSW to head
originating above the nose is exceedingly rare (0 –
1.4%).
• Incidence of spinal injury from isolated GSW to head
originating below the nose and above the jaw is still <
10%
• Excludes GSW to back and neck
• GSW patients die from head injury, hypoxia, and
hypotension. Many require immediate airway control
which SMR can complicate.
• It is clinically advantageous to delay or defer altogether
SMR in isolated GSW to head until airway is managed.
37. Other GSW
• GSW to spine (particularly the neck and back) contributing to 13% - 17% of
all spinal injuries
• Either direct injury by path of bullet or indirect by cavitation or vascular damage
• Most spinal injuries are immediately evident with immediate neurological deficits
• Patients with penetrating trauma to the trunk, below the clavicle and no
evidence of spinal injury (neurological deficit) do not require
immobilization.
• In line with recommendations from the ACS Committee on trauma.
• Patients with penetrating trauma to the trunk, below the clavicle who are
altered or show signs of neurological deficits do require SMR.
38. Pay attention to LOC
• Altered LOC is one of the major commonalities in missed
injuries.
• An altered level of alertness can include any of the
following:
• A Glasgow Coma Scale score of 14 or less.
• Disorientation to person, place, time, or events,
including chronic disorientation (i.e. Dementia)
• A delayed or inappropriate response to external
stimuli, or other findings.
41. KEY POINT
When presented with an
altered level of alertness in a
blunt traumatic patient,
providers should err on the
side of spinal precautions
(i.e. a cervical collar).
42. What are Distracting
Injuries?
• While any injury may be considered
distracting in the right context, specific
injuries of concern would be:
• Any moderate injury to the
proximal upper extremity, shoulder,
clavicle, or lateral neck
• Facial injuries suspicious for
fracture or significant discomfort.
• Any injury requiring analgesia
43. KEY POINT
•If an injury is bad enough to require Analgesia, it
can be considered distracting.
44. Are there any innovative
solutions in SSMR?
Describe the role of soft and malleable SSMR devices in EMS
Intercranial Pressure
Normal: . <15 mmHg
Mild : 20-30 mmHg
Herniation and brain damage can still occur at “mild levels” in head trauma
Moderate: 30-40 mmHg
Requires treatment in most cases
Severe: > 40 mmHg
Lifethreatening
Rigid Collars were studied in closed head injury patients with and without Increased Intercranial pressure.
Application of a cervical collar consistently increased ICP 4-10 mmHg
It is believed to be caused by compression of venous structures (i.e. the Jugular veins) preventing venous outflow from the brain.
The purpose of this education is not just to inform you, but to actually change your practice!
The Canadian C-Spine Rule is applicable to patients who are in an alert (Glasgow Coma Scale score of 15) and stable condition following trauma where cervical spine injury is a concern.
It is not applicable in non-trauma cases, if the patient has unstable vital signs, acute paralysis, known vertebral disease or previous history of Cervical Spine surgery and age <16 years. Negative Likelihood Ratio associated with this highly sensitive test is less than 5%. This means there is only a 5% chance that if you get a negative finding for this test, the patient would still have the condition
Mechanism of Injury
There is insufficient evidence to support absolute criteria for mechanism of injury (MOI) either as an inclusion or exclusion criteria for any spinal immobilization consideration. That said, a prudent prehospital provider should carefully evaluate the role of mechanism of injury in the total clinical presentation with a tendency to err on the side of immobilization, particularly with the frail, chronically bedridden, or extremes of age (< 12 or >65 years of age).
Other MOI of concern would include are not limited to:
1. Falls greater than 3 feet or 5 stairs
a. Any fall for the frail, chronically bedridden, or elderly (>65 years of age) may be concerning
2. Motorsports and extreme-sports injuries
3. High impact MVC
a. defined as < 60 mph (100 km/hr)
b. or with intrusion < 6 inches
c. Rollover or Ejection
d. Vehicle vs. Pedestrian
4. Bicycle and motorcycle accidents.
5. Football and high impact athletic activities
6. Suspected Axial Loading injuries.
a. Note: Axial loading of cervical spine is not recommended.
http://forums.canadiancontent.net/hot-topics/128787-elderly-woman-found-filthy-emaciated.html
“… frail, chronically bedridden, or extremes of age (< 12 or >65 years of age).”
High impact MVC defined as < 60 mph (100 km/hr)or with intrusion < 6 inchesRollover or EjectionVehicle vs. Pedestrian
Photo credit http://www.ubfc8.org/apps/public/news/newsView.cfm?News_ID=151
Simple Rear End MVC
Not “ushed or displaced
Pt not frale or infirm
Patient ambulatory PTA
Delayed onset of pain
Note: Axial loading of cervical spine is not recommended
https://sportsmedicineguy.com/the-nata-recently-updated-their-consensus-statement-with-new-recommendations-for-the-care-of-spine-injured-athletespatients-for-more-information-visit-httpwww-nata-orgfiexecu/
Ian Butler Hall Comment:
I think this study is rather silly and has no clinical outcomes related to it. Ok, so one way you move the head less. You still have to take off the shoulder pads and helmet at some point. They need to come off regardless. Just take them off as soon as possible. Similar to Dr. Cornett's spinal lectures, the damage is done at the time of injury, not on the way to the hospital. Whether it's in the field or once they remove them from the field prior to transport, I think it's best to remove the helmet and shoulder pads together as soon as possible by trained individuals.
Ben Cornett Comments:
leave the pads and helmet and put them on a backboard to get them off the playing field. After they have been extricated from the field of play, then as Dr. Butler Hall stated, it is using trained people to remove the helmet and pads observing spinal precautions both cervical and thoracolumbar areas. But it had to be an all or nothing decision to remove all pads and helmet or leave them all since it creates angles of stress to the spine if one and not the other is removed and there are barriers to getting cervical collars on and around some football pads.
Once they have been extricated off a field then they do not need a long spine board since they have been "extricated" which is what the device is for. They can then be moved with scoop or 5 man lift to the stretcher for transport just as we have been doing.
ON FIELD: OK to leave pads/helmet on on-field and extricate off-field with a LSB or remove on-field at scene of injury (depending on AT guidance)
This limits the possibility of conflict with AT on which approach is better since both approaches are likely in use
ONCE OFF THE FIELD: Remove pads and helmet for transport (if not already removed) along with LSB in accordance with current protocols.
Make sure you have enough hands on scene to do so (Typically 3 or more)
Incorporate the help of the AT as appropriate.
An altered level of alertness can include any of the following:
- A Glasgow Coma Scale score of 14 or less.
- Disorientation to person, place, time, or events, including chronic disorientation (i.e. Dementia)
- A delayed or inappropriate response to external stimuli, or other findings.
Falls greater than 3 feet or 5 stairs
Any fall for the frail, chronically bedridden, or elderly (>65 years of age) may be concerning
Any fall for the frail, chronically bedridden, or elderly (>65 years of age) may be concerning
More comfortable
No “traction”
Better “fit”
Does not compress venous structures of the neck = does not increase ICP.