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Analysis of cervical spine immobilization during patient transport in emergency medical services

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

It remains controversial how to immobilize the cervical spine (CS) in trauma patients. Therefore, we analyzed different CS immobilization techniques during prehospital patient transport.

Methods

In this explorative, biomechanical analysis of immobilization techniques conducted in a standardized setting, we recorded CS motion during patient transport using a wireless human motion tracker on a volunteer. To interpret spinal movement a benchmark called motionscore (MS) was developed based on biomechanics of the injured spine.

Results

We found the best spinal motion restriction using a spine board, head blocks and immobilization straps with and without a cervical collar (CC) (MS 45 vs. 27). Spinal motion restriction on a vacuum mattress with CC and head blocks was superior to no CC or head blocks (MS 103 vs. 152). An inclined vacuum mattress was more effective with head blocks than without (MS 124 vs. 187). Minimal immobilization with an ambulance cot, CC, pillow and tape was slightly superior to a vacuum mattress with CC and head blocks (MS 92 vs. 103). Minimal immobilization without CC showed the lowest spinal motion restriction (MS 517).

Conclusions

We suggest an immobilization procedure customized to the individual situation. A spine board should be used whenever spinal motion restriction is indicated and the utilization is possible. In some cases, CS immobilization by a vacuum mattress with CC and head blocks could be more beneficial. In an unstable status of the patient, minimal immobilization may be performed using an ambulance cot, pillow, CC and tape to minimize time on scene caused by immobilization.

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Acknowledgements

The authors would like to thank all our participating staff. Furthermore, we thank the team from Fire and Rescue Training Centre (FRTC) of the Frankfurt fire department.

Funding

We gratefully acknowledge the funding of the BG Trauma Centre Ludwigshafen, the German Association of Emergency Medical Technicians (Deutscher Berufsverband Rettungsdienst e.V. DBRD) and the Friends Association of the Air Rescue Centre Frankfurt. The sponsors had no influence on the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, 67071, Ludwigshafen, Germany

    Philip Christian Nolte, Davut Deniz Uzun, Matthias Münzberg, Adrian Rittmann, Paul Alfred Grützner & Michael Kreinest

  2. Faculty of Medicine, Eberhard Karls University Tübingen, 72076, Tuebingen, Germany

    David Häske

  3. DRK Rettungsdienst Reutlingen, 72764, Reutlingen, Germany

    David Häske

  4. Julius Wolff Institute, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany

    Jeronimo Weerts

  5. Centre of Rescue- and Emergency Medicine, BG Trauma Centre Ludwigshafen, 67071, Ludwigshafen, Germany

    Matthias Münzberg

Authors
  1. Philip Christian Nolte
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  2. Davut Deniz Uzun
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  7. Paul Alfred Grützner
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  8. Michael Kreinest
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Corresponding author

Correspondence to Michael Kreinest.

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Conflict of interest

DH and DU are PHTLS instructors. The other authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Ethics Committee of the State Medical Association of the Rhineland-Palatinate [ID 837.508.15 (10276)] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study is registered in the German Clinical Trials Register with the ID DRKS00009505.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article. Data collection, coding, routing and analysis were in accordance with legal data protection policy.

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Nolte, P.C., Uzun, D.D., Häske, D. et al. Analysis of cervical spine immobilization during patient transport in emergency medical services. Eur J Trauma Emerg Surg 47, 719–726 (2021). https://doi.org/10.1007/s00068-019-01143-z

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  • DOI: https://doi.org/10.1007/s00068-019-01143-z

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