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Spinal injuries
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Immobilisation for transport should no longer be performed on a rigid long spinal board due to the increased discomfort and risk of tissue pressure damage. Immobilisation for short transfers to definitive care should be carried out using a modern scoop stretcher (Figure 13.7). In addition to being more comfortable, and potentially having a lower risk of tissue pressure damage, use of a scoop stretcher should shorten timelines and transfers at definitive care.
Detection of intracranial hematomas in the emergency department using near infrared spectroscopy
Published in Brain Injury, 2019
Vassilios Kontojannis, Isabel Hostettler, Robert James Brogan, Muhammad Raza, Abby Harper-Payne, Haider Kareem, Martyn Boutelle, Mark Wilson
We designed our study so as to include all the potential head injury patients that arrive in AE department aiming to assimilate the conditions that the paramedical and medical personal has to deal with on the site of injury, such as patient blocked on a scoop stretcher with collar and tape. In the first place we tested the efficiency of the device to detect intracranial hematomas and then we examined whether the results could lead to a decision on the management of the trauma patient suffering from a potential TBI. The local trauma pathway comprises patients being placed in a scoop stretcher with triple immobilization (collar, blocks, and tape). As such, access to the occipital region is difficult and hence this study examined frontal, parietal and temporal regions. In the current study, once the patients arrived in the emergency department after the injury, they were scanned at the end of the primary survey. In other studies patients were scanned up to 12 h from injury.
Comparison of Three Junctional Tourniquets Using a Randomized Trial Design
Published in Prehospital Emergency Care, 2019
Micah J. Gaspary, Gregory J. Zarow, Michael J. Barry, Alexandra C. Walchak, Sean P. Conley, Paul J.D. Roszko
The present study should be replicated with more diverse samples in realistic field settings that may include limited lighting and external stressors, such as time limitations, loud noises, and other distractions that may commonly occur in situations that require a JTQ to be applied. To foster realism, replication studies should also include more rigorous transport paradigms. Research is needed to determine the most effective manner of transferring patients to foster the retention of pulse elimination. For civilian EMS providers, tourniquet effectiveness and stability in transport may vary with the use of other equipment (e.g. rigid long-board, vacuum mattress, scoop stretcher) to move a casualty. It is also important to test junctional tourniquets bilaterally and on upper extremities, and to consider including the Abdominal Aortic and Junctional Tourniquet (Compression Works), which was recently cleared by the FDA for junctional use. It is crucial to work with manufacturers to improve JTQ products so that they can maintain pulse elimination during transport. Lastly, research is needed to determine the optimal training needed so that users can successfully apply JTQs to save lives.
Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction
Published in Prehospital Emergency Care, 2018
Erik E. Swartz, W. Steven Tucker, Matthew Nowak, Jason Roberto, Amy Hollingworth, Laura C. Decoster, Thomas W. Trimarco, Jason P. Mihalik
Indeed, two studies have questioned the long spineboard's effectiveness to even achieve immobilization (9, 10). Other research reported less capability of the spineboard to control spine motion compared to a vacuum mattress (11), scoop stretcher (12), and to a padded litter used for air transport (13). One study compared TSI to SMR for lateral motion control (only) during simulated hospital transport in an ambulance (14) and reported superior motion control when subjects were secured to the stretcher mattress without a long spineboard. However, no research exists comparing TSI to SMR in limiting three-dimensional head and neck motion throughout the entire spine-injured patient's acute, pre-hospital management experience. Generating additional evidence to support these protocol changes is paramount to enhancing patient safety and adoption of emerging SMR protocols.