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Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
During this phase of assessment, the spine should be protected initially by MILS, followed by three-point immobilization with rigid collar, blocks and tape or straps. The whole spine must be maintained in neutral alignment after gentle controlled movement to a neutral position if this is necessary. Attempts to bring the head into neutral alignment against palpable resistance or if the patient complains of pain should be abandoned and the head immobilized as it is found. The rest of the spine should be immobilized during extrication and transfer using an extrication device or scoop stretcher. The majority of trauma patients will have been immobilized during the pre-hospital phase.19 The adequacy of immobilization and the position of cervical collars, head blocks and other extrication devices should be checked on arrival at the emergency department. Patients who are agitated and moving around should not have their cervical spine immobilized in isolation. Scoop stretchers should be removed as soon as possible, usually as part of the log roll, decreasing the risk of pressure sore development in the spinally injured. The concept of selective immobilization for injured patients is gaining traction as the use of spinal boards and cervical collars is not without complications. Assessment of patient conscious level, symptoms of pain localized to the spine or any neurological signs can help the decision-making process of whether to maintain immobilization or remove early.
Safe Patient Handling and Mobility
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Christopher M. Wilson, Amy J. Litterini
In order to reduce friction and shear, there are friction-reducing devices that can be placed underneath the patient in preparation for repositioning activities such as boosting up in bed or sliding from one surface to the other (e.g. stretcher/gurney to bed). There are several models available from different manufacturers, but in general, these consist of either one or two separate sheets made of plastic or some other slippery material. The other commonly encountered bed mobility device is an inflatable air cushion that is placed under the patient. Some of the advantages of these devices are that they greatly reduce the amount of force required to move a patient in a laying position. As with some of the other devices, infection control and cost containment are important considerations. In general, these devices are not designed to be kept underneath the patient, as they are typically not moisture permeable. Sweat and other bodily fluids may build up if they remain underneath the person causing infections or skin breakdown. Finally, one of the disadvantages of these devices is that they still require the healthcare providers to have the person roll from side to side (aka logrolling) to be able to get the device underneath them. This may be an added task that was not otherwise required if two providers were simply coming in to boost a patient up in bed using a previously placed cloth draw sheet. Biomechanically, rolling side to side is generally less strenuous on caregivers than the actual boosting, but the logrolling and then boosting tends to take a little more time.
Other Hazards in Clinical NMR Examinations
Published in Bertil R. R. Persson, Freddy Ståhlberg, Health and Safety of Clinical NMR Examinations, 2019
Bertil R. R. Persson, Freddy Ståhlberg
Another major concern with clinical NMR examinations has been the ability to accommodate nonambulatory patients and to handle emergency situations. A stretcher is required to move nonambulatory patients into the examination room. This stretcher, which has to be nonferromagnetic and match the height of the examination table, can often be offered by the manufacturer of the NMR equipment. To deal with emergency situations it is recommended that all personnel in the NMR department (including technologists, secretaries, physicians, nurses, and physicists) would be trained in cardiopulmonary resuscitation. They must have practiced rapid removal of the patient from the imaging suite on a nonmetallic stretcher so that this procedure would take only moments. A standard crash cart would be placed outside the 0.5-T line. Resuscitation efforts can then proceed in a routine manner.
Existing Science on Human Factors and Ergonomics in the Design of Ambulances and EMS Equipment
Published in Prehospital Emergency Care, 2019
Bronson Du, Michelle Boileau, Kayla Wierts, Sue Hignett, Steven Fischer, Amin Yazdani
A series of 4 articles developed and implemented an innovative set of tools, slide boards, and rods, to address the awkward postures and high forces used in traditional lateral bed-to-stretcher transfers. In traditional transfers, EMS personnel would kneel on the bed, and using the bedsheet, they would lift and push the patient towards the stretcher, while other EMS personnel pulled from the stretcher side. With the use of the slide board, a low friction interface that bridged the gap between the bed and the stretcher, biomechanical forces, and perceived exertion were reduced (35). Furthermore, rolling rods into the bedsheets made gripping the sheets easier and allowed both EMS personnel to stand by the stretcher rather than having one kneel on the unstable bed. However, there was a fear that, if both EMS personnel pulled from the stretcher side, the patient would roll off the other side of the bed (35).
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.
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
Historically, multiple medical disciplines have supported guidelines for healthcare providers that recommend using a long spineboard, headblocks, and cervical collar to achieve full spinal immobilization in patients with suspected spine injuries during extrication and transport (1–3). This method, referred to here as traditional spinal immobilization (TSI), was believed to limit spine motion and therefore protect patients from exacerbating a spine injury. More recently, emergency medical services (EMS) protocols in many states have evolved such that TSI using long spineboards and headblocks is no longer recommended for routine prehospital use (4, 5). Alternatively, patients are managed by a technique often referred to as Spinal Motion Restriction (SMR), whereby a patient is fitted with a cervical collar and secured flat on a standard ambulance cot. Long spineboards or scoop stretchers may still be used for extrication and patient movement on scene but patients are removed from these devices when transferred to the ambulance cot for transportation. The rationale for changing the protocol derives from evidence demonstrating potential patient complications from using long spineboards including increased pain (6), skin pressure wounds (6), and respiratory compromise (7), as well as operational considerations such as increased scene time (8), in conjunction with little evidence demonstrating improved patient outcomes by utilizing TSI. While the use of SMR is becoming more prevalent, there remains a notable lack of evidence supporting these protocol changes.