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Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system
James C Etheridge1, Robert D Sinyard, John Atiyeh
1From the Department of Surgery (J.C.E., J.M.H.), Brigham and Women's Hospital; Department of Surgery (R.D.S.), Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine (J.A.), Orlando Regional Medical Center, Orlando, Florida; Center for Clinical Investigation (G.Z.), Brigham and Women's Hospital, Boston, Massachusetts; and Department of Surgery (J.N.C.), Eastern Virginia Medical School, Norfolk, Virginia.
A new protocol for selective spinal immobilization in prehospital trauma care did not reduce overall immobilization rates. Further education is needed to change ingrained practices and eliminate unnecessary immobilization, especially for penetrating trauma.
Area of Science:
- Trauma Care
- Emergency Medical Services
- Spinal Immobilization Protocols
Background:
- Universal spinal immobilization has been standard prehospital trauma care since the 1960s.
- Selective immobilization protocols are safe and effective but their impact on reducing unnecessary practices is unclear.
- This study evaluated the effect of a selective spinal immobilization protocol on practice patterns within a regional trauma system.
Purpose of the Study:
- To assess the impact of implementing a selective spinal immobilization protocol on prehospital practice patterns.
- To determine if the protocol led to a reduction in unnecessary spinal immobilization.
- To identify areas for improvement in prehospital trauma care protocols.
Main Methods:
- Analysis of 63,981 traumatic injury encounters from the Tidewater Emergency Medical Services region (2010-2016).
- Interrupted time series analysis to evaluate practice changes after protocol implementation in 2013.
- Intravenous access rates were used as a nonequivalent outcome measure for comparison.
Main Results:
- Prehospital full spinal immobilization occurred in 16.7% of patients at baseline.
- The selective immobilization protocol did not significantly alter overall immobilization rates compared to intravenous access trends.
- Cervical spinal immobilization increased post-protocol, and rates for isolated penetrating trauma remained unchanged.
Conclusions:
- Implementation of a selective spinal immobilization protocol did not decrease prehospital immobilization rates.
- More intensive education and training are required to modify established immobilization practices.
- Eliminating immobilization for isolated penetrating trauma is crucial due to its association with increased mortality.
