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doi: 10.1136/emj.15.2.1081998 15: 108-109J Accid Emerg Med

M W Cookeand emergency department.Use of the spinal board within the accident

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1 8 A c c i d E m e r g Med 1 9 9 8 ; 1 5 : 1 0 8 - 1 1 3

SHORT REPORTS

Use o f t h e s p i n a l b o a r d w i t h i n t h e a c c i d e n t a n demergency d e p a r t m e n tMatthew Cooke

A b s t r a c t p o s t a l q u e s t i o n n a i r e was s e n t t o a l l c o n -s u l t a n t s and s p e c i a l i s t t r a i n e e s i n t h e WestMidlands a b o u t t h e u s e o f s p i n a l b o a r d s i nt h e a c c i d e n t and emergency (A E) d e -p a r t m e n t . R e s p o n s e r a t e was 7 0 . Therewas w i d e s p r e a d u s e o f b o a r d s i n Ed e s p i t e an ATLS recommendation t o t h ec o n t r a r y . H o s p i t a l s s h o u l d r e v i e w t h e i rp o l i c i e s on u s e o f s p i n a l b o a r d s w i t h i n t h ed e p a r t m e n t , u s i n g t h e e v i d e n c e a v a i l a b l et o d e t e r m i n e t h e b es t means o f i m m o b i l i -s a t i o n .( J A c c i d E m e r g Med 1 9 9 8 ; 1 5 : 1 0 8 - 1 0 9 )K e y w o r d s : s p i n a l b o a r d s

Department o fAccident andEmergency M e d i c i n e ,U n i v e r s i t y o fBi r m i n g ham and C i t yH o s p i t a l NHS T r u s t ,Birmingham, UK CookeC o r r e s p o n d e n c e t o : C o o k e , ED e p a r t m e n t , C i t y H o s p i t a l ,D u d l e y R o a d , B i r m i n g h a mB1 8 7QH, U K; e m a i lM.W.COOKE@bham.ac.ukA c c e p t e d d a t e

Th e r o l e o f t h e s p i n a l b o a r d w i t h i n t h ea c c i d e n t a n d e m e r g e n c y ( A & E ) d e p a r t m e n th a s b e e n c h a l l e n g e d r e c e n t l y . I t w a s o r i g i n a l l yd e v e l o p e d a s a n e x t r i c a t i o n d e v i c e u s i n g i t ss m o o t h s u r f a c e t o a l l o w a p e r s o n t o b e s l i d o u to f a v e h i c l e . H o w e v e r , i t i s d i f f i c u l t t o r e m o v ehim f r o m t h e b o a r d i n t h e f i e l d a n d t h e r e f o r et h e p a t i e n t i s m o s t c o m m o n l y t r a n s p o r t e d t ot h e A E d e p a r t m e n t o n t h e s p i n a l b o a r d . Then o n - c o n f o r m i n g n a t u r e o f t h e b o a r d m e a n st h a t p r e s s u r e p o i n t s r e x p o s e d t o h i g h i n t e r -f a c e p r e s s u r e s 2 a n d t h r i s a r i s k o f p r e s s u r es o r e s d e v e l o p i n g . I n a d d i t i o n , t h e s h a p e o f t h eb o a r d d o e s n o t c o n f o r m t o t h e s h a p e o f t h es p i n e .A l t e r n a t i v e s i n c l u d e t h e vacuum s p l i n t ,w h i c h p r o v i d e s b e t t e r i mm o b i l i s at i o n o f t h et r u n k w i t h l e s s s l i p p a g e on a g r a d u a l l a t e r a l t i l t ;t h e b a c k b o a r d w i t h h e a d b l o c k s , w h i c h i ss l i g h t l y b e t t e r a t i m m o b i l i s i n g t h e h e a d a n dt h e vacuum m a t t r e s s , w h i c h h a s d i s a d v a n t a g e si n p r e h o s p i t a l u s e b u t may b e p r e f e r a b l e i nh o s p i t a l . 4Th e a i m o f t h i s s t u d y w a s t o d e t e r m i n e hows p i n a l b o a r d s a r e u s e d w i t h i n t h e E d e p a r t -T a b l e I S t a g e a t w h i c h p a t i e n t r e m o v e d f r o m b o a r d

No E a r l y i n p r i m a r y s u r v e y 2 6A f t e r i n i t i a l x r a y s 2 6A f t er x r a y a n d l o g r o l l 2 2 6 3W he n s p i n a l i n j u r y e x c l u d e d 3A f t e r l o g r o l l 3 9A f t e r s e c o n d a r y s u r v e y 3 9A f t e r c o m p u t e r i s e d t o m o g r a p h y 3A f t e r d e f i n i t i v e c a r e 3

m e n t , w i t h p a r t i c u l a r r e f e r e n c e t o t h e t i m ewhen t h e p a t i e n t i s r e m o v e d f r o m t h e b o a r da n d t h e p r i m a r y u s e o f b o a r d s w i t h i n t h ed e p a r t m e n t .Methods p o s t a l q u e s t i o n n a i r e w a s s e n t t o a l l A Ec o n s u l t a n t s a n d s p e c i a l i s t t r a i n e e s i n t h e W e s tM i d l a n d s . S e v e n t y p e r c e n t ( 3 5 o f 5 0 ) r e t u r n e dt h e q u e s t i o n n a i r e . A n o n y m i t y w a s p r e s e r v e d ,s o t h e r e w a s n o f o l l o w u p o f n o n - r e s p o n d e r s .R e s p o n d e n t s w e r e a s k e d s i x o p e n q u e s t i o n sr e l a t i n g t o t h e i r u s e o f s p i n a l b o a r d s w i t h i n t h eA E d e p a r t m e n t .R e s u l t sT h i r t y o n e r e s p o n d e n t s ( 8 8 ) h a d a s p i n a lb o a r d i n t h e d e p a r t m e n t .I f a p a t i e n t w a s b r o u g h t t o t h e A E d e p a r t -ment o n a s p i n a l b o a r d h e w o u l d b e r e m o v e d a ta v a r i e t y o f s t a g e s i n t h e r e s u s c i t a t i o n p r o c e s s .T h e s e a r e l i s t e d i n t a b l e 1 . Th e m a j o r i t y ( 3 2 ,9 1 ) w o u l d n o t b e r e m o v e d u n t i l a t l e a s t a f t e rc o m p l e t i o n o f t h e p r i m a r y s u r v e y , i n i t i a l r e s u s -c i t a t i o n , a n d f i r s t l i n e x r a y s .Th e p r e f e r r e d m e t h o d o f i m m o b i l i s a t i o nw i t h i n t h e A E d e p a r t m e n t was t h e s p i n a lb o a r d i n c o n j u n c t i o n w i t h a c o l l a r a n d s i d es u p p o r t o f t h e h e a d . T h i s w a s u s e d b y 1 5r e s p o n d e n t s ( 4 3 ) . E l e v e n ( 3 1 ) s t a t e d t h a t as p i n a l b o a r d w a s t h e p r e f e r r e d m e t h o d b u t d i dn o t s p e c i f y u s e o f o t h e r a d j u n c t s . F i v e ( 1 4 )p r e f e r r e d i m m o b i l i s a t i o n o n t h e A E d e p a r t -ment t r o l l e y w i t h c o l l a r a n d s i d e s u p p o r t .I n o r d e r t o t r a n s f e r a p a t i e n t f r o m b e d t o b e do r f r o m b e d t o s c a n n e r , v a r i o u s m e t h o d s w e r ei n u s e . E i g h t e e n ( 5 1 ) s t a t e d t h e y w o u l d u s e as p i n a l b o a r d , n i n e ( 2 6 ) a c o n t r o l l e d l i f t t h r e e( 9 ) e i t h e r a l i f t o r a b o a r d , o n e ( 3 ) as t r e t c h e r c a n v a s , a n d t w o ( 6 ) e i t h e r a s c o o ps t r e t c h e r o r b o a r d . p a t i e n t n o t a l r e a d y on a b o a r d w o u l d b ep u t on a b o a r d i n t h e E d e p a r t m e n t i f t h e r ew a s a h i g h r i s k o f i n j u r y ( 1 8 , 5 1 ) , i f t h e y h a da known s p i n a l i n j u r y ( 2 , 6 ) , o r f o r t r a n s f e r t oa n o t h e r d e p a r t m e n t o r h o s p i t a l ( 4 , 1 2 ) . N i n er e s p o n d e n t s ( 2 6 ) s a i d t h e y w o u l d n e v e r p u t ap a t i e n t on a b o a r d a f t e r t h e y h a d a r r i v e d i n t h e E d e p a r t m e n t .W he n q u e s t i o n e d on p r o b l e m s r e l a t e d t os p i n a l b o a r d s , 1 8 q u o t e d t h e r i s k o f p r e s s u r es o r e s a n d 2 0 t h a t b o a r d s w e r e u n c o m f o r t a b l e .O t h e r p r o b l em s q u o t ed i n c l u d e d g i v i n g a f a l s e

1 0 8group.bmj.comon October 5, 2013 - Published byemj.bmj.comDownloaded from group.bmj.comon October 5, 2013 - Published byemj.bmj.comDownloaded from

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s e n s e o f s e c u r i t y ( 4 ) , d i f f i c u l t y m o v i n g t h ep a t i e n t o n a b o a r d ( 4 ) , i n a p pr o pr i at e u s e o f t h eb o a r d ( 4 ) , t h e n o n - c o n f o r m i n g n a t u r e o f t h eb o a r d ( 4 ) , p r e v e n t i n g p r o p e r e x a m i n a t i o n ( 3 ) ,a n d s c ar in g t h e p a t i e n t ( 2 ) .D i s c u s s i o nT h e r e i s w i d e s p r e a d u s e o f s p i n a l b o a r d sw i t h i n t h e A E d e p a r t m e n t . A d v a n c e dTrauma L i f e S u p p o r t ( A T L S ) c l e a r l y s t a t e st h a t t h e l o n g b o a r d i s f o r u s e b e f o r e a n dd u r i n g t r a n s f e r 5 a n d n o t f o r u se w i t h i n t h e E d e p a r t m e n t . T h i s s u r v e y r e v e a l s t h a t s e n -i o r s t a f f a r e w e l l a w a r e o f t h e r i s k s o f s p i n a lb o a r d s . H o w e v e r , b o a r d s r e m a i n t h e p r ef e rr edm e t h o d o f i m m o b i l i s a t i o n d e s p i t e e v i d e n c et h a t o t h e r s u r f a c e s a re l e s s h a z a r d o u s a n d p o s -s i b l y g i v e b e t t e r s u p p o r t . 2 Th e r e a s o n s f o r p r e f -e r e n c e o f t h e s p i n a l b o a r d a r e n o t c l e a r .I t i s u n d e r s t a n d a b l e t h a t i f a p a t i e n t i sb r o u g h t t o A E o n s p i n a l b o a r d t h e n i n i t i a lr e s u s c i t a t i o n s h o u l d t a k e p r i o r i t y o v e r r e m o v a lf r o m t h e b o a r d . H o w e v e r , many c l i n i c i a n sd e l a y r e m o v a l w e l l b e y o n d t h i s t i m e . E v e n t h eb e s t b o a r d s w i l l a f f e c t t h e q u a l i t y o f x r a y st a k e n t h r o u g h t h e m - a n o t h e r r e a s o n f o r r e -

m o v a l b e f o r e t h e e n d o f t h e p r i m a r y s u r v e y .Th e p a t i e n t w i l l o f t e n h a v e b e e n on t h e b o a r df o r a t l e a s t 1 5 - 3 0 m i n u t e s b e f o r e a r r i v a l i n t h e E d e p a r t m e n t a n d t h e r e f o r e t i s s u e d a m a g emay a l r e a d y b e o c c u r r i n g . Many p l a c e t h ep a t i e n t o n a b o a r d a f t e r a r r i v a l i n A E. I nt h e s e c i r c u m s t a n c e s , t h e u s e o f vacuum m a t -t r e s s w o u l d b e p r e f e r a b l e . I t may b e t h a t ATLSh a s i n t ro d u c e d p eo p l e t o t h e s p i n a l b o a r d b u th as n o t made t h e m s u f f i c i e n t l y a w a r e o f t h e i rp r o b l e m s o r t h e a l t e r n a t i v e s a v a i l a b l e .

H o s p i t a l s s h o u l d r e v i e w t h e i r p o l i c i e s o n u s eo f s p i n a l b o a r d s w i t h i n t h e d e p a r t m e n t u s i n gt h e e v i d e n c e a v a i l a b l e t o d e t e r m i n e t h e b e s tm e a n s o f i mm o b i l i sa t i o n w i t h i n t h e Ed e p a r t m e n t .

Cooke MW . S p i n a l b o a r d s i n A E. J A c c i d Emerg Med1 9 9 6 ; 1 3 : 4 3 3 .2 Main PW , L o v e l l ME. r e v i e w o f s ev en s u pp o r t s u r f a c e sw i t h e m p h a s i s o n t h e i r p r o t e c t i o n o f t h e s p i n a l l y i n j u r e d . JA c c i d Emerg Med 1 9 9 6 ; 1 3 : 3 4 - 7 .3 J o h n s o n DR, H a u s w a l d M, S t o c k h o f f C . C o m p a r i s o n o f vacuum s p l i n t d e v i c e t o a r i g i d b a c k b o a r d f o r s p i n a l immo-b i l i s a t i o n . m J Emerg Med 1 9 9 6 ; 1 4 : 3 6 9 - 7 2 .4 C a r n e y C . S u p p o r t s u r f a c e s . J A c c i d Emerg Med 1 9 9 6 ; 1 3 :

3 0 2 .5 A m e r i c a n C o l l e g e o f S u r g e o n s A d v a n c e d Trauma L i f e S u p -p o r t . C h i c a g o : ACS, 1 9 9 3 .

R e l a t i v e s i n t h e r e s u s c i t a t i o n r o o m : t h e i r p o i n t o fv i e wF B a r r a t t , D N W a l l i s

A b s t r a c tO b j e c t i v e - T o i n v e s t i g a t e whether b e -r e a v e d n e x t o f k i n would l i k e t o h a v e beenp r e s e n t i n t h e r e s u s c i t a t i o n r o o m d u r i n ga t t e m p t e d cardiopulmonary r e s u s c i t a t i o no f t h e i r r e l a t i v e , and t h e i r e x p e r i e n c e o rknowledge o f what i s i n v o l v e d i n c a r d i o p -ulmonary r e s u s c i t a t i o n .Methods-The n e x t o f k i n o f p a t i e n t s w h ohad r e c e n t l y d i e d a f t e r u n s u c c e s s f u l c a r -diopulmonary r e s u s c i t a t i o n i n t h e a c c i -d e n t and emergen cy departmen t werec o n t a c t e d i n i t i a l l y by t e l e p h o n e and t h e ns e n t a p o s t a l q u e s t i o n n a i r e .Results-Four ( 1 1 ) o f 3 5 r e s p o n d e n t shad been a s k e d whether t h e y wished t o bep r e s e n t i n t h e r e s u s c i t a t i o n room; 2 4( 6 9 ) would l i k e t o h a v e been o f f e r e d t h eo p p o r t u n i t y , e v e n though n o t a l l wouldhave a c c e p t e d . Th e r e s p o n d e n t s had aw i d e v a r i e t y o f p e r c e p t i o n s o f what h a p -p e n s d u r i n g r e s u s c i t a t i o n , few o f whichc o r r e s p o n d e d t o c l i n i c a l p r a c t i c e .Conclusions-Most r e l a t i v e s o f p a t i e n t sr e q u i r i n g cardiopulmonary r e s u s c i t a t i o nwould l i k e t o be o f f e r e d t h e p o s s i b i l i t y o fb e i n g i n t h e r e s u s c i t a t i o n room; t h i s c o u l dh a v e s e v e r a l b e n e f i t s .( J A c c i d E m e r g Med 1 9 9 8 ; 1 5 : 1 0 9 - 1 1 )K e y w o r d s : r e l a t i v e s ; c a r d i o p u l m o n a r y r e s u s c i t a t i o n ;r e s u s c i t a t i o n room

T h e r e h a s b e e n r e c e n t d e b a t e ` o v e r t h ep re se n c e o f r e l a t i v e s i n t h e r e s u s c i t a t i o n r o o m ,n o t o n l y t h e p a r e n t s o f c h i l d r e n b u t a l s or e l a t i v e s o f a d u l t p a t i e n t s . Most r e s e a r c h h a sc o n c e n t r a t e d o n t h e a t t i t u d e s a n d f e e l i n g s o fm e d i c a l a n d n u r s i n g s t a f f , 4 a n d i n o n e s t u d y 475 o f m e d i c a l a n d n u r s i n g s t a f f a g r e e d w i t ht h e s t a t e m e n t , R e l a t i v e s s h o u l d h a v e t h eo p p o r t u n i t y t o b e w i t h a f a m i l y member who i sr e q u i r i n g c a r d i o p u l m o n a r y r e s u s c i t a t i o n , p r o -v i d e d a p p r o p r i a t e p r o f e s s i o n a l s u p p o r t i s a v a i l -a b l e . By c o n t r a s t l i t t l e h a s b e e n p u b l i s h e d o nt h e a t t i t u d e o f r e c e n t l y b e r e a v e d r e l a t i v e s ,a l t h o u g h t h e R es u s ci t a t i o n C o u n c i l ( U K ) p u b -l i s h e d r e p o r t i n 1 9 9 6 w i t h r e c o m m e n d a t i o n sf o r p r a c t i c e a n d t r a i n i n g . 6T h i s s t u d y h a d t w o a i m s : f i r s t t o d e t e r m i n ew h e t h e r b e r e a v e d n e x t o f k i n f e l t t h e y w o u l d l i k et o h a v e b e e n p r e s e n t i n t h e r e s u s c i t a t i o n roomd u r i n g t h e a t t em pt e d c a r d i o p u l m o n a r y r e s u s c i -t a t i o n o f t h e i r r e l a t i v e ; a n d s e c o n d , t o e v a l u a t et h e i r k n o w l e d g e a n d e x p e r i e n c e o f w h a t i si n v o l v e d i n c a r d i o p u l m o n a r y r e s u s c i t a t i o n .MethodsTh e n e x t o f k i n - a s s t a t e d o n t h e a c c i d e n t a n de m e r g e n c y c a r d - o f p a t i e n t s o v e r t h e a g e o f 1 6y e a r s who h a d d i e d a f t e r u n s u c c e s s f u l c a r d i o p -u l m o n a r y r e s u s c i t a t i o n d u r i n g a n i n e monthp e r i o d i n t h e a c c i d e n t a n d e m e r g e n c y ( A & E )d e p a r t m e n t o f a n i n n e r c i t y t e a c h i n g h o s p i t a lw a s c o n t a c t e d a f t e r a minimum i n t e r v a l o f

A c c i d e n t andEmergencyD e p a r t m e n t , G u y ' sand S t Thomas' T r u s t ,London SE1F B a r r a t tD N W a l l i sC o r r e s p o n d e n c e t o :Dr F B a r r a t t , A c c i d e n t a n dE m e r g e n c y D e p a r t m e n t ,U n i ve rs i t y H o s p i t alL e w i s h a m , L e w i s h a m H i g hS t , London SE1 3 6LH, UK.A c c e p t e d f o r p u b l i c a t i o n2 2 O c t o b e r 1 9 9 7