PREHOSPITAL CARE

Prehospital clearance of the cervical spine: does it need to be a pain in the neck?

B P Armstrong¹, H K Simpson¹, R Crouch², C D Deakin³

¹ Emergency Department, Basingstoke & North Hampshire Foundation Trust (formerly North Hampshire Hospital Trust), Basingstoke, UK
² Emergency Department, Southampton University Hospital NHS Trust, Southampton, UK
³ South Central Ambulance Service—Hampshire Division, Highcroft, Winchester, UK

Correspondence to:
Correspondence to:
MrB P Armstrong
Emergency Department, Basingstoke & North Hampshire Foundation Trust (formerly North Hampshire Hospital Trust), Aldermaston Road, Basingstoke RG24 9NA, UK; bruce.armstrong{at}bnhft.nhs.uk

Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations.

Abbreviations: c-spine, cervical spine; CSI, cervical spine injury; ED, emergency department

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This article has been cited by other articles:

• Blackham, J., Benger, J. (2009). `Clearing' the cervical spine in conscious trauma patients. Trauma 11: 93-109 [Abstract]