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A statewide,
prehospital emergency medical service selective patient spine
immobilization protocol. BACKGROUND:
To evaluate the practices and outcomes associated with a statewide,
emergency medical services (EMS) protocol for trauma patient spine
assessment and selective patient immobilization. METHODS: An
EMS spine assessment protocol was instituted on July 1, 2002 for
all EMS providers in the state of Maine. Spine immobilization
decisions were prospectively collected with EMS encounter data.
Prehospital patient data were linked to a statewide hospital database
that included all patients treated for spine fracture during the
12-month period following the spine assessment protocol implementation.
Incidence of spine fractures among EMS-assessed trauma patients
and the correlation between EMS spine immobilization decisions
and the presence of spine fractures-stable and unstable-were the
primary investigational outcomes. RESULTS: There
were 207,545 EMS encounters during the study period, including
31,885 transports to an emergency department for acute trauma-related
illness. For this cohort, there were 12,988 (41%) patients transported
with EMS spine immobilization. Linkage of EMS and hospital data
revealed 154 acute spine fracture patients; 20 (13.0%) transported
without EMS-reported spine immobilization interventions. This
nonimmobilized group included 19 stable spine fractures and one
unstable thoracic spine injury. The protocol sensitivity for immobilization
of any acute spine fracture was 87.0% (95% confidence interval
[CI], 81.7-92.3) with a negative predictive value of 99.9% (95%
CI, 99.8-100). CONCLUSIONS: The use of this statewide EMS spine assessment protocol resulted in one non-immobilized, unstable spine fracture patient in approximately 32,000 trauma encounters. Presence of the protocol affected a decision not to immobilize greater than half of all EMS-assessed trauma patients.
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