It is always important to review what has been published in professional literature and determine the value of that which was learned. In 2010, research in emergency medicine and EMS has produced evidence that intends to improve patient care.
In reviewing the information provided by several journals during 2010, a number of articles were evaluated that should be considered for information they provide. The aim of this article is to draw these studies to your attention and highlight the important points. The hope is that you can take the information and decide for yourself the relevance of these data and weigh their potential impact on the care you provide to your patients, EMS systems and the field of prehospital medicine.
In no particular order, what I believe to be five interesting articles of 2010 were selected based on the definitive questions they answer, the frequency of occurrence (relevance), quality of study design (if applicable), and intangible aspects of concept and expressive conclusions. Beyond commonly discussed articles between colleagues and articles read through personal subscription to emergency medicine and prehospital journals, a search was conducted on PubMed using certain criteria. The MeSH terms was searched for "Emergency Medical Services," and limitations were placed for Clinical Trial, Meta-Analysis, Practice Guideline, Randomized Controlled Trial, published in English, and published in 2010. I have a personal interest in out-of-hospital cardiac arrest (OOHCA) and resuscitation. However, not all are related to this topic. These articles were of interest to me, and I apologize for omitting other articles that merit review and recognition for their contribution to EMS literature.
Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma 68(1):115-20; discussion 120-1, 2010.
Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med 55(3):235-246.e4, 2010.
Summary: The Haut study is a retrospective analysis of over 45,000 penetrating trauma patients. These authors assert that spinal immobilization is associated with a higher mortality.
The manuscript gives excellent overview of the current recommendations and standards in the opening section. Among all patients, 4.3% received spinal immobilization. The overall mortality for all patients was 8.1%. Mortality between immobilized and non-immobilized patients was 14.7% and 7.2%, respectively (p
However, patients who were immobilized in the prehospital setting were more likely to have moderate-to-severe injuries (31.2% vs 20.4%, p
The Newgard study uses data from over 3,600 patients in the Resuscitation Outcomes Consortium to show there was no significant association between EMS times and patient morality. Patients with physiologic abnormalities (i.e., systolic blood pressure 29 breaths/minute, a Glasgow Coma Scale (GCS) score
Discussion: At first glance, the Haut article seems interesting solely for the purpose of establishing further data to support that spinal immobilization in penetrating trauma patients can be detrimental to patient outcomes.
It raises a deeper question regarding spinal immobilization: What evidence is there to support spinal immobilization? In concept, it seems to make logical sense. Numerous studies have shown improvements in patient comfort. And there are studies, like this one, that show changes in mortality associated with immobilization. However, I was unable to find any evidence from any trial that showed prehospital, spinal immobilization prevents or reduces further vertebral or spinal cord injury from blunt or penetrating trauma.