To drive the point home in Houston, personnel were shown the fluoroscopic images of the vertebral separation. "With the experience of just watching that," says Persse, "silence would fall across the room."
Additional research published by the Journal of Trauma also found higher mortality in victims of penetrating trauma who were spine-immobilized. Those authors, from Johns Hopkins, advised against the routine use of spinal immobilization for those patients.
With dissociative neck injuries, most mechanisms will be blunt, and the Baylor team wasn't able, in reviewing trauma center records, to find any patients who'd survived them. They did, however, find a handful who experienced otherwise-unexplained hypotension and died.
"That was unnerving," says Persse. "Now they're wondering if those folks could all have been in neurogenic shock when everybody was looking for sources of hypovolemic shock, which they could never find."
Splinting Cervical Injuries in Position
You want your patient’s head in a neutral position, but patients with potential cervical injuries aren’t always found that way. Being “smarter than the problem” could mean splinting them in the position found, rather than moving an unstable neck.
“Say a patient fell out of a tree and landed on his shoulders and neck, and he’s complaining his neck hurts really, really bad,” says Houston Fire Department Medical Director David Persse, MD, EMT-P, FACEP. “His head’s turned to the left. He can feel and wiggle his fingers and toes. You probably need to move him with minimal movement to his neck, but you’re not going to get him into a standard collar with his head turned. You have to kind of splint them as they lie.”
That may take you back to the days of improvising with sweatshirts and sandbags. Another option could be products like EmeGear’s XCollar and NexSplint, which can be applied to patients in their position of injury, allowing use on those who are asymmetrical. While they may not reduce potential distraction in severe neck injuries, they do seem to reduce movement: A study by the University of Pittsburgh’s Emergency Responder Human Performance Laboratory found the XCollar more protective against movement in all directions—flexion/extension, left and right flexion and left and right rotation—on both seated and boarded patients than other collars tested.
The NexSplint was named a Top Innovation at EMS EXPO in 2008. For more, visit www.XCollar.com.?