Pennardt A M, Zehner W J
Department of Emergency Medicine, SUNY Health Science Center, Syracuse, N.Y. 13210, USA.
Prehosp Disaster Med. 1994 Jan-Mar;9(1):40-3. doi: 10.1017/s1049023x00040826.
Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should "wear that collar and be strapped to that board." Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.
Algorithms exist for physicians to "clear" the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.
A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.
All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).
Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.
目前护理人员的培训要求，对于所有受伤机制通常被视为易导致脊柱创伤的患者，无论有无症状，都要进行完全固定。护理人员与那些能行走、无症状但不理解为何要“戴颈托并被绑在板子上”的事故受害者发生冲突的情况很常见。固定好后感到沮丧的患者可能会在繁忙的急诊科等待数小时，直到医生宣布他们没有脊柱损伤。患者经常拒绝治疗和转运。
存在一些算法，医生可据此在不进行影像学检查的情况下“排除”颈椎损伤。据推测，护理人员在对患者的评估中会常规评估并记录这些指标。
对一家地区医疗中心在52个月期间收治的161例诊断为颈椎损伤的患者（第1组）进行回顾性病历审查。然后研究了在五个月期间由救护车转运至急诊科的225例机动车事故（MVA）受害者的病历（第2组）。提取了紧急医疗服务（EMS）人员记录的颈椎损伤指标。
所有患者在被转运至医院之前均接受了EMS工作人员的精神状态评估和全脊柱固定（颈部和背部）。每份院前护理报告（PCR）上都记录了两项或更多可能的颈椎损伤指标。
护理人员已经评估了颈椎损伤排除算法的大部分（如果不是全部）标准，但在记录所有相关发现是否存在方面并不一致。
