Thompson Lee, Shaw Gary, Bates Charlotte, Hawkins Christopher, McClelland Graham, McMeekin Peter
North East Ambulance Service NHS Foundation Trust ORCID iD: http://orcid.org/0000-0002-0820-1662.
North East Ambulance Service NHS Foundation Trust.
Br Paramed J. 2021 May 1;6(1):38-45. doi: 10.29045/14784726.2021.6.6.1.38.
Spinal cord injury (SCI) is a rare event, with high numbers of patients unnecessarily immobilised with no potential benefit based on limited evidence from the 1950s and 1960s. Contemporary opinion now challenges the notion that traditional immobilisation prevents movement and protects the spine. Current literature suggests that these methods which include semi-rigid collars can potentially cause more movement of the spine and harm the patient. The purpose of this study was to explore the views and perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar.
Focus groups were used to allow individuals to discuss and comment on a new method of immobilisation which omits the semi-rigid collar and to capture the thoughts, feelings and experiences of participants. Thematic analysis of the coded transcriptions was used to identify emerging themes.
Three focus groups were conducted with 15 participants in each. Participants were all exposed to patients sustaining trauma within their professional roles. Six intertwined themes emerged from the analysis: communication, conflict, education/training, empowerment, risk and the patient. Woven between these themes are the complex interactions that bring together the inter-professional relationships with other emergency services and hospital staff, the patient, the public and pre-hospital care providers.
Existing immobilisation practices are being challenged, with clinicians empowered to tailor practice to meet specific patient needs. There is limited empirical evidence to support current immobilisation practices. Contemporary literature suggests current practices may potentially cause harm. New pragmatic immobilisation practices are gradually being adopted by some pre-hospital care providers.
This study explored the perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar for potential SCI. The consensus of the participants supports a pragmatic approach to managing potential SCI that provides safe, high-quality patient-centred care.
脊髓损伤（SCI）是一种罕见事件，基于20世纪50年代和60年代的有限证据，大量患者被不必要地固定，却没有潜在益处。当代观点现在对传统固定可防止移动并保护脊柱这一观念提出了挑战。当前文献表明，这些方法，包括半刚性颈托，可能会导致脊柱更多移动并对患者造成伤害。本研究的目的是探讨院前护理人员对不使用半刚性颈托固定患者的看法和观点。
采用焦点小组讨论的方式，让个人对一种省略半刚性颈托的新固定方法进行讨论和评论，并收集参与者的想法、感受和经历。对编码后的转录本进行主题分析，以确定新出现的主题。
共进行了三个焦点小组讨论，每组有15名参与者。所有参与者在其职业角色中都接触过创伤患者。分析得出六个相互交织的主题：沟通、冲突、教育/培训、赋权、风险和患者。这些主题之间交织着复杂的相互作用，将与其他急救服务和医院工作人员、患者、公众以及院前护理人员的跨专业关系汇聚在一起。
现有的固定方法正受到挑战，临床医生被赋予权力，可根据特定患者的需求调整操作。支持当前固定方法的实证证据有限。当代文献表明，当前的做法可能会造成伤害。一些院前护理人员逐渐采用新的实用固定方法。
本研究探讨了院前护理人员对不使用半刚性颈托固定潜在脊髓损伤患者的观点。参与者的共识支持一种实用的方法来管理潜在的脊髓损伤，即提供安全、高质量的以患者为中心的护理。
