Cowley Alan, Nelson Magnus, Hall Claire, Goodwin Simon, Kumar Dhushyanthan Surendra, Moore Fionna
South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-3093-4395.
South East Coast Ambulance Service NHS Foundation Trust.
Br Paramed J. 2022 Dec 1;7(3):59-67. doi: 10.29045/14784726.2022.12.7.3.59.
Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia.
A specialist group was commissioned to review the topic of pre-hospital spinal immobilisation and explore potential for evidence-based improvement. In conjunction with local trauma networks, subject matter experts and a thorough review of recent literature, a series of recommendations were made in order to improve spinal care within the authoring trust.
Seven recommendations were made, and an updated set of guidelines produced. These included the removal of semi-rigid collars from pre-hospital spinal immobilisation; the creation of two tiers of patients to ensure that the high-risk and low-risk populations are considered separately and an accompanying decision tool to safeguard both cohorts; an increased emphasis on the risk of spinal injury in the frail and older patient; an emphasis on spinal motion restriction rather than rigid immobilisation; an increased emphasis on self-extrication; and the use of a marker for emergency departments.
An updated set of guidance has been produced using a combination of specialist and expert opinion alongside a literature review with close involvement of key stakeholders, both public and professional. The new guidance helps to ensure a patient-centred approach where each person is considered an individual with their risk of injury and management measures tailored to their specific needs.
多年来，脊柱评估与固定一直是一个备受争议的话题。尽管有新的证据基础，且海外也发布了新的指南，但英国院前急救实践中几乎没有什么变化。自2018年以来，东南海岸救护车服务国民保健服务基金会信托机构花时间与当地创伤网络以及该地区的专业知识和国际同行合作，制定了一套颈椎评估与固定指南，该指南反映了当前国际上可得的最佳证据以及来自斯堪的纳维亚和澳大利亚等地区的国际院前急救实践中的重大变化。
委托一个专家小组审查院前脊柱固定的主题，并探索基于证据进行改进的可能性。结合当地创伤网络、主题专家以及对近期文献的全面审查，提出了一系列建议，以改善编写该指南的信托机构内的脊柱护理。
提出了七条建议，并制定了一套更新的指南。这些建议包括：在院前脊柱固定中去除半刚性颈托；设立两类患者，以确保分别考虑高风险和低风险人群，并配备一个辅助决策工具以保护这两类人群；更加重视体弱和老年患者脊柱损伤的风险；强调脊柱活动限制而非刚性固定；更加重视自我解救；以及在急诊科使用标记物。
通过结合专家和专业意见以及文献综述，并在公共和专业关键利益相关者的密切参与下，制定了一套更新的指南。新指南有助于确保以患者为中心的方法，即每个人都被视为个体，根据其受伤风险和管理措施来满足其特定需求。
