New Consensus Statement on Spine-Injured Athlete Treatment

[atstudent]

The NATA announced last week a new consensus statement on the treatment of the spine-injured athlete. Would be interested in your thoughts as Emergency Physicians as this moves forward...

http://www.nata.org/NR06242015

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[cofcemt]

The NATA announced last week a new consensus statement on the treatment of the spine-injured athlete. Would be interested in your thoughts as Emergency Physicians as this moves forward...

http://www.nata.org/NR06242015

Having been an EMT and an ATC prior to EM, there are several things that I disagree with.
1) There is no cited literature for their recommendations.
2) There are no level of evidence indicators in the recommendations, as has become standard practice for most specialties.
3) A scoop stretcher is probably the best modality to move patients of this type, not an 8 person lift (often there are not enough available providers on the field).
4) Removal of all equipment on the field is likely not indicated and if it would cause significant delays, is unnecessary. That being said, face mask removal should be done on all injured athletes.
5) A LSB is unnecessary and not proven to do anything. Just transport on ambulance stretcher and then move again with scoop stretcher.
6) EAPs should involve receiving EDs (this is unfortunately frequently not done).

Otherwise the rest of the recommendations are quite good.

 

[atstudent]

I also listened to a speaker last week who talked about "just transporting on a stretcher." What happens if the patient needs to be rolled while in the ambulance? The stretcher is anchored to the floor. A spine board would allow that log rolling. Also, there was research presented that discussed the various ways of transferring patients. The 8-man was the best and I believe the log roll was second. Several of the other recommendations (as recommended by a group of paramedics) were found to be VERY poor. This study was conducted in a lab I think at University of Florida, using cadavers and measuring movement of sensors attached to various parts of the vertebral bodies.

Regarding the inclusion of the receiving ED, how would you propose doing that in a city? Yes, in a community where there is 1-2 schools and one hospital with one EMS team, I'm sure that could be pulled off. But, for example, I am inside the city limits of Dallas, TX. Our patients are transported by Dallas Fire Rescue to Baylor Downtown which is a major trauma center. Do you think the ED or EMS staff are going to be willing to practice with every high school in the area?

 

[deleted109597]

Why does someone need to be logrolled in an ambulance again?
Most of this is reasonable. Agree that receiving facilities should be included, but also agree that getting buy in is hard. I don't see a lot to argue with, but I do concede the the level of evidence is lacking in their statement. It really isn't hard to include it (unless everything is conscensus statements to begin with).

 

[cofcemt]

What happens if the patient needs to be rolled while in the ambulance? The 8-man was the best and I believe the log roll was second.

Regarding the inclusion of the receiving ED, how would you propose doing that in a city?

You answered your own question, you just log roll the patient. Have you ever been on a backboard and rolled onto your side? There is a lot of lateral movement of the spine due to strap placement (most EMS systems and ATCs cannot afford vacuum splints). Most places and studies do not use scoop stretchers (the study you refer to certainly didnt). They are old tech and often forgotten, but great if used appropriately.

To answer your question about inclusion of the ED. Most places should have a protocol to transport these patients to the nearest trauma center. Most places that will be one hospital, some it will be multiple. But, you just contact the ED/Trauma team and let them know you would be interested in setting up a protocol for these transports. You can work through your EMS agency as they will know the right people in the ED to talk to. Buy in is important because many places have specific protocols in place for spinal injured athletes (ie MAP pushes, emergent OR, specific spine guys that work woth these athletes, etc) and can help make care more fluid.

I think the biggest reason why they didn't list the evidence is that it would rank poorly, as you said, most are likely consensus statements.