Grant: Operating Grant

Each year, Canadian Emergency Medical Services (EMS) bring 1.3 million patients who may have injured their neck (c-spine) in falls or motor vehicle collisions to local emergency departments (ED). Less than 1% of all these patients have a c-spine injury (bone or ligament), and even less (0.5%) have a spinal cord injury (nerve damage). Most spinal cord injuries occur before EMS arrival and not during transport to hospital, yet most trauma victims (with or without c-spine injury) are transported in ambulances using backboard, collar, and head immobilizers. They stay fully immobilized until an ED bed is made available (sometimes up to 3 hrs, also holding up the EMS crew), or until physician assessment and/or X-rays are complete. This prolonged immobilization is often unnecessary, adds considerably to patient discomfort, and also adds to the burden of our EMS system and overcrowded Canadian EDs. A clinical decision rule helps health care workers make clinical decisions using information from the history, examination, or simple tests. We have developed the Canadian C-Spine rule (CCR) to be used by physicians, nurses, and paramedics for alert and stable trauma patients. After evaluating more than 30,000 patients, the CCR has never missed a significant injury. Physicians and nurses already use the CCR in clinical practice to remove immobilization devices without the need for X-rays. Paramedics recently evaluated 1,949 patients using the CCR and identified all injuries. The goal of this project is to evaluate the safety and potential impact of an active strategy to empower paramedics to evaluate and not immobilize the c-spine of very low-risk trauma patients before transport. Our ethics board believe that teaching paramedics to evaluate the c-spine of very low-risk trauma patients is safe and has the potential to significantly improve patient care in our busy EMS system and Canadian EDs. We expect the results of this study to be used by paramedics throughout Canada.