The Effectiveness of Immobilizing Trauma Patients on Backboards Outline
TheEffectiveness of Immobilizing Trauma Patients on Backboards
ABSTRACT – Trauma and injuries are the major leading cause of disability around and spinal immobilization has been utilized for a number of years in patients with suspected spinal injuries.
INTRODUCTION – The impact of spinal injuries
BODY – Summary of the articles, examination of the strengths and weaknesses, description of the enablers and barriers of the project, expected outcomes, and overall contribution of this project to various players.
of the articles
Brief summary of the articles
Data analysis and Results
Examination of strengths and weaknesses
Enablers and barriers
Implications of future research
Anticipated changes in practice
Overall contribution of the project
Contributions to the nursing profession
Contributions to the health care service
Contributions to the consumers and the society
CONCLUSION – Summary of the paper and the concluding statement
Injuriesand trauma are among the leading causes of disability and mortalityaround the world. It is estimated that by 2020, accidents will becomeamong the top three causes of death (Vincent, 2012). About 2% of theinjuries presented to the emergency departments are those affectingthe spinal cord (Vincent, 2012). While the percentage may seem low,traumatic injuries to the spinal cord are a serious matter. One ofthe main reasons for adhering to austere immobilization guidelinesand assessment is the ultimate cost misdiagnosis of a spinal injury(Vincent, 2012). This risk of misdiagnosis may be the reason as towhy the practice of spine immobilization before transporting thepatient to the hospital may have remained unchallenged andunquestioned for the past thirty years (Vincent, 2012). This approachhas been adopted and implemented as a form of standard care withlittle medical evidence of its effectiveness. In fact, many articlesand studies have shown that this type of standard care may bring moreharm than good in a given category of trauma patients. This paperwill look into spinal immobilization for trauma patients and itseffectiveness as a form of standard care for trauma patients.
Keywords:Spinal immobilization, spinal injury, trauma patients, adverseeffects
TheEffectiveness of Immobilizing Trauma Patients on Backboards
Spinalcord injuries have a profound impact on the quality of life of theaffected individuals and their careers in general. These injuriesoften lead to permanent disability if not handled correctly and ontime. In America alone, approximately 50% of the spinal injuriesaffect the cervical spine (Vincent, 2012). There are a lot ofconcerns that unstable spine increases the severity and frequency ofneurological damage. Therefore, there is a need to devise appropriateways of immobilizing the spine to avoid injury.
of the Articles
Thearticles examine the different methods utilized for spinalmobilization versus lack of mobilization and the effects of thesemethods used to spinal stability, mortality, neurological stability,and the adverse effects they bear on the patients (Kwan, Bunn &Roberts, 2001). The authors give a brief background on why spinalimmobilization is necessary and widely recommended in patientssuspected to have suffered spinal injuries.
Theprimary aim of these articles is to quantify the different methodsutilized in spinal immobilization and review their effects onmortality, spinal stability, neurological disability, and adverseeffects on the affected patients (Kwan et al., 2001).
Theauthors used randomized control trials in this review. Theparticipants were patients suspected to have suffered spinal cordinjuries. All strategies of immobilization were used includingmattress splints, backboards, soft and rigid collars, straps,sandbags, holding the head by the midline, and rolling the patient(Cooney, Wallus, Asaly & Wojcik, 2013). The types of outcomesmeasured were mortality, adverse effects, neurological injury, anddegree of spinal stability. The search methods employed by theresearchers included electronic searches which were done onelectronic databases such as Cochrane injuries group’s specializedregister. MEDLINE, EMBASE, CINAHL, ZETOC among others were searchedbetween 2003 and 2007. In addition to these searches, authors ofbackground papers and manufacturers of immobilization devices werecontacted. The authors also carried out selection studies anddetermined whether the results were in agreement with the selectioncriteria (Cooney et al., 2013). Different authors then worked on dataextraction, and synthesis for example in types of interventions andparticipants and then the data collected was synthesized andcomparisons made. For conflicting results, the relative risk wascalculated at 95% confidence intervals and later applied in clinicalsituations, and sensitivity analysis carried out (Kwan et al., 2001).The results were recorded and the effects of the interventions noted.
Examinationof the Strengths and Weaknesses of the Articles
Thereport draws its strength from the fact that it analyses thedifferent methods utilized in spinal cord immobilization and alsomakes a comparison between the impacts of spinal immobilizationversus no immobilization (Kwan et al., 2001). The results obtainedwere compared and any differences arising addressed. Also, the numberof relevant papers screened was good, and this enabled theresearchers to draw grand conclusions about spinal cord mobilization.It is also good to note that the authors managed to contact variousplayers relevant to this topic like manufacturers of immobilizationdevices and this helped in the collection of vital information (Kwanet al., 2001). However, the data from randomized controlled trialslacked, hence the support for spinal cord immobilization beforeseeing a doctor lacked. The researchers also point out that there isa need to conduct trials on the various immobilization strategies andcompare their effects regarding outcomes on respiratory effects,immobilization efficacy, patient comfort, and tissue pressure (Cooneyet al., 2013). For these trials to be successful, healthy individualshave to be involved to get useful information about the effectivenessof these immobilization methods.
Althoughthe discussion on the various methods of spinal immobilization shedslight on which method can offer best results, the article does notpoint out the effects of these immobilization techniques on theneurological injury, mortality, adverse effects, and spinal stabilityin the affected patients (Kwan et al., 2001). It is important to notethat airway obstruction is the leading cause of preventable deaths intrauma patients and that spinal immobilization especially the oneinvolving the cervical spine may compromise the airways thus,increasing morbidity and mortality (Cooney et al., 2013).
Enablersand Barriers to the Implementation of this Project
Therandomized controlled trials, the participants involved in the study,and the types of interventions used made the implementation processof this project smooth (Kwan et al., 2001). The study materialschosen and the search methods utilized played a vital role in theimplementation of this project. The electronic searches from a widerange of electronic databases were crucial in the collection ofcritical data for this project. A total of 4453 papers were screenedfrom various electronic databases (Kwan et al., 2001). Theinvolvement of other players like manufacturers of immobilizationdevices led to the unearthing of vital information on the variousspinal immobilization methods used before arrival in the hospital.Lack of data from randomized trials was one to the barriers as thisdata is vital in supporting this practice in trauma patients (Kwan etal., 2001). Others included patient preferences, recruitmentchallenges, and concerns about consent and information. Thesebarriers should be addressed ensuring randomized controlled trialshave been conducted and addressing the concerns on recruitmentchallenges, patient preferences, and consent. This information isalso critical as it helps in the quantification of the adverseeffects of the various methods used for spinal immobilization.
Implicationsfor Future Research
Theresults obtained from this study are not conclusive hence the needfor large prospective studies to validate the decision standard forspinal immobilization in injured individuals (Kwan et al., 2001).Also, randomized controlled trials should be conducted in future tocompare the various immobilization strategies available to determinethe best strategy of immobilization. Many physicians note that theutilization of backboards for immobilization ought to be judiciousand should only be utilized if the potential benefits outweigh theadverse effects of the method used (Kwan et al., 2001).
AnticipatedChanges in Practice
Asnoted earlier, pre-hospital immobilization of the spinal cord intrauma patients has been used for a long time as a standard form ofcare. Immobilization has been accepted without concrete scientificevidence to justify the practice (Vincent, 2012). There is limiteddata on the positive neurological outcomes of the practice onpatients with suspected spinal injuries. This lack of data has mademany medical experts question the practice. It has also led to thedevelopment of new guidelines that offer support for evidence-basedand progressive approaches in a bid to reduce unnecessary spinalimmobilizations (Vincent, 2012).
Besides,the potential dangers and harmful sequelae of immobilization must betaken into consideration in any field of protocol (Vincent, 2012).The new guidelines have diminished the need of immobilizing traumapatients without neurologic deficits. In 2010, the American HeartAssociation released guidelines that classified cervical spineimmobilization as potentially harmful unless there is clear evidenceof injury on examination or history taking (Vincent, 2012).
Backboardbased immobilization has potentially dangerous consequences thatinclude discomfort, anxiety, and airway obstruction (Kwan et al.,2001). It may also aggravate any existing injuries, and it increasesthe risk of aspiration as the injured persons cannot adequatelyprotect their airways. Studies have shown that immobilization forlong periods of time may lead to the development of pressure ulcers,hematomas, and edema in some areas (Vincent, 2012). Therefore, infuture, there is need to reduce spinal immobilizations unless theinjured patients show signs of neurologic deficits. Recent studieshave shown that spinal immobilization for longer periods indeed doesmore harm than good to the patients hence the need to change thispractice (Kwan et al., 2001).
TheOverall Contribution of this Project to the Nursing Profession,Consumers, the Health Care Service, and the Society
Inthe last decades, nursing professionals have been rated as the mostethical and trusted professionals. This recognition is as a result ofimprovements that have been brought to the profession, thehealthcare, and the patient population in general. Nurses areadvocates for the health care system and their profession whichcomprises of groups of populations, communities, and their families(Vincent, 2012). Pre-hospital immobilization of the spinal cord isutilized in trauma patients who are suspected to have damaged theirvertebral column.
Time-basedand efficient practices are in place for certain reasons and aresupported by the literature. As nurses, we should support andadvocate for the need for accurate triage at the scene of potentialspinal trauma patients (Vincent, 2012). Nurses should be at theforefront of advocating for appropriate assessment of spinal injuriesin line with the set algorithms and guidelines. By doing so, therates of morbidity and mortality arising from the use of differentmethods of spinal immobilization will reduce (Vincent, 2012). Nursesshould also be actively involved in research on spinal immobilizationin a bid to catch up with the latest evidence on the spinalimmobilization practice.
Tothe health care service, the project will enable the serviceproviders to determine which spinal immobilization technique isappropriate for different trauma patients (Vincent, 2012). Havingequipped the medical personnel with vital information on spinalimmobilization, eliminating the unnecessary utilization of thisprocedure will ensure the trauma patients are managed on time thusdecreasing the morbidity and mortality rates (Adib-Hajbaghery,Maghaminejad & Rajabi, 2014).
Theimplementation of the project will make sure that the community andthe society as a whole receive quality care especially traumapatients with suspected spinal cord injuries (Adib-Hajbaghery et al.,2014). Armed with the knowledge on the best pre-hospital carepractices for trauma patients, the health service providers caneducate the public on the necessary measures undertaken in suchincidences. This knowledge will, in turn, help the public know whatthey should do in cases of accidents just before the paramedicsarrive.
Spinalcord immobilization has been employed for a long period of time as aform of standard care for trauma patients with suspected spinalinjuries. Although there was lack of scientific data to support thispractice, many practitioners continued using this technique. However,after studies were done, it was revealed that spinal immobilizationmay have more harmful effects than benefits. Most researchers havecautioned against this method unless the potential benefits outweighthe adverse effects.
Adib-Hajbaghery,M., Maghaminejad, F., & Rajabi, M. (2014, August). Efficacy ofPrehospital Spine and Limb Immobilization in Multiple TraumaPatients. Retrieved April 05, 2017, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199294/
Cooney,D., Wallus, H., Asaly, M., & Wojcik, S. (2013). Backboard Timefor Patients Receiving Spinal Immobilization by Emergency MedicalServices. InternationalJournal of Emergency Medicine.Retrieved April 5, 2017, fromfile:///C:/Users/user/Downloads/Backboard_time_for_patients_receiving_spinal_immobilization_by_emergency_medical_services%20(3).webarchive.
Kwan,I., Bunn, F., & Roberts, I. (2001). Spinal Immobilization forTrauma Patients [Abstract]. CochraneDatabase of Systematic Reviews.Retrieved April 5, 2017, fromhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002803/pdf
Vincent,J. L. (2012). Annualupdate in intensive care and emergency medicine.Berlin: Springer.
No related posts.