Offenbach an der Queich, Germany
Offenbach an der Queich, Germany

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Kreinest M.,Trauma Center Ludwigshafen | Kreinest M.,PHTLS Europe Research Group | Goller S.,Trauma Center Ludwigshafen | Goller S.,PHTLS Europe Research Group | And 8 more authors.
European Journal of Trauma and Emergency Surgery | Year: 2016

Purpose: Spinal immobilization is a standard procedure in emergency medicine. Increasing awareness of complications associated with immobilization of trauma patients leads to controversial discussions in the literature. Current guidelines require to include considerations of accident mechanism, an assessment of the patient’s condition and an examination of the spine in the decision-making process if immobilization of the spine should be performed. This requires sound knowledge of assessing these parameters. The aim of the current study is to analyze German paramedics’ subjective uncertainty in terms of their prehospital assessment and treatment of patients suffering from spine injuries. Methods: Over a period of 17 months participants in a trauma course were asked to complete a standardized anonymous questionnaire about subjective uncertainty of prehospital assessment and management of spinal trauma before participation in that course. Questions about the frequency of application of different immobilization tools and skills training on spinal immobilization were also asked. Results: A total of 465 paramedics were surveyed. The participants did not indicate any uncertainty about the prehospital diagnosis and treatment of spinal injuries. The feeling of confidence was significantly greater in participants who had already attended another course on structured trauma care before. The participants agreed with the statements that standardized algorithms facilitate teamwork and that there is a need for a protocol for the prehospital treatment of spinal injuries. Conclusions: Paramedics do not feel uncertain about the prehospital assessment and treatment of spinal injuries. The feeling of confidence in participants who had already attended a course on the treatment of trauma patients before was significantly higher. © 2016 Springer-Verlag Berlin Heidelberg


Kreinest M.,Trauma Center Ludwigshafen | Kreinest M.,PHTLS Europe Research Group | Gliwitzky B.,PHTLS Europe Research Group | Schuler S.,University of Heidelberg | And 3 more authors.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2016

Background: In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel. Methods: A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol. Results: Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol. Discussion: Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support. Conclusions: The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular. © 2016 Kreinest et al.


Kreinest M.,Trauma Center Ludwigshafen | Kreinest M.,PHTLS Europe Research Group | Goller S.,Trauma Center Ludwigshafen | Goller S.,PHTLS Europe Research Group | And 8 more authors.
PLoS ONE | Year: 2015

Background/Objective: The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars. Material and Methods: Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. Results: The test subjects included professional rescue personnel (80.8%) and emergency physicians (12.5%). The average occupational experience of all study participants in pre-clinical emergency care was 11.1±8.9 years. Most study participants had already attended a certified training on trauma care (61%) and felt "very confident" in handling a cervical collar (84%). 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses. Conclusion: Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded. © 2015 Kreinest et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | PHTLS Europe Research Group, S2 Services, Trauma Center Ludwigshafen and Nurnberg University of Applied Sciences
Type: | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Spinal immobilization is a standard procedure in emergency medicine. Increasing awareness of complications associated with immobilization of trauma patients leads to controversial discussions in the literature. Current guidelines require to include considerations of accident mechanism, an assessment of the patients condition and an examination of the spine in the decision-making process if immobilization of the spine should be performed. This requires sound knowledge of assessing these parameters. The aim of the current study is to analyze German paramedics subjective uncertainty in terms of their prehospital assessment and treatment of patients suffering from spine injuries.Over a period of 17months participants in a trauma course were asked to complete a standardized anonymous questionnaire about subjective uncertainty of prehospital assessment and management of spinal trauma before participation in that course. Questions about the frequency of application of different immobilization tools and skills training on spinal immobilization were also asked.A total of 465 paramedics were surveyed. The participants did not indicate any uncertainty about the prehospital diagnosis and treatment of spinal injuries. The feeling of confidence was significantly greater in participants who had already attended another course on structured trauma care before. The participants agreed with the statements that standardized algorithms facilitate teamwork and that there is a need for a protocol for the prehospital treatment of spinal injuries.Paramedics do not feel uncertain about the prehospital assessment and treatment of spinal injuries. The feeling of confidence in participants who had already attended a course on the treatment of trauma patients before was significantly higher.


PubMed | PHTLS Europe Research Group, University of Heidelberg and Trauma Center Ludwigshafen
Type: | Journal: Scandinavian journal of trauma, resuscitation and emergency medicine | Year: 2016

In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel.A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol.Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol.Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support.The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular.


PubMed | Mittelbaden Clinic, PHTLS Europe Research Group, University of Heidelberg and Trauma Center Ludwigshafen
Type: Journal Article | Journal: PloS one | Year: 2015

The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars.Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire.The test subjects included professional rescue personnel (80.8%) and emergency physicians (12.5%). The average occupational experience of all study participants in pre-clinical emergency care was 11.18.9 years. Most study participants had already attended a certified training on trauma care (61%) and felt very confident in handling a cervical collar (84%). 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses.Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded.


Based on upcoming knowledge of complications coming along with spinal immobilization, current guidelines recommend a sophisticated indication for spinal immobilization. The mechanism of accident, the physical examination of the spine and the current patient's status might be considered for the decision about spinal immobilization. Thus, emergency physicians must provide substantiated knowledge and skills of these parameters. The aim of the current study is the analysis of subjective self-assurance towards the assessment of the mentioned parameters before and after participation at a trauma course. In a time period of 17 months 333 emergency physicians could be asked by a standardized anonymously questionnaire. Emergency physicians are confident with preclinical assessment and therapy of patients that suffered from a spine injury. But self-assurance could be significantly increased in all parameters by participating at a trauma course. Furthermore, emergency physicians agreed to the statement that structured treatment protocols make teamwork easier and that there is need of a structured protocol for out-of-hospital treatment of patients with spinal trauma. © Georg Thieme Verlag KG.


Kreinest M.,Klinik fur Unfallchirurgie und Orthopadie | Kreinest M.,PHTLS Europe Research Group | Gliwitzky B.,PHTLS Europe Research Group | Grutzner P.A.,Klinik fur Unfallchirurgie und Orthopadie | And 2 more authors.
Notfall und Rettungsmedizin | Year: 2016

Background: Spinal immobilization has been a standard procedure in out-of-hospital treatment of trauma patients for decades. There are increasing reports in the current literature about complications of spinal immobilization. Thus, the use of decision aids for the indication of spinal immobilization is recommended. The application of most existing immobilization protocols is limited to some extent. To our knowledge, an immobilization protocol, applicable for all adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries is currently not available. Objectives: The aim of the current study was to develop a protocol as a decision aid for preclinical spinal immobilization of adult trauma patients and to perform a preliminary test of applicability by German medical students via a questionnaire. Materials and methods: A structured literature search for publications concerning spinal immobilization was performed. Afterwards, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients, basing on the current literature and guidelines, was developed. A preliminary test of applicability was performed with 86 German medical students by means of a questionnaire. Results: A new protocol for preclinical spinal immobilization could be provided and visualized. Questions that analyze the correct application and understanding of the E.M.S. IMMO Protocol were predominantly answered correctly by German medical students. The main reasons for incorrect answers were evaluated in a direct feedback session and were not found to be directly related with the E.M.S. IMMO Protocol but with a lack of experience in emergency medicine. Conclusions: The E.M.S. IMMO Protocol provides a decision aid for the indication for out-of-hospital spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization methods in particular. © 2016 Springer-Verlag Berlin Heidelberg


Kreinest M.,Klinik fur Unfallchirurgie und Orthopadie | Kreinest M.,PHTLS Europe Research Group | Gliwitzky B.,PHTLS Europe Research Group | Gliwitzky B.,MegaMed Notfallmanagement GbR | And 4 more authors.
Notfall und Rettungsmedizin | Year: 2015

Background and objectives: The question about the need of spinal immobilization of trauma patients in general, and the various ways to do it in particular are nowadays increasingly discussed in scientific literature. Furthermore, daily practice of spinal immobilization routines also reflects a huge heterogeneity. The aim of this article is to give an overview about exemplarily selected literature on the subject of spinal immobilization of trauma patients. Thus, possible recommendations concerning spinal immobilization could be derived by the reader. Spinal immobilization of trauma patients: The general lack of evidence towards spinal immobilization is well known. In the current scientific literature increasing hints can be found that the sole application of a cervical collar does not ensure a sufficient immobilization of the cervical spine. Thus, total spine immobilization, meaning fixation of the entire body of the trauma patient is recommended. However, total spine immobilization is also said to be associated with significant complications such as aggravated airway management or reduced lung function due to restrictions. Furthermore, the application of a cervical collar can lead to increased intracranial pressure. Thus, the indication for spinal immobilization should be sophisticated on behalf of immobilization decision tools such as the Canadian C-spine rule. In patients with acute life threatening conditions such as Hemorrhagic shock, it must be decided whether the immediate transport can be delayed by immobilization procedures. In the case of a trauma patient suffering from severe traumatic brain injury, one should consider whether the application of a cervical collar is mandatory or if alternative ways of immobilization could be carried out. Hence, the vacuum mattress offers better stability and greater comfort during total spinal immobilization compared to the spine board. © 2015 Springer-Verlag Berlin Heidelberg

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