Are your clinicians ready to clear C-spine in the field?
Implementing a new procedure for clearing C-spines requires supplementary data, buy-in from leadership and hands-on training
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By Xavier De La Rosa
Many years ago, the NEXUS study was published and told us that clearing a patient’s need for a cervical collar was possible if certain criteria were met and guidelines followed. This practice has slowly trickled into EMS and now, many agencies are putting backboards next to the EOAs and MAST trousers. Is your agency ready to move into the next generation of medicine and stop utilizing backboards for anything other than extrication and patient movement?
Implementing a new EMS procedure
Rolling out any new procedure or medication must be prefaced with adequate preparation, and as you practice under the discretion of your agency medical director, you must have their support. In Texas, we are fortunate to have liberties with the discretion of our agency medical directors.
Most medical directors are on board with progressive changes and moving toward evidenced-based medicine. If your medical director is more resistant to change, you may have to present more data than just the NEXUS study.
Another avenue to pursue is to present other similar agencies that have implemented a c-spine clearance procedure and have had success. The closer the agency to yours (in geographical proximity) the better.
Next comes writing the actual procedure. Follow the NEXUS criteria and use other agencies’ procedures as references. You will need this written procedure before you take this to your field leaders. Show them the research and data, as well as the procedure, and have them digest it. Allow them to ask questions, review the document and look for errors. If you allow them to be part of the process, they will be more likely to own it.
Finally, gather the troops and push this out. Starting with your field training officers and senior medics will foster the greatest success. Gather them, show them the data and research in the same fashion you would with your medical director. You must have total buy in from this group if you want to have success.
Don’t be afraid to remove backboards all together. The research is out there, go get it! If you encounter patients that don’t meet the clearance criteria, a c-collar and transport in a position of comfort will do wonders for your patients.
Train the trainers
Implementation begins with training the trainers. Not only will the data and research be an important component, but you must provide your people with hands-on practice. They must practice palpating a cervical spine, and not just a quick touch. We want real palpation, just as they would in the field. The must ask all the same questions as they would a real patient and practice the range of motion exam.
Once your trainers feel comfortable, bring in the masses. Again, share the data and research supporting the change, and allow your trainers to demonstrate and oversee the hands-on portion of the process.
Evaluate procedure implementation success
The next, and – in my opinion – most important part of the process is follow-up and feedback. Monitor your field staff via scene responses, especially on calls that you know used to warrant full immobilization. Ask questions about how it’s going, what their comfort level is and what can be improved.
Monitor charts and see if immobilization with a collar and backboard are still occurring and, if so, why? Also, follow up with your trainers and senior staff. They tend to be more honest and can give you genuine feedback about how things are going and what can be improved. This should be performed around the 30-day and six-month period after implementing the new procedure. You can re-evaluate at a year as well. At that time, most everyone should be comfortable with the process.
About the author
Xavier A. De La Rosa, BS, LP, NRP, FP-C, has held multiple roles including for-profit EMS, 911 EMS, flight medicine and EMS-based fire service. Currently he is a lieutenant in the Training Division at Fort Bend County EMS, located just outside of Houston, Texas.
He has a degree in Emergency Health Sciences from the University of Texas Health Science Center San Antonio and is in a Johns Hopkins University Master of Business Administration program, with concentrations in Healthcare Administration and Leadership.