Saturday, August 14, 2010

More proof that STEMI Systems work

A recent news article showcased the coordination of care between EMS and a hospital in Vancouver for patients having an MI: En-route diagnoses save heart attack victims’ lives. It is unfortunate that despite increasing global evidence that pre-hospital diagnosis is an integral piece of improving patient outcomes with STEMI, there are still barriers and turf wars that prevent the same. So how do we change this?

Sunday, August 8, 2010

Putting a sacred cow to pasture - cervical and spinal immobilization

The American Emergency Physicians News recently published a piece on the use of spinal immobilization and cervical collars. Despite evidence against the use and very little evidence that using immobilization techniques and equipment protects the patient from further injury this practice continues to put patients at risk for injury. There is increasingly more literature that discusses the harms associated with inappropriate cervical and spinal immobilization, which is defined as either incorrectly applied devices or inappropriately placed on patients without signs/symptoms of injury. This practice has been under scrutiny since the 1980s yet both pre-hospital and emergency departments use this practice routinely despite valid and recent evidence recommending otherwise. Disclaimer: this is not to say that there are not situations that spinal and/or cervical immobilization is not appropriate or necessary; and there is literature that supports this practice.

Further contributing to increased morbidity is prolonged immobilization once in the emergency department. Delays in being evaluated by an emergency department physician or nurse practitioner leave the patient lying immobilized for a prolonged period of time increasing the risk for extension injuries, skin complications, airway complications, elimination issues and emotional distress. Many nurses are not trained or competencied to adequately care for a patient with cervical collars and/or spinal immobilization let alone application and removal; this is often the case in non-trauma centers or in an academic institution with medical residents. Nurses often lose track of how long their patients are immobilized and a substantial delay occurs before being evaluated and removed from such devices. Once in the emergency department, nurses must advocate for their patients and treat immobilization as a priority of care.

Both paramedics and nurses must be familiar with evidence-based practices and know both the risks and benefits of the care they provide. Performing a skill on the basis of “that’s how we’ve always done it” is dangerous business for the patients we care for and it is incumbent upon us to ensure the care we provide is rooted in evidence and not just another scared cow.