(Ivanhoe Newswire) -- The time-consuming, on-scene medical intervention
of immobilizing the spines of shooting and stabbing victims before they are
taken to the hospital appears to double the risk of death, compared to
immediately transporting patients to a trauma center.
The findings by Johns Hopkins researchers suggest that pre-hospital spine
immobilization for these kinds of patients provides little benefit and may
lethally delay proven treatments for what are often life-threatening injuries.
Wounds from guns and knives are often far from the spine, yet patients are
routinely put in a cervical collar and secured to a board, according to the
investigators.
"If you're twice as likely to die, that seems like a bad thing to do," study
leader Elliott R. Haut, M.D., assistant professor of surgery at the Johns
Hopkins University School of Medicine, was quoted as saying. "We like to use
interventions that preserve life."
Haut says he hopes that as a result of his study, Maryland will consider
changing that part of its protocol that requires spine immobilization for nearly
all shooting and stabbing victims. The researchers caution, however, that spine
immobilization has been shown to effectively save lives and reduce disability
from injuries sustained in car crashes and similar events.
One finding that Haut said startled his team was that gunshot or stab wound
victims with the most minor injuries appeared to be at greater risk of death if
time is spent on pre-hospital immobilization.
"The patients who are very, very severely injured from their penetrating trauma
are going to die no matter what you do," said Haut. "But if someone is stabbed
in the lung or shot in the liver, what we do for them and how fast we do it
makes a huge difference. That time difference in getting them to the hospital
for treatment may make the difference between life and death."
EMTs and others who immobilize gunshot and stab wound patients do not intend to
do harm, Haut emphasized, but a cervical collar may, for example, conceal an
injury to the trachea or make inserting a breathing tube more difficult. Recent
studies have also called into question the merits of other pre-hospital
protocols, such as universal intravenous fluid administration.
Haut and his colleagues looked at records from more than 45,000 patients with
penetrating trauma included in the National Trauma Data Bank from 2001 to 2004.
They calculated that the chance of benefiting from spine immobilization in those
cases was 1 in 1,000, while potentially 15 additional people died for every
1,000 shooting or stabbing victims immobilized before being taken to the
hospital.
Haut concluded, "The idea of putting a board and collar on everybody is probably
not the way to go."
SOURCE: Journal of Trauma, January 2010
