Cervical
Extrication
Device
STUDIES
There are only a limited number of independent Cervical Extrication Device (CED) studies published, all of which confirm that the CED provides improved immobilisation to that of a Cervical Collar alone. These studies are presented below.
J Trauma 1985 Jul;25(7):649-53
A
comparison
of methods of
cervical
immobilization used in patient extrication and transport.
Cline JR, Scheidel E, Bigsby EF.
We radiographically studied the efficacy of seven methods of cervical
immobilization used in the prehospital setting. The methods were:
Philadelphia collar, Hare extrication collar, rigid plastic collar,
Philadelphia collar + short board, Hare extrication collar + short
board, rigid plastic collar + short board, and the short board used
alone. Ninety-seven normal volunteers were randomized to one of these
seven methods and each volunteer served as his or her own control.
Efficacy was expressed as per cent reduction of baseline movement in
the sagittal, frontal, and horizontal planes.
The
short-board technique appeared to be superior to all the three collars
studied. The collars provided no augmentation of immobilization
over that provided by the short board alone. We believe that the
short-board technique described herein, which is commonly used in the
prehospital setting, can be used as the standard of comparison against
which newer prehospital devices can be objectively compared.
A radiographic
comparison
of prehospital
cervical
immobilization methods.
Graziano AF, Scheidel EA, Cline JR, Baer LJ.
Department of Emergency Medicine, Butterworth Hospital, Grand Rapids,
Michigan.
Three methods of prehospital cervical immobilization were studied
radiographically and compared to the short board technique (SBT). The
methods were California Stif-Neck Immobilizing Collar (CSC), Kendrick
Extrication Device (KED), and Extrication Plus-One (XP-One).
Forty-five volunteers were immobilized in the short board (SB) and one
of the test devices studied. Cervical movement in the sagittal and
frontal planes was measured radiographically. Movement in the
horizontal plane was measured directly. Two-tailed, paired t test
analysis was performed comparing test devices to the SBT. The SBT
proved to be significantly better (P less than .05) in the following
comparisons: the CSC in extension and lateral bending; the KED in
lateral bending; and the XP-One in extension. We confirm the SBT as
the standard of comparison against which newer prehospital devices can
be compared objectively.
Of
the three devices compared against the SBT, the factory-fabricated
short board devices (KED and XP-One) provided the greatest degree of
immobilization, in addition to logistical advantages over the SBT.
A
practical
radiographic
comparison of
short
board technique and
Kendrick
Extrication Device.
Howell JM, Burrow R, Dumontier C, Hillyard A.
Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas.
Cervical spine immobilization is necessary during the prehospital care
of most trauma patients. Earlier studies performed in controlled, indoor
settings suggested short board technique (SBT) was the standard against
which other methods of cervical stabilization should be measured. Our
study approximated the prehospital setting by comparing the use of tape,
SBT, and Philadelphia collar (PC) with tape, the Kendrick Extrication
Device (KED), and PC after immobilization in and extrication from a
compact car. Seven men were immobilized with KED and SBT in addition to
PCs and tape. These subjects were extricated and then taken by ambulance
stretcher across a 50-yd length of concrete to the radiology suite.
Flexion, extension, lateral bending, and rotation were measured. KED-PC
(16 degrees +/- 8 degrees) was statistically superior to SBT-PC (41
degrees +/- 5 degrees) in limiting rotation (P less than .001). KED-PC
and SBT-PC were similar in their abilities to limit extension (8 degrees
+/- 4 degrees vs 6 degrees +/- 5 degrees), flexion (4 degrees +/- 2
degrees vs 4 degrees +/- 4 degrees), and lateral bending (13 degrees +/-
5 degrees vs 17 degrees +/- 6 degrees).
In
an approximation of the prehospital setting, tape, a PC, and either KED
or SBT substantially limit extension, flexion, and lateral bending of
the normal cervical spine. KED-PC is more beneficial in rotation.
Evaluation
of a new
cervical
immobilization/extrication device.
Joyce SM, Moser CS.
Division of Emergency Medicine, University of Utah School of Medicine,
Salt Lake City 84132.
A new cervical immobilization device (the Philadelphia Red E.M. Collar
with Head Immobilizer/Stabilizer), has been introduced as an adjunct
in extricating potentially neck-injured patients. This study compared
the efficacy of immobilization using the collar to that of a short
spine board. In addition, experienced EMS personnel rated the collar
in simulated field situations. METHODS: In Part I of the study, the
collar and a short spine board were applied to 25 adult volunteers in
a sitting position, using standard methods. Each subject then exerted
maximal force in flexion, extension, rotation, and abduction. Degrees
of head motion from neutral position were measured in each direction.
Mean values were compared using Student's t-test. For Part II, 10 EMS
personnel were asked to apply the collar to volunteers. Each rated the
performance of the collar on a scale of 1 (poor) to 4 (excellent)
regarding: ease of application (sitting and supine), ease of
extrication (lifting, logrolling, transfer), access to patient (chest
auscultation, CPR, airway management), storage, and overall utility.
RESULTS:
The
Red EM was significantly better than the short spine board in both
lateral and rotational immobilization (p less than 0.001).
There was no significant difference for flexion or extension (p
greater than 0.05). The Red E.M. limited motion to a mean of 15
degrees or less in any direction. Ratings by EMS personnel for the
device (mean+/- standard error) were: ease of application (sitting)
3.5+/-0.2, (supine) 2.7+/-0.2; ease of extrication 3.1+/-0.2; access
to patient 3.4+/-0.2; storage 3.1+/-0.3; and overall utility
3.1+/-0.2.
Cervical
spine
stabilization
in
pediatric patients:
evaluation
of current techniques.
Huerta C, Griffith R, Joyce SM.
Department of Emergency Medical Services, Mount Sinai Medical Center,
Cleveland, Ohio.
We evaluated the performance of commercially available infant and
pediatric cervical collars, both alone and in combination with commonly
used supplemental devices (eg, Kendrick Extrication Device, half-spine
board). One infant and 11 pediatric-sized collars were tested on
mannequins representing an infant and a 5-year old child. Maximum forces
generated by cooperative children were measured, then applied to the
mannequins to reproduce head and neck flexion, extension, rotation, and
lateral motion. Limitation of motion was measured in each direction for
each collar and combination method. In general, collars of rigid plastic
construction performed better than did foam types. However, when used
alone none of the collars provided acceptable immobilization, with even
the best allowing 17 degrees flexion, 19 degrees extension, 4 degrees
rotation, and 6 degrees lateral motion. When combined with supplemental
devices, immobilization to 3 degrees or less in any direction could be
achieved. Findings were verified using cooperative children and selected
collars. Overall, combination methods were more effective than cervical
collars alone (P less than .001) or supplemental devices alone (P less
than .05).
The
modified half-spine board used with a rigid collar and tape was the most
effective combination method. We conclude that prehospital cervical
spine stabilization in pediatric patients is best accomplished using a
rigid-type cervical collar in combination with supplemental devices as
described.
Respiratory effects of spinal immobilization in children.
Schafermeyer
RW, Ribbeck BM, Gaskins J, Thomason S, Harlan M, Attkisson A.
Department of Emergency Medicine, Carolinas Medical Center, Charlotte,
North Carolina.
STUDY OBJECTIVE: To assess the restrictive effects of two spinal
immobilization strapping techniques on the respiratory capacity of
normal, healthy children. DESIGN: Prospective study with each subject
serving as his own control. PARTICIPANTS: Fifty-one healthy children 6
to 15 years old. INTERVENTIONS: Participants' forced vital capacity
(FVC) measurements were first obtained with children standing and
lying supine and then in full spinal immobilization using two
different strapping configurations, cross straps and lateral straps.
Straps were tightened to allow one hand to fit snugly between the
strap and child. MEASUREMENTS AND MAIN RESULTS: Supine FVC was less
than upright FVC (P less than .001). FVC in spinal immobilization
ranged from 41% to 96% of supine FVC (80 +/- 9%). There was no
difference in FVCs between strapping techniques (P = .83). CONCLUSION:
Spinal immobilization significantly reduced respiratory capacity as
measured by FVC in healthy patients 6 to 15 years old. There is no
significant benefit of one strapping technique over the other devices
(EMS) personnel in addition to those challenges faced when
immobilizing an adult. Most equipment commonly carried by EMS
personnel is sized for adult use and as a result does not routinely
provide adequate static or dynamic immobilization of a child. In
addition, children often resist immobilization and can free themselves
from standard strapping techniques. These problems have led to the
modification of existing equipment and the development of several
pediatric-specific devices. An ideal pediatric immobilization device
would be one that uses an existing piece of equipment, is of limited
additional cost, is routinely used by EMS providers, could be easily
modified to immobilize a child, could easily be taught to EMS
providers, and provides excellent static and dynamic immobilization.
The
Kendrick extrication device (KED) used as the authors describe meets
these goals of an ideal pediatric immobilization device.
