The Northern Ohio Trauma System’s (NOTS) goal is to improve patient outcomes and decrease the mortality of the trauma patient through research, collaboration and education. For NOTS to be effective, this research, collaboration and education begins with EMS. The fire and EMS services in the region are our first responders to trauma, and their initial assessment, treatment and decisions impact patient outcomes. Early recognition of injury through the initial assessment and triage, their decisions on how to transport the patient, and patient destination all impact survivability of a traumatic injury.
NOTS has an EMS Committee that meets every other month, composed of physicians, hospital coordinators, fire chiefs and EMS providers representing Ashtabula, Lake, Geauga, Cuyahoga, Medina and Lorain counties. The NOTS EMS Committee is committed to supporting EMS through communication, education and research. The communication will be available through various avenues, keeping EMS informed on the trends in trauma. Our education is available at no cost to fire/EMS services throughout our region. Lastly, NOTS is involved in trauma research, and EMS plays a role in this as well. The group will support the area EMS Coordinators from various hospitals by providing educational resources and personnel to help meet the needs of their providers. The goal is to continue to decrease mortality, improve patient care and ultimately get the right patient to the right place, at the right time.
Trauma Mechanisms of Injury- Falls
Though many trauma triage algorithms discuss falls from greater than 20 feet, NOTS data has refined their algorithm as there is evidence that shows significant injuries in falls greater than 10 feet.
Spinal Motion Restriction
- Evidence now shows that a long board and cervical collar does not “immobilize” the spine, and the new term that is used is Spinal Motion Restriction.
- Evidence now shows that placing patients on long boards with cervical collars is not benign, as there are many negative effects caused by this routine treatment
- Evidence shows that patients in this position are more susceptible to airway compromise including aspiration 1-5
- Evidence shows that a patient in this supine position secured to a longboard with cervical collar in place can have a reduced tidal volume 1, 6, 7
- Evidence shows that mortality increases in patients suffering penetrating trauma to the head, neck and torso when placed on a longboard with cervical collar 2, 3, 4
- Evidence suggests that a cervical collar alone frequently increases intracranial pressure 8
- Evidence shows that skin breakdown can occur within 30 minutes resulting in pressure sores in otherwise healthy patients 9
1. Kwan I, Bunn F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20(1):47–53.
2. Barkana Y, Stein M, Scope A, et al. Prehospital stabilization of the cervical spine for penetrating injuries of the neck: Is it necessary? Injury. 2000;31(5):305–309.
3. Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: More harm than good? J Trauma. 2010;68(1):115–120; discussion 120–121.
4. Brown JB, Bankey PE, Sangosanya AT, et al. Prehospital spinal immobilization does not appear to be beneficial and may complicate care following gunshot injury to the torso. J Trauma. 2009;67(4):774–778.
5. Kwan I, Burns F. Spinal immobilization for trauma patients (Cochrane Review). Cochrane Review; 2009; 11
6. Chan D, Goldberg R, Tascone A, et al. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med. 1994;23(1):48–51.
7. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999;3(4):347–352.
8. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27(9):647–649.
9. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes, E. Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards. Prehosp Emerg Care. 2010;14:419–24.