A-14 Stabilization of spinal injury for early transfer

A-13 PROSPECTIVE RANDOMIZED EVALUATION OF M E T H O D S TO SECURE E N D O T R A C H E A L TUBES Robert J. Schwartz, R o n a l d A. Salonia, L e n w o r t h M. Jacobs, D e p a r t m e n t of E m e r g e n c y Medicine/Trauma, Hartford Hospital, 80 Seymour Street, Hartford, CT 06115 Introduction: The d e f i n i t i v e m e t h o d of airway control is e n d o t r a c h e a l i n t u b a t i o n (ET). Securing the a i r w a y in place is important prior to transport. Methods: A p r o s p e c t i v e r a n d o m i z e d double c r o s s o v e r s t u d y e v a l u a t i n g two m e t h o d s of s e c u r i n g an e n d o t r a c h e a l tube, tape w i t h b e n z o i n (TB) and a c o m m e r c i a l tube holder (TH). Results: There were 16 p a t i e n t s (49%) in the TB group, 5(31%) w e r e s u c c e s s f u l and ii failed r e q u i r i n g digital s t a b i l i z a t i o n . Of these ii patients, 8 r e c e i v e d the TH in the c r o s s o v e r design and 7(88%) TH were successful. T h e r e were 17(51%) p a t i e n t s in the TH group, 16(94%) were successful, I(6%) was not. TB was not used in the p a t i e n t because of a r r i v a l to the hospital. There was an a s s o c i a t i o n between failed TB and p r e s e n c e of fluid about the face, TH w o r k e d well under these c i r c u m s t a n c e s . Gloves could be used m o r e f r e q u e n t l y with the TH than w i t h the TB, but still only used in 41% of the p a t i e n t s (p=.034). For the s u c c e s s f u l a p p l i c a t i o n s , it took a mean of 74 seconds to a p p l y the TB and 29 seconds to a p p l y the TH (p=.029). Conclusion: The tube holder is s i g n i f i c a n t l y better than tape with benzoin. It can be a p l i e d faster and has a higher s u c c e s s rate, even in the p r e s e n c e of fluid about face. It can be a p p l i e d more f r e q u e n t l y w i t h gloves on. We r e c o m m e n d its use for all p r e h o s p i t a l intubations.

A-14 STERILIZATION OF SPINAL INJURY FOR EARLY TRANSFER Richard E. Burney, Russell Waggoner Survival Flight, University of Michigan, BIC255 UH, 1500 E. Med Ctr Dr, Ann Arbor, MI 48109-0014 INTRODUCTION Early or immediate transfer of persons with acute spinal cord injuries (SCI) is an integral part of regional SCI center care. We have reviewed the means of transport and type of stabilization used for all pts transferred to our center since 1984 to determine what effect these variables may have had on change in level of impairment and chances for neurologic improvement after arrival. METHODS Data has been gathered prospectively on all SCI pts since 1984. All records were reviewed to determine means of transport, method of stabilizing the spine during transfer, level of function prior to and after transfer, and at discharge. RESULTS Full records were available for review on 46 pts. There were 34 males, 12 females. Mean age was 35 + 20 yrs (range 13-83). Mean distance was 60 + 51 mi (range 2-245). 22 pts (48%) ~ r e transported by ground ambulance, 21 (46%) by rotor craft, 3 (6%) by fixed wing aircraft. 33 pts (72%) had C-spine injuries, 8 (17%) T-spine, and 5 (ll%) L-spine injuries. A variety of standard stabilization methods were used during transport. No patient suffered ascending level of injury as a result of transfer. Level of function improved prior to discharge in 18/46 (39%). There was no significant difference in the probab i l i t y of improvement between a ir (8/22) or ground transport (10/24). Skeletal traction was used during transfer in 4 of 33 C-spine injured pts, and was maintained as a method of treatment in only one patient. No complications occurred related to spine management. CONCLUSION Adults with acute SCI can be safely transported by air or ground using standard precautions. Distance and extent of associated injury are the best determinants of mode of transport. Skeletal traction does not appear to be a prerequisite for safe, early transfer of SCI pts. ~$

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