Title: EMS Cervical Spine Clearance<br/>
Author: Robert Flint<br/>
<a href='mailto:rflint@som.umaryland.edu'>[Click to email author]</a><hr/>
Link: <a href='https://umem.org/educational_pearls/4619/'>https://umem.org/educational_pearls/4619/</a><hr/><p>This Canadian study looked at the safety of paramedics using the modified Canadian C-Spine Rule to determine which pre-hospital blunt trauma patients required immobilization. These were MVC and fall patients predominately. Bottom line: appropriately trained paramedics can use the modified Canadian C-Spine rule to clinically clear cervical spines in the field. </p>
<p><img src="https://umem.org/files/uploads/content/pearls/gr1-67003841595a0.jpg" alt="" /></p>
<table>
<thead>
<tr>
<th>Result of Application</th>
<th>Paramedics’ Interpretation</th>
<th>Investigators’ Interpretation</th>
</tr>
</thead>
<tbody>
<tr>
<td>Injury</td>
<td>No Injury</td>
<td>Injury</td>
</tr>
<tr>
<td>---</td>
<td>---</td>
<td>---</td>
</tr>
<tr>
<td><strong>Immobilization required (N)</strong></td>
<td>10</td>
<td>1,342</td>
</tr>
<tr>
<td><strong>Immobilization not required (N)</strong></td>
<td>1</td>
<td>2,668</td>
</tr>
<tr>
<td>Sensitivity, % (95% CI)</td>
<td>90.9 (58.7–99.8)</td>
<td>90.9 (58.7 to 99.8)</td>
</tr>
<tr>
<td>Specificity, % (95% CI)</td>
<td>66.5 (65.1–68.0)</td>
<td>68.2 (66.7 to 69.7)</td>
</tr>
<tr>
<td>Positive likelihood ratio, (95% CI)</td>
<td>2.7 (2.2–3.4)</td>
<td>2.9 (2.4 to 3.5)</td>
</tr>
<tr>
<td>Negative likelihood ratio (95% CI)</td>
<td>0.1 (0.0–0.9)</td>
<td>0.1 (0.0–0.9)</td>
</tr>
</tbody>
</table>
<fieldset><legend>References</legend><h4>Implementation of the Modified Canadian C-Spine Rule by Paramedics</h4>
<p>Vaillancourt, Christian et al.</p>
<p>Annals of Emergency Medicine, Volume 81, Issue 2, 187 - 196</p>
</fieldset>