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Lawrence Livermore National Laboratory

Summary report: 2002 Medical Group Office Management Systems Survey.

The Canadian c-spine rule (CCR) allows safe, reproducible use of radiography in alert, stable patients with potential c-spine injury in the emergency setting [Stiell, I., Clement, C., McKnight, R., Brison, R., Schull, M., Lowe, B., Worthington, J., Eisenhauer, M., Cass, D., Greenberg, G., MacPhail, I., Dreyer, J., Lee, J., Bandiera, G., Reardon, M., Holroyd, B., Lesiuk, H., G. Wells, 2003. The Canadian c-spine rule versus the nexus low-risk criteria in patients with trauma. The New England journal of medicine 349 (26), 2510-2518; Stiell, I., Wells, G., Vandemheen, K., Clement, C., 2001. The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA 286 (15), 1841]. This paper reports on a study of emergency nurses' ability to identify patients requiring immobilisation using the CCR. Emergency department triage nurses (N = 112) were trained in the use of the CCR and then asked to use the tool over the following 14 months in the assessment of 460 patients who presented with potential c-spine injury. Trained medical staff repeated 55% of the clinical assessments independently using the rule. The level of agreement between nurse and medical judgement was calculated. The inter-rater reliability using the kappa statistic was 0.6 (95% CI 0.50-0.62 N = 254) indicating a 'good' level of agreement. The majority of nurses indicated they were comfortable using the rule. The results suggest that UK emergency department nurses were able to use the Canadian c-spine rule to successfully guide selective immobilisation. A 25% reduction in immobilisation rates would have been achieved if the rule had been followed. Further studies are needed to test the reduction in levels of immobilisation that could be achieved in clinical practice.

Can emergency nurses use the Canadian cervical spine rule to reduce unnecessary patient immobilisation?

To determine the potential of the Canadian Cervical Spine Rule (CCR) to safely reduce the number of cervical spine (c-spine) radiographs performed in the UK emergency department setting.

Validation of the Canadian c-spine rule in the UK emergency department setting.

The deployment experiences of military mental health providers (MMHP) since September 2001 have been largely unexamined. MMHP are an integral part to the military health system and play a key role in maintaining a fit fighting force. MMHP deploy and are expected to help others manage their deployment experiences while being faced with their own emotional challenges during deployment and while transitioning home. This study examines two questions: First, how do MMHP experience reintegration to their families and jobs after being deployed, and second, how do MMHP assess and cope with their own postdeployment issues. In this study, 27 mental health professionals including social workers, psychiatrist, and psychologist were interviewed to examine their deployment and postdeployment experiences. Results indicated 81% of MMHP recognized some level of dysfunction in their lives, at home, at work, or at both, upon their return from deployment. The ability for MMHP to manage their own reintegration issues has significance for their own personal well-being as well as their ability to provide specialized care for others. Attention needs to be given to how MMHP are supported postdeployment and possibly tailor a transitional process for postdeployment reintegration based on the unique nature of their work.

Article	Year
Summary report: 2002 Medical Group Office Management Systems Survey. The Journal of medical practice management : MPM\| PubMed ID: 12661482	2003
Can emergency nurses use the Canadian cervical spine rule to reduce unnecessary patient immobilisation? Accident and emergency nursing\| PubMed ID: 16730989	2006
Validation of the Canadian c-spine rule in the UK emergency department setting. Emergency medicine journal : EMJ\| PubMed ID: 21068171	2011
Postdeployment experiences of military mental health providers. Military medicine\| PubMed ID: 24306013	2013

Phil Miller

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