Lateral trauma position

September 24, 2011 by  
Filed under All Updates, EMS, Resus, Trauma

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The tradition of transporting trauma patients to hospital in a supine position may not be the safest approach in obtunded patients with unprotected airways. The ‘solution’ of having them on an extrication board (backboard / long spine board) to enable rolling them to one side in the event of vomiting may not be practicable for limited crew numbers.

The Norwegians have been including the option of the lateral trauma position in their pre-hospital trauma life support training for some years now.

A questionnaire study demonstrates that this method has successfully been adopted by Norwegian EMS systems.

The method of application is described as:

  • Check airways (look, listen, feel).
  • Apply chin lift/jaw thrust, suction if needed.
  • Apply stiff neck collar.
  • If the patient is unresponsive, but has spontaneous respiration: Roll patient to lateral/recovery position while maintaining head/neck position.
  • Roll to side that leaves the patient facing outwards in ambulance coupé.
  • Transfer to ambulance stretcher (Scoop-stretcher, log-roll onto stretcher mattress, or use multiple helpers, lifting by patient’s clothing).
  • Support head, secure with three belts (across legs, over hip, over shoulder)
  • Manual support of head, supply oxygen, observation, suction, BVM (big valve mask) ventilation when needed.

Different options for supporting the head in the lateral position, according to questionnaire responders, include:

  • putting padding under the head, such as a pillow or similar item (81%)
  • a combination of padding and putting the head on the lower arm (7%)
  • rest the head on the lower arm alone (10%)
  • rest the head on the ground (<1%)

 


BACKGROUND: Trauma patients are customarily transported in the supine position to protect the spine. The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) principles clearly give priority to airways. In Norway, the lateral trauma position (LTP) was introduced in 2005. We investigated the implementation and current use of LTP in Norwegian Emergency Medical Services (EMS).

METHODS: All ground and air EMS bases in Norway were included. Interviews were performed with ground and air EMS supervisors. Questionnaires were distributed to ground EMS personnel.

RESULTS: Of 206 ground EMS supervisors, 201 answered; 75% reported that LTP is used. In services using LTP, written protocols were present in 67% and 73% had provided training in LTP use. Questionnaires were distributed to 3,025 ground EMS personnel. We received 1,395 (46%) valid questionnaires. LTP was known to 89% of respondents, but only 59% stated that they use it. Of the respondents using LTP, 77% reported access to written protocols. Flexing of the top knee was reported by 78%, 20% flexed the bottom knee, 81% used under head padding. Of 24 air EMS supervisors, 23 participated. LTP is used by 52% of the services, one of these has a written protocol and three arrange training.

CONCLUSIONS: LTP is implemented and used in the majority of Norwegian EMS, despite little evidence as to its possible benefits and harms. How the patient is positioned in the LTP differs. More research on LTP is needed to confirm that its use is based on evidence that it is safe and effective.

The lateral trauma position: What do we know about it and how do we use it? A cross-sectional survey of all Norwegian emergency medical services
Scand J Trauma Resusc Emerg Med. 2011 Aug 4;19:45
Open Access Full Text

Comments

3 Responses to “Lateral trauma position”

  1. Pete on September 26th, 2011 07:51

    I worked with some South African colleagues that have been doing this for years. Immobilise on a scoop preferably with spider straps and place scoop on its side and wedge something between the board and stretcher/cot sides (i.e. bag of vacuum splints) and tighten down with the stretcher straps. I believe there was also someone who developed (maybe patented) a specific mount for the stretcher to negate the use of an ad hoc bag.

    I can say I have done this with a number of patients most notably a pt with a le fort 2 fracture who could not maintain his airway in a supine position due bleeding. Put him in the lateral position on a scoop as described above and he was fine with either a bit of suction and or personal manual airway manourvres (spiiting). Once in ED the team decided that they wanted him off the scoop and supine. They could not manage his airway and ended up RSI’ ing the patient to maintain his airway. I also use it a lot on vomiting etoh patients who have blunt trauma from assaults.

    Also of note is to be careful with laterel sided injuries, as LTP (especially on a scoop) can be fairly umcomfortable in these group of patients.

  2. Cliff on September 26th, 2011 09:08

    Thanks Pete – some great tips there

  3. VinceD on September 27th, 2011 08:46

    I’m in a bit of a callous mood, but it sounds like we’re going through a lot of effort to maintain the illusion of c-spine protection when really our first priority should be airway protection.
    The literature on the utility of spinal precautions seems pretty unimpressive, but it’s well known that patients who aspirate or lose their airway do not fair well, so why are we making our (and the patients’) lives more difficult by doing the immobilization song-and-dance rather than putting all of our energy to keeping that airway open and clear. I also have some reservations about affixing an unresponsive patient in a position where I cannot easily turn them supine for intubation or visualization of the oropharynx while in the back of the ambulance.

    With all that negativity out of the way, they’re good tips to have on hand if the right scenario comes up in the field, especially since immobilization is still the standard of care (and doesn’t seem to be going anywhere). It’s been a while since I’ve commented on here, but thanks again for this amazing blog.