{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T23:00:14Z","timestamp":1769641214764,"version":"3.49.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Various rescue techniques are used for the prehospital transport of trauma patients. This study compares different techniques in terms of immobilization of the cervical spine and the rescue time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A wireless motion capture system (Xsens Technologies, Enschede, The Netherlands) was used to record motion in three-dimensional space and the rescue time in a standardized environment. Immobilization was performed by applying different techniques through different teams of trained paramedics and physicians. All tests were performed on the set course, starting with the test person lying on the floor and ending with the test person lying on an ambulance cot ready to be loaded into an ambulance. Six different settings for rescue techniques were examined: rescue sheet with\/without rigid cervical collar (P1S1, P1S0), vacuum mattress and scoop stretcher with\/without rigid cervical collar (P2S1, P2S0), and long spinal board with\/without rigid cervical collar (P3S1, P3S0). Four time intervals were defined: the time interval in which the rigid cervical collar is applied (T0), the time interval in which the test person is positioned on rescue sheet, vacuum mattress and scoop stretcher, or long spinal board (T1), the time interval in which the test person is carried to the ambulance cot (T2), and the time interval in which the ambulance cot is rolled to the ambulance (T3). An ANOVA was performed to compare the different techniques.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During the simulated extrication procedures, a rigid cervical collar provided biomechanical stability at all angles with hardly any loss of time (mean angle ranges during T1: axial rotation P1S0 vs P1S1 p&lt;0.0001, P2S0 vs P2S1 p&lt;0.0001, P3S0 vs P3S1 p&lt;0.0001; lateral bending P1S0 vs P1S1 p = 0.0263, P2S0 vs P2S1 p&lt;0.0001, P3S0 vs P3S1 p&lt;0.0001; flexion\/extension P1S0 vs P1S1 p = 0.0023, P2S0 vs P2S1 p&lt;0.0001). Of the three techniques examined, the scoop stretcher and vacuum mattress were best for reducing lateral bending in the frontal plane (mean angle ranges during T1: P2S1 vs P3S1 p = 0.0333; P2S0 vs P3S0 p = 0.0123) as well as flexion and extension in the sagittal plane (mean angle ranges during T2: P1S1 vs P2S1 p&lt;0.0001; P1S0 vs P2S0 p&lt;0.0001). On the other hand, the rescue sheet was clearly superior in terms of time (total duration P1S0 vs P2S0 p&lt;0.001, P1S1 vs P2S1 p&lt;0.001, P1S0 vs P3S0 p&lt;0.001, P1S1 vs P3S1 p&lt;0.001) but was always associated with significantly larger angular ranges of the cervical spine during the procedure. Therefore, the choice of technique depends on various factors such as the rescue time, the available personnel, as well as the severity of the suspected instability.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292300","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T18:47:56Z","timestamp":1701197276000},"page":"e0292300","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of different techniques for prehospital cervical spine immobilization: Biomechanical measurements with a wireless motion capture system"],"prefix":"10.1371","volume":"18","author":[{"given":"Sarah","family":"Morag","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5347-7425","authenticated-orcid":true,"given":"Martin","family":"Kieninger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Eissnert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Auer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Dendorfer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Popp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e4rbel","family":"Kieninger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,11,28]]},"reference":[{"issue":"12","key":"pone.0292300.ref001","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1007\/s00586-011-1866-7","article-title":"Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study.","volume":"20","author":"RM Hasler","year":"2011","journal-title":"Eur Spine J"},{"issue":"1","key":"pone.0292300.ref002","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/PL00003446","article-title":"[Complex injuries of the spine].","volume":"27","author":"M Blauth","year":"1998","journal-title":"Orthopade"},{"issue":"10","key":"pone.0292300.ref003","first-page":"911","article-title":"[Shock trauma room management of spinal injuries in the framework of multiple trauma","volume":"107","author":"A Woltmann","year":"2004","journal-title":"A systematic review of the literature]. Unfallchirurg"},{"issue":"3","key":"pone.0292300.ref004","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1553-2712.1998.tb02632.x","article-title":"Unnecessary out-of-hospital use of full spinal immobilization.","volume":"5","author":"TP McHugh","year":"1998","journal-title":"Acad Emerg Med"},{"issue":"1","key":"pone.0292300.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10903129908958895","article-title":"Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting.","volume":"3","author":"MD Muhr","year":"1999","journal-title":"Prehosp Emerg Care."},{"issue":"1","key":"pone.0292300.ref006","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13049-016-0345-x","article-title":"The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury","volume":"25","author":"DK Kornhall","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"3","key":"pone.0292300.ref007","doi-asserted-by":"crossref","first-page":"59","DOI":"10.29045\/14784726.2022.12.7.3.59","article-title":"Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust.","volume":"7","author":"A Cowley","year":"2022","journal-title":"Br Paramed J"},{"key":"pone.0292300.ref008","unstructured":"Deutsche Gesellschaft f\u00fcr Unfallchirurgie e.V.: S3-Leitlinie Polytrauma\/Schwerverletzten-Behandlung (AWMF Registernummer 187\u2013023), Version 4.0 (31.12.2022), verf\u00fcgbar unter https:\/\/www.awmf.org\/leitlinien\/detail\/ll\/187-023.html. 2022 [cited 2023-02-15]."},{"issue":"2","key":"pone.0292300.ref009","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.injury.2019.10.079","article-title":"An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures.","volume":"51","author":"D Haske","year":"2020","journal-title":"Injury"},{"issue":"3","key":"pone.0292300.ref010","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s00068-019-01143-z","article-title":"Analysis of cervical spine immobilization during patient transport in emergency medical services","volume":"47","author":"PC Nolte","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"pone.0292300.ref011","doi-asserted-by":"crossref","first-page":"20619","DOI":"10.1038\/s41598-021-00194-w","article-title":"Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars.","volume":"11","author":"MK Jung","year":"2021","journal-title":"Sci Rep."},{"issue":"1","key":"pone.0292300.ref012","doi-asserted-by":"crossref","first-page":"22","DOI":"10.15441\/ceem.16.185","article-title":"Cervical collar makes difficult airway: a simulation study using the LEMON criteria.","volume":"5","author":"M Yuk","year":"2018","journal-title":"Clin Exp Emerg Med"},{"issue":"2","key":"pone.0292300.ref013","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s12028-019-00760-1","article-title":"Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies.","volume":"32","author":"RA Nunez-Patino","year":"2020","journal-title":"Neurocritical care"},{"issue":"3","key":"pone.0292300.ref014","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1177\/1460408618777773","article-title":"Is our current method of cervical spine control doing more harm than good?","volume":"21","author":"A Phaily","year":"2019","journal-title":"Trauma."},{"issue":"4","key":"pone.0292300.ref015","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1017\/S1049023X2000059X","article-title":"Remaining Cervical Spine Movement Under Different Immobilization Techniques.","volume":"35","author":"DD Uzun","year":"2020","journal-title":"Prehosp Disaster Med."},{"issue":"Suppl 3","key":"pone.0292300.ref016","doi-asserted-by":"crossref","first-page":"S188","DOI":"10.4103\/2152-7806.98584","article-title":"Eliminating log rolling as a spine trauma order","volume":"3","author":"BP Conrad","year":"2012","journal-title":"Surg Neurol Int"},{"issue":"24","key":"pone.0292300.ref017","doi-asserted-by":"crossref","first-page":"E1398","DOI":"10.1097\/BRS.0000000000002260","article-title":"Comparison of the Vacuum Mattress versus the Spine Board Alone for Immobilization of the Cervical Spine Injured Patient: A Biomechanical Cadaveric Study.","volume":"42","author":"ML Prasarn","year":"2017","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"pone.0292300.ref018","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0020-1383(94)90158-9","article-title":"A comparison of the spinal board and the vacuum stretcher, spinal stability and interface pressure.","volume":"25","author":"ME Lovell","year":"1994","journal-title":"Injury."},{"issue":"4","key":"pone.0292300.ref019","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S0735-6757(96)90051-0","article-title":"Comparison of a vacuum splint device to a rigid backboard for spinal immobilization.","volume":"14","author":"DR Johnson","year":"1996","journal-title":"Am J Emerg Med"},{"issue":"5","key":"pone.0292300.ref020","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/emj.20.5.476","article-title":"Comparison of a long spinal board and vacuum mattress for spinal immobilisation.","volume":"20","author":"MD Luscombe","year":"2003","journal-title":"Emerg Med J."},{"issue":"3","key":"pone.0292300.ref021","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0736-4679(96)00034-0","article-title":"Backboard versus mattress splint immobilization: a comparison of symptoms generated.","volume":"14","author":"D Chan","year":"1996","journal-title":"J Emerg Med"},{"issue":"2","key":"pone.0292300.ref022","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5505\/tjtes.2011.53333","article-title":"Effects of spinal immobilization devices on pulmonary function in healthy volunteer individuals.","volume":"17","author":"D Ay","year":"2011","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"pone.0292300.ref023","doi-asserted-by":"crossref","first-page":"21514593211012391","DOI":"10.1177\/21514593211012391","article-title":"The Influence of Cervical Spine Angulation on Symptoms Associated With Wearing a Rigid Neck Collar.","volume":"12","author":"TD Kelani","year":"2021","journal-title":"Geriatr Orthop Surg Rehabil."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T18:48:18Z","timestamp":1701197298000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292300"}},"subtitle":[],"editor":[{"given":"Hans-Peter","family":"Simmen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,28]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292300","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,28]]}}}