EMS Providers' Beliefs Regarding Spinal Precautions for Pediatric Trauma Transport

Figures & data

Table 1. Respondent demographics and employment characteristics

	n (%) N = 4946
Gender
Male	3,574 (74.1)
Female	1,248 (25.9)
Race/Ethnicity
White, non-Hispanic	3,996 (87.1)
Other	592 (12.9)
Age
Average (SD)	39.3 (11.7)
Certification Level
EMT	1,077 (21.8)
EMT-Intermediate	888 (17.9)
AEMT	995 (20.1)
Paramedic	1,770 (35.8)
Critical Care	216 (4.4)
Years of EMS Experience
Less than 5 years	1,214 (24.5)
5 to 15 years	2,243 (45.4)
More than 15 years	1,487 (30.1)
Agency Type
Fire	2,054 (41.7)
Private	1,474 (29.9)
Government	658 (13.4)
Hospital	567 (11.5)
Military	148 (3.0)
Tribal	25 (0.5)
Primary Service Provided
9-1-1 response with transport capability	3,512 (71.9)
9-1-1 response without transport capability	664 (13.6)
Medical transport	183 (3.8)
Air medical	118 (2.4)
Rescue	67 (1.4)
Specialty care transport	73 (1.5)
Paramedic intercept	46 (0.9)
Hazmat	8 (0.2)
Other	210 (4.3)
Primary EMS Role
Patient care provider	4,022 (81.4)
First-line supervisor	347 (7.0)
Administrator/Manager	251 (5.1)
Educator/Preceptor	212 (4.3)
Other	111 (2.2)
Weekly Call Volume
Less than 5 calls	1,190 (24.1)
5 to 19 calls	2,112 (42.8)
20 or more calls	1,632 (33.1)
Pediatric Calls
Never	262 (5.3)
Once per year or less	456 (9.3)
Between once per year and once per month	1,893 (38.4)
Between once per month and once per week	1,717 (34.9)
More than once per week	596 (12.1)
Community Size
Urban (≥ 25,000 residents)	2,882 (58.5)
Rural (< 25,000 residents)	2,043 (41.5)
Highest Level of Education Completed
High school/GED or less	364 (7.4)
Some college	1,889 (38.4)
Associate's degree	1,184 (24.0)
Bachelor's degree or higher	1,486 (30.2)
Parent
Yes	3,340 (67.8)
No	1,587 (32.2)

EMT: emergency medical technician; AEMT: advanced emergency medical technician; EMS: emergency medical services.

Table 2. Beliefs among nationally-certified EMS professionals regarding common devices and methods for maintenance of pediatric spine in optimal position

Devices/Methods for Optimal Spine Position	n (%) N = 4946
Rigid cervical collar
Yes	3,327 (67.8%)
No	1,581 (32.2%)
Semi-Fowler position on a mattress gurney
Yes	2,218 (46.1%)
No	2,598 (54.0%)
Supine on a mattress gurney
Yes	2,577 (53.3%)
No	2,256 (46.7%)
Long backboard with a soft conforming surface
Yes	3,874 (79.4%)
No	1,005 (20.6%)
Rigid long backboard
Yes	1,898 (38.7%)
No	3,007 (61.3%)

EMS: emergency medical services.

Table 3. Beliefs among nationally-certified EMS professionals regarding appropriate means of providing spinal precautions for a pediatric patient who has experienced blunt trauma by risk factor and patient age group

	Most Appropriate Means of Providing Spinal Precautions N = 4946
	Nothing	Rigid cervical collar, car seat, secured to mattress gurney	Rigid cervical collar secured to mattress gurney semi-Fowler	Rigid cervical collar secured to mattress gurney supine	Rigid cervical collar and long backboard with soft conforming surface	Rigid cervical collar and rigid long backboard	Unsure
Injury Risk Factor
Altered Mental Status (GCS 3–8)
0–4 years	315 (6.4%)	1,099 (22.4%)	387 (7.9%)	591 (12.0%)	1,559 (31.7%)	808 (16.5%)	153 (3.1%)
5–18 years	325 (6.7%)	—	598 (12.2%)	878 (18.0%)	1,555 (31.8%)	1,423 (29.1%)	111 (2.3%)
Altered Mental Status (GCS 9–13)
0–4 years	387 (8.0%)	1,340 (27.6%)	583 (12.0%)	641 (13.2%)	1,297 (26.7%)	460 (9.5%)	151 (3.1%)
5–18 years	405 (8.4%)	—	913 (19.0%)	954 (19.9%)	1,425 (29.7%)	995 (20.7%)	111 (2.3%)
Focal Neurologic Deficits
0–4 years	124 (2.5%)	833 (17.0%)	403 (8.2%)	592 (12.1%)	1,883 (38.3%)	953 (19.4%)	123 (2.5%)
5–18 years	104 (2.1%)	—	516 (10.6%)	873 (17.9%)	1,847 (37.9%)	1,444 (29.6%)	88 (1.8%)
Neck Pain or Tenderness to Palpation
0–4 years	79 (1.6%)	1,341 (27.3%)	618 (12.6%)	622 (12.7%)	1,435 (29.2%)	734 (14.9%)	86 (1.8%)
5–18 years	78 (1.6%)	—	1,084 (22.1%)	966 (19.7%)	1,494 (30.5%)	1,221 (24.9%)	60 (1.2%)
Complaint of Difficulty Moving Neck
0–4 years	150 (3.1%)	1,366 (27.8%)	612 (12.5%)	555 (11.3%)	1,383 (28.1%)	742 (15.1%)	106 (2.2%)
5–18 years	145 (3.0%)	—	1,130 (23.1%)	925 (18.9%)	1,408 (28.7%)	1,225 (25.0%)	69 (1.4%)
Substantial Torso Injury
0–4 years	365 (7.4%)	403 (8.2%)	294 (6.0%)	722 (14.7%)	1,939 (39.4%)	1,085 (22.0%)	115 (2.3%)
5–18 years	358 (7.3%)	—	323 (6.6%)	805 (16.4%)	1,725 (35.1%)	1,608 (32.7%)	92 (1.9%)
MVC with Significant Mechanism of Injury
0–4 years	57 (1.2%)	537 (10.9%)	210 (4.3%)	520 (10.6%)	1,965 (39.9%)	1,536 (31.2%)	96 (2.0%)
5–18 years	57 (1.2%)	—	306 (6.2%)	661 (13.5%)	1,746 (35.6%)	2,061 (42.0%)	80 (1.6%)
Axial Load/Diving Mechanism
0–4 years	48 (1.0%)	431 (8.8%)	304 (6.2%)	576 (11.7%)	2,006 (40.8%)	1,383 (28.2%)	164 (3.3%)
5–18 years	43 (0.9%)	—	398 (8.1%)	704 (14.4%)	1,762 (35.9%)	1,866 (38.1%)	131 (2.7%)

EMS: emergency medical services; GCS: Glasgow Coma Score; MVC: motor vehicle collision.

Table 4. Odds Ratios for characteristics associated with EMS providers' belief that the rigid cervical collar and rigid long backboard maintain an injured pediatric spine in optimal position

	Rigid Cervical Collar		Rigid Long Backboard
	Univariable OR	Multivariable OR	Univariable OR	Multivariable OR
	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Gender
Female	Ref	—	Ref	—
Male	0.87 (0.76–1.00)	—	0.85 (0.74–0.97)^*	—
Provider Level
BLS	Ref	Ref	Ref	Ref
ALS	0.53 (0.45–0.62)^***	0.67 (0.56–0.80)^***	0.46 (0.40–0.53)^***	0.52 (0.45–0.60)^***
EMS Experience
<5 years	Ref	Ref	Ref	—
5–15 years	0.59 (0.50–0.69)^***	0.75 (0.63–0.90)^**	0.71 (0.61–0.82)^***	—
> 15 years	0.43 (0.36–0.51)^***	0.63 (0.51–0.77)^***	0.70 (0.59–0.81)^***
Agency Type
Fire	Ref	—	Ref	—
Private	1.16 (1.00–1.34)^*	—	1.04 (0.90–1.19)	—
Other	0.98 (0.84–1.13)	—	1.06 (0.92–1.22)	—
Role
Other	Ref	Ref	Ref	Ref
Patient Care Provider	1.74 (1.50–2.01)^***	1.41 (1.20–1.66)^***	1.32 (1.14–1.54)^***	1.25 (1.07–1.46)^**
Pediatric Call Volume
Never- 1 per year	Ref	—	Ref	Ref
1 per year- 1 per month	1.01 (0.84–1.21)	—	0.74 (0.62–0.88)^***	0.82 (0.68–0.98)^*
1 per month- 1 per week	0.91 (0.75–1.10)	—	0.58 (0.49–0.70)^***	0.69 (0.57–0.83)^***
>1 per week	1.07 (0.85–1.36)	—	0.64 (0.51–0.80)^***	0.78 (0.62–0.99)^*
Community Size
Urban	Ref	—	Ref	—
Rural	0.97 (0.86–1.10)	—	1.11 (0.99–1.25)	—
Education
HS/GED or less	Ref	Ref	Ref	Ref
Some college	0.74 (0.57–0.96)^*	0.71 (0.54–0.92)^*	0.71 (0.56–0.89)^**	0.73 (0.58–0.92)^**
Associates	0.58 (0.44–0.76)^***	0.60 (0.45–0.79)^***	0.51 (0.40–0.65)^***	0.57 (0.44–0.72)^***
Bachelors or higher	0.56 (0.43–0.73)^***	0.56 (0.43–0.74)^***	0.52 (0.41–0.66)^***	0.55 (0.43–0.69)^***
Parent Status
Non-parent	Ref	Ref	Ref	—
Parent	0.71 (0.62–0.81)^***	0.83 (0.72–0.96)^*	1.03 (0.91–1.17)	—

^* p < 0.05.

^** p < 0.01.

^*** p < 0.001. CI: confidence interval; OR: odds ratio; BLS: basic life support; ALS: advanced life support; EMS: emergency medical services.