Rachis et extraction de véhicules

An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures.

Häske D et Al. Injury. 2020 Feb;51(2):185-192.

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Un travail qui interpelle par ses  implications potentielles sur la manière d'extraire les combattants de véhicules qu'ils soient terrestres ou aéronautiques.

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OBJECTIVES:

The extrication of patients following a road traffic collision is among the basic procedures in emergency medicine. Thus, extrication is a frequently performed procedure by most of the emergency medical services worldwide. The appropriate extrication procedure depends on the patient's current condition and accompanying injuries. A rapid extrication should be performed within a few minutes, and the cervical spine (at least) should be immobilized. To our knowledge, the scientific literature and current guidelines do not offer detailed recommendations on the extrication of injured patients. Thus, the aim of the current study is to compare the effectiveness of spinal stabilization during various out-of-hospital extrication procedures.

METHODS: This is an explorative, biomechanical analysis of spine motion during different extrication procedures on an example patient. Movement of the cervical spine was measured using a wireless human motion tracker. Movement of the thoracic and lumbar spine was quantified with 12 strain gauge sensors, which were positioned paravertebrally on both sites along the thoracic and lumbar spine. To interpret angular movement, a motionscore was developed based on newly defined axioms on the biomechanics of the injured spine.

RESULTS: Self-extrication showed the least spinal movement (overall motionscore sum = 667). Movement in the cervical spine could further be reduced by applying a cervical collar. The extrication by a rescue boa showed comparable results in overall spinal movement compared to the traditional extrication via spineboard (overall motionscore sum = 1862vs. 1743). Especially in the cervical spine, the spinal movement was reduced (motionscore sum = 339 vs. 595). However, the thoracic spine movement was increased (motionscore sum = 812 vs. 432).

Self- extrication without a cervical collar	Self- extrication with a cervical collar	Rapid extrication	Rapid extrication with rescue boa	Rapid extrication with a slide board and rescue boa	Rapid extrication with a patient transfer sheet
C1 – C7	flexion/extension	25	6	117	132	199	27
	rotation	28	6	287	165	216	32
	lateral bending	76	19	191	42	65	52
	sum	129	31	595	339	480	111
Th1 – Th9	flexion/extension	18	17	69	91	76	24
	rotation	157	122	286	598	559	156
	lateral bending	65	52	77	123	107	85
	sum	240	191	432	812	742	265
Th10 – L2	flexion/extension	21	46	83	109	82	43
	rotation	99	185	146	180	114	114
	sum	120	231	229	289	196	157
L3 – L5	flexion/extension	38	251	143	254	117	25
	rotation	73	93	286	93	178	64
	lateral bending	67	67	58	75	117	102
	sum	178	411	487	422	412	191
Total sum		667	864	1743	1862	1830	724

CONCLUSION: In case of a suspected cervical spine injury, guided self-extrication seems to be the best option. If the patient is not able to perform self-extrication, using a rescue boa might reduce cervical spinal movement compared to the traditional extrication procedure. Since promising results are shown in the case of extrication using a patient transfer sheet that has already been placed below the driver, future developments should focus on novel vehicle seats that already include an extrication device.