Saturday, December 21, 2019

Wilderness Medical Society Practice Guidelines

We recently updated the Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning. This document, an update from the original 2014 version, provides evidence-based recommendations for both the pre-hospital and hospital settings, focused on austere environments.  Definitely a must read for anyone who participates in wilderness activities or rescue operations.

Link: https://www.wemjournal.org/article/S1080-6032(19)30117-6/fulltext

Reference:
Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS.
Wilderness Medical Society Clinical Practice Guidelines for the Treatment and
Prevention of Drowning: 2019 Update. Wilderness Environ Med. 2019
Dec;30(4S):S70-S86.

Tuesday, December 10, 2019

BET 1: cervical spine immobilisation in the management of drowning victims

Title: BET 1: cervical spine immobilisation in the management of drowning victims
Authors: Jones T, Rennie A
Journal: Emerg Med J. 2019 Dec;36(12):766-767

This article describes the findings of a "short cut review" to analyze previous literature regarding the incidence of cervical spine injuries in drowning patients. This is an important topic because there are still agencies around the world that, despite the known rarity of this type of injury in drowning, still require their providers to facilitate spinal motion restriction for all drowning patients. Unfortunately, focusing on the spine in many of these patients can take the focus away from proper resuscitation and complicate an already complicated airway. This is in addition to the paucity of data to support the use of spinal motion restriction on any trauma patients.

This was a quick review as there are only 3 pertinent articles. As expected, the review found that cervical spine injury is extremely rare in drowning and the authors agree with current recommendations to not focus on this treatment modality in the rescue and resuscitation of all drowning patients. Patients known to have suffered a high risk injury pattern may benefit from inline stabilization during resuscitation, but focusing on prolonged efforts of full spinal motion restriction is unnecessary.

One final note about this article and a similar one reported in the same journal; the authors prominently use the out-dated term "near drowning" through out the manuscript. We know that this continues to be a very prevalent problem in peer-reviewed literature, and its use in high impact journals from British Medical Journal is upsetting.  I see a letter to the editor in my future...

Reference:
Jones T, Rennie A. BET 1: cervical spine immobilisation in the management of
drowning victims. Emerg Med J. 2019 Dec;36(12):766-767.