Medical Directive ID:
Lead Contact Person:
Janice Qubty, Manager, Adult Emergency Services, Victoria Hospital
Sue Kriening, Manager, Adult Emergency Services, University Hospital
Alison Armstrong, Clinical Educator, Emergency Services, Victoria Hospital
Dr. Gary Joubert, Chief, Department of Emergency Medicine
Dr. Trevor Gilkinson, VH Site Chief, Emergency Medicine
Dr. Karl Theakston, UH Site Chief, Emergency Medicine
Emergency Medicine - Emergency Department
Medical Advisory Committee
Original Effective Date:
Wednesday, May 8, 2013
Wednesday, May 8, 2013
To Be Reviewed Date:
Friday, May 8, 2015
This Medical Directive Applies to the following sites:
This Medical Directive Applies to the following patient population:
Victoria Hospital (VH) and University Hospital (UH) qualified Registered Nurses (RN) in the Emergency Department (ED) may log-roll appropriate immobilized patients off the transport immobilization board using accepted log-rolling technique and documenting a pre/post log roll assessment including neurological vital signs.
Patients for whom diagnostic imaging is anticipated will remain on a slider board.
- At UH, patient will remain in Cervical Collar and await physician assessment.
- At VH, qualified RNs will proceed to the next order of this directive.
- Patients for whom diagnostic imaging is anticipated will remain on a slider board.
VH Qualified Registered Nurses (RN) in the VH Adult Emergency Department may remove the cervical collar on emergency patients in accordance with the conditions identified in the Canadian Cervical-Spine Rule (CCR) and specified in the CCR Medical Directive (EMG-2011-004).
- Implementers will evaluate the patient for inclusion and exclusion criteria to determine eligibility for appropriateness of applying the CCR (Canadian Cervical-Spine Rule) using the London Health Sciences Centre (LHSC) checklist Emergency Department Checklist Cervical Spine (C-Spine) - (NS6698) for assessment and documentation. This assessment will include the evaluation of neck tenderness and range of motion, when appropriate- and may require removal of tape and neck restraints as well as temporary loosening of the C-Spine collar – for assessment (NS6698)
- If the patient is determined to no longer require C-Spine immobilization according to the CCR, then the RN will remove the C-Spine collar and any other neck restraints as per the directive.
- VH Qualified Registered Nurses (RN) in the VH Adult Emergency Department may discontinue spinal precautions on appropriate emergency patients who have C-Spine Precautions discontinued in accordance with the conditions identified in the CCR Medical Directive (EMG-2011-004).
The nurse will evaluate the patient for inclusion and exclusion criteria to determine eligibility for discontinuing spinal precautions using the CCR Tool.
- If any abdominal, pelvic or thoracic/lumbar spine pain, patient will remain lying flat. Use slider board if radiological imaging anticipated. If no abdominal/pelvic pain or thoracic/lumbar spine pain, the patient will be assisted to a seated and then standing position; if tolerated, patient will be ambulated to an appropriate assessment area.
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