脊椎評価の妥当性

日本ではまだまだ非医療従事者による脊椎損傷の評価は全面的に認められているわけではありません。しかしながら、これにより避難方法の安全性が格段に増し、生命のリスクも大きく変わります。WMTCの脊椎評価プロトコルは、世界最先端の脊椎マネジメントの理論を応用しています。

野外での脊椎損傷の疑いを除去するプロトコルとして、次の5つが一般的である;1)Canadian C-spine Rule (CCR)、2)the National Emergency X-Radiography Utilization Study (NEXUS)基準、3)修正版NEXUS基準, 4)メーン州基準(NEXUS基準に基づく)、5)the Wilderness Medical Society (WMS) アルゴリズム(CCRとNEXUSの統合)。

CCR

NEXUS

WMS

CCRは、MOIを注意深く観察することにより、頚椎損傷の疑いの除去に重きを置いている。NEXUS、修正版NEXUS、メーン州基準、WMSは、脊椎損傷を前提とし、S/SXによりその疑いを除去することに重点を置いている。NEXUSと修正版NEXUSの違いは、NEXUSが頚椎に重点を置いているのに対し、修正版NEXUSは、脊椎全体を問題としている。NEXUSは、脊椎の痛みの評価を含んでいないが、修正版NEXUSは、NEXUSもより慎重な評価となっており、メーン州基準は脊椎両側の圧痛も含んでいる。WMSは、CCRと修正版NEXUSを融合している。WMTCの脊椎評価は、これらの全てのプロトコルを含んでいる。

・脊椎評価を用いるかどうかに関わらず、まず傷病者評価テストの全体評価、一次評価、二次評価を終了させる。脊椎評価を行う場合は、傷病者の意識があり、協力的で、通常の痛み反応があり、脊椎に集中できない痛みがない信頼できる状態である。
・信頼性のない傷病者は、脊椎損傷を前提とし、より詳しい診断を受けるためにできる限り早く避難する。
・脊椎評価に合格した傷病者は、脊椎の問題のために、避難する必要はない。
・脊椎評価に不合格の傷病者は、脊椎損傷の疑いがあり、6-24時間以内に医師の診断を受けるために、避難すべきである。感覚、運動テストに不合格した傷病者は、脊髄損傷の疑いもある。
・脊椎評価の結果はSOAPノートに記述すること。
・WMTCの脊椎評価はデジタルハンドブックを参照する。
・SOAPノート、デジタルハンドブックの正確な活用にはWMTCのWFA/WFRコースを受講することが必要である。

Author: Paul Nicolazzo/ Translator: Taito Okamura

引用文献

Andrew Eyre(2006)Overview and Comparison of NEXUS and Canadian C-Spine Rules, American Journal of Clinical Medicine,3(4):12-15

Spinal Assessment Protocol Maine EMS 2002, Reported Paper.

Robert M. Domeier (1999)Indications for Prehospital Spinal Immobilization, Prehospital Emergency Care,3(3):251-253

Robert H.Quinn,Jason Williams,BradL.Bennett,Gregory Stiller ,ArthurA.Islas, Seth McCord(2014)Wilderness Medical Society Practice Guidelines for Spine Immobilization in the Austere Environment, Wilderness & Environmental Medicine,25:105–117

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