The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics’ attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss’ kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics’ estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents’ composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21–4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09–0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

中文翻译：

---

医护人员对院前脊柱护理的态度：横断面调查

脊柱运动限制 (SMR) 在院前环境中的最佳应用仍然存在争议。很少有研究检查紧急医疗服务 (EMS) 人员如何接收和解释不断变化的指南。本研究调查了护理人员对院前环境中潜在脊柱损伤治疗的态度、观察和自我报告的做法。这是对北美 EMS 机构的横断面调查。在开发和试点之后，调查的最终版本包含四个部分，涵盖对 1）一般实践、2）特定技术、3）评估协议和 4）损伤机制 (MOI) 的态度。问题使用李克特量表、多项选择、是/否和自由文本回答。探索性因素分析 (EFA) 用于识别响应中的潜在结构，通过有序逻辑回归分析因子得分与人口特征（包括资格水平、性别和工作年限）的关联。评估 MOI 评估的评估者间可靠性（Fleiss' kappa）。遵循 Elo & Kyngäs (2008) 的归纳定性内容分析用于检查自由文本响应。收到了 220 份回复（占员工总数的 36%）。原始结果表明，受访者认为 SMR 被认为不如过去重要，他们治疗的患者比以前少，并且他们在大多数情况下都遵循协议。EFA 确定了两个因素：一个（判断 MOI）捕获了护理人员的估计，即提出的 MOI 可能会导致脊柱损伤，另一个（治疗价值）反映了受访者对 SMR 的有效性、重要性和适用性的综合看法。与基本生命支持 (BLS) 级别的受访者相比，具有高级生命支持 (ALS) 资格的受访者更可能对 SMR 的价值持怀疑态度（OR：2.40，95%CI：1.21–4.76，p = 0.01）。总体而言，受访者在评价 MOI 方面表现出公平的一致性（k = 0.31，95%CI：0.09-0.49）。内容分析确定了受访者在 SMR-as-directed 和 SMR-as-applied 之间表达的紧张关系。这项调查的结果表明，EMS 人员对 SMR 的许多要素持怀疑态度，但使用各种策略来平衡协议遵守与优化患者护理。在确定未来研究的几个领域的同时，