• Christian Vaillancourt, Manya Charette, Julie Sinclair, Richard Dionne, Peter Kelly, Justin Maloney, Marie-Joe Nemnom, George A Wells, and Ian G Stiell.
• Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada; Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ottawa, Ontario, Canada. Electronic address: cvaillancourt@ohri.ca.
• Ann Emerg Med. 2023 Feb 1; 81 (2): 187196187-196.

Study ObjectiveThe Canadian C-spine rule was modified and validated for use by the paramedics in a multicenter study where patients were assessed with the Canadian C-spine rule yet all transported with immobilization. This study evaluated the clinical impact of the modified Canadian C-spine rule when implemented by paramedics.MethodsThis single-center prospective cohort implementation study took place in Ottawa, Canada (from 2011 to 2015). Advanced and primary care paramedics were trained to use the modified Canadian C-spine rule, collect data on a standardized study form, and selectively transport eligible patients without immobilization. We evaluated all consecutive low-risk adult patients (Glasgow Coma Scale [GCS] 15, stable vital signs) at risk for a neck injury. We followed all patients without initial radiologic evaluation for 30 days. Analyses included descriptive statistics with 95% confidence intervals (CI), sensitivity, specificity, and kappa coefficients.ResultsThe 4,034 enrolled patients had a mean age of 43 (range 16 to 99), and 53.4% were female. Motor vehicle collisions were the most common mechanism of injury (55.1%), followed by falls (23.9%). There were 11 clinically important injuries. The paramedics classified these injuries with a sensitivity of 90.9% (95% CI, 58.7 to 99.8) and specificity of 66.5% (95% CI, 65.1 to 68.0). There was no adverse event or resulting spinal cord injury. The kappa agreement between paramedics and investigators was 0.94. A total of 2,583 (64.0%) immobilizations were avoided using the modified Canadian C-spine rule.ConclusionParamedics could accurately apply the modified Canadian C-spine rule to low-risk trauma patients and significantly reduce the need for spinal immobilization during transport. This resulted in no adverse event or any spinal cord injury.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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