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Paramedic Commander Shannon Leduc (left) and emergency medicine researcher Dr. Christian Vaillancourt (right) hold up a backboard and cervical collar, which provide rigid support during movement of trauma patients. Unfortunately, they’re not most people’s idea of comfortable. 

When Shannon Leduc was a primary care paramedic in the early 2000s, she responded to a call for someone who may have suffered a cervical spine injury.

When she arrived, the patient was mobile but couldn’t remember whether he had a fall. And because he possibly had a very serious neck injury, the protocol at the time dictated that Shannon had to immobilize him and carry him out. This means she had to put a cervical collar around his neck and strap him to a rigid backboard to prevent any movement of his spine.

But there were a few problems.

“The patient was in a rooming house, in a half-basement,” recalls Shannon, who’s now a paramedic commander with the Ottawa Paramedic Service. “The stairs were so narrow that the backboard couldn’t fit. We had to carry the patient up these rickety old wood stairs on an angle.”

If Shannon faced this same situation today, she would be able to do things a lot differently.

“The patient could have walked out on his own two feet,” she says, “which would have been safer for both the patient and the paramedics.” 

Today, the vast majority of low-risk trauma patients across Ontario can be transported to hospital without the awkward and uncomfortable backboard. And plans are underway for most to be transported without the collar either.

Shannon, her paramedic colleagues across Ontario and researchers at The Ottawa Hospital all played a big role in making these changes happen. As their truly epic, years-long story finally comes to a close, discover how researchers and paramedics make for a powerful team that can completely transform patient care.

Responding to the concerns of patients

Back in the days when Shannon was on the road, paramedics had to immobilize all patients with a potential cervical spine injury, even patients who had no visible signs of injury. The rationale was that paramedics had to play it safe and allow emergency room physicians and nurses to make the call whether to remove the patient’s immobilization equipment, which is usually only after completing diagnostic imaging.

But patients without a cervical spine injury were often spending hours unnecessarily strapped to a backboard, leading to significant discomfort — and even pain, as the backboard can cause pressure points on the spine.

“More and more, we understood the discomfort and pain experienced by patients, as well as the resulting increase in health-care resources, such as unnecessary medical imaging and time delays for paramedics,” explains Dr. Christian Vaillancourt, emergency medicine researcher and Senior Scientist with The Ottawa Hospital’s Acute Care Research Program. “The best-case scenario would be that paramedics could use a clinical decision rule to determine whether to immobilize their patients in the first place.”

Re-thinking an old Rule

Dr. Vaillancourt and his research team collaborated with paramedic services across Ontario for two studies that showed that paramedics could accurately determine which patients were at low risk for a spinal injury and therefore didn’t require immobilization or medical imaging.

To assess their patients, paramedics used the Canadian C-Spine Rule, a set of criteria developed by Dr. Ian Stiell of the Ottawa Hospital Research Institute more than 20 years ago. Before Dr. Vaillancourt’s first study with the Ottawa Paramedic Service between 2010 and 2015, only emergency physicians and nurses could assess patients with the Rule, which they used to determine if the backboard and collar could be removed.

But that study was such a success that the Ontario Ministry of Health allowed Ottawa paramedics to continue to transport patients without immobilization as long as they passed the Rule — a win for both patients and Shannon’s colleagues. “Paramedics have told me this is the single most influential thing that has happened to make their career better,” reports Shannon, who helped train Ottawa paramedics to assess their patients with the C-Spine Rule.

And in 2017, before Dr. Vaillancourt wrapped up a successful second study with paramedic services across the province, the Ministry of Health introduced a new protocol allowing most low-risk patients in Ontario to be transported without the backboard. “Inspired and informed by the research we’ve done, the Ministry got rid of the most painful part of immobilization,” reports Dr. Vaillancourt.

And plans are now underway at the Ministry to allow all Ontario paramedics to nix the collar if the patient passes the C-Spine Rule. Dr. Vaillancourt is currently working with the Ministry to iron out the details and develop a training program for paramedics.

The Ottawa Hospital empowers paramedicine research

The Ottawa Hospital has collaborated with paramedics on research for more than 25 years, but the relationship between researchers and paramedics has gotten much closer over time.

“Historically, researchers would come up with the research questions and then approach the paramedics to help us answer them,” explains Dr. Vaillancourt. “Now, we have paramedic champions on our research studies, and we consult with them to come up with these questions. Nobody understands prehospital care better than they do. There is a growing number of paramedic researchers in Canada.”

Shannon, herself a trained paramedic researcher, has long been one of those champions, participating in an array of paramedicine research projects with the hospital over the years. “What The Ottawa Hospital has done is help foster our own ability to do research within the paramedic profession,” she says. “Our collaboration has set us paramedics up for future research that will help a lot of patients over time.”

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