Clinical clearance of spinal immobilization in the air medical environment: a feasibility study.

BACKGROUND: Various decision algorithms have been developed for use in the prehospital setting to analyze those trauma patients who do not require spinal immobilization. The feasibility of applying these algorithms in the air medical transport environment has not been studied. METHODS: All adult patients (>/=age 16) transported to three Level I trauma centers were eligible for the study. Medical crews completed a data collection sheet during transport which was later used to analyze whether the transported patient would be eligible for spinal clearance based on the absence of all of the following clinical findings: (1) abnormal level of consciousness; (2) evidence of intoxication; (3) distracting painful injury; (4) spinal tenderness or pain; or (5) abnormal neurologic examination. The outcomes were (1) the proportion of transported patients potentially eligible for spinal clearance and (2) the ability of the algorithm to predict spinal injury. RESULTS: Three hundred twenty-nine patients were enrolled in the study. Forty-nine (15%) had spinal injuries with 12 (24%) considered unstable. Only 40 patients met criteria for deferring spinal immobilization; 4 of these patients had spinal fractures. The algorithm had a sensitivity of 90% and a specificity of 16%. CONCLUSION: Clearance of spinal immobilization using prehospital clinical algorithms during air medical transport did not appear to be useful. These criteria were not found to be sensitive, specific, or predictive of spinal injury in this population of blunt trauma patients. Prehospital spinal immobilization clearance algorithms using existing criteria should not be adopted for patients transported by helicopter.

"They were only joking": efforts to decrease LGBTQ bullying and harassment in seattle public schools.

BACKGROUND: Seattle Public Schools has implemented policies and programs to increase safety, family involvement, and student achievement for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This case study examines students' perceptions of bullying and harassment in the school environment, and teacher intervention when these problems arise in the presence of strong district policies and programs aimed at reducing LGBTQ bullying and harassment in schools. METHODS: We surveyed students in Gay-Straight Alliance (GSA) groups at 13 secondary schools (N = 107). We also conducted focus groups with GSA students and students not involved in the GSAs in 7 of 13 schools (N = 16 groups, including 154 students). RESULTS: GSA students who were lesbian, gay, bisexual, or questioning (LGBQ) were significantly more likely than straight students to experience several types of harassment. On the basis of student report, the 2 most common intervention strategies by teachers for verbal harassment included stopping the harassment and explaining why it is wrong; teachers intervened in physical harassment by trying to stop the harassment. Students provided input on how to strengthen teacher interventions, including the need for more consistency in responding and following up. Students also noted a need for more focus on educating those who harass, rather than just asking them to stop. CONCLUSIONS: Seattle Public Schools has made great strides in creating safe and welcoming schools for LGBTQ students, but still have to work further toward reaching this goal. Data from students on how they experience their school environment can help identify areas for improvement.