FACEM trainee Rob Baker has worked at Western Health for the past two years, after beginning his training in the UK and emergency medicine career at Queensland's Hervey Bay Hospital.
Recently awarded the Al Spilman Early Career Researcher Grant, Rob was not always interested in research.
'Beyond a few audits and projects here and there I didn't really have much on my CV. I felt like getting involved in more serious research was a full-time job in itself.'
A research course he undertook last year with Monash University and The Alfred Emergency and Trauma Centre changed his opinion on that.
The Emergency Medicine Research Course is a semester-long program that satisfies a component of FACEM training (4.10), while enabling students to acquire practical skills to design and conduct a research project and to identify and incorporate the best available research into their clinical training and practice.
The project for which he was awarded the research grant for began as coursework for the program.
'I came up with the idea for a project on neck collars from my time spent in Queensland where the ambulance service managed patients with suspected C spine injuries with soft foam neck collars, instead of the traditional rigid (Philadelphia) collars.'
'It was different from what I had been taught regarding C-spine immobilisation in the UK Advanced Trauma Life Support course.'
Rob had been surprised when he moved to Victoria to find they were using rigid collars.
'I had assumed the Queensland approach was a nationwide thing in Australia.'
By the time the project came up, Rob had reasonable experience with both approaches.
'I hadn't given it much thought until I was tasked with formulating a research question and writing a grant proposal for the course. It was my experience that soft collars seemed to be much better tolerated. Patients almost always complain of discomfort from rigid collars, and they interfere with eating and drinking. Not only that but many of these patients are often stuck in these for long periods, often overnight, while they await clearance.
Radiologically, this of course requires the CT to be reported by a certified radiologist, and typically this only occurs in normal working hours.
A literature review revealed a few surprises.
'There was zero high level evidence supporting rigid collars and a number of studies implicating them with various adverse events, including skin damage and – infrequently – neurological deterioration. The lack of any randomised control trials on the subject seemed to be a big gap in the literature, as well as an injustice to all our patients.
'Given the variation in practice even within Australia the results of a study comparing the two collars could be far-reaching.'
Rob credits FACEM Anne-Maree Kelly – who also works at Western Health – with guiding him to the grant.
'I did not know about the grant myself, so I have Professor Kelly to thank for directing me to the application; and for her expertise in editing and finalising the proposal.'
'Most projects require funding so securing the grant has given us the ability to get the project off the ground.'
