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38 MARCH 2015 | EMSWORLD.com O ver the past decade prehospital care has undergone a transformation toward evidence-based medicine. Advances in research have changed how prehos- pital providers perform CPR, use lights and sirens, and manage patients experiencing heart attacks and strokes. Unfortunately, since prehospital care was founded on the idea of applying good ideas that seemed like common sense, some of the age-old skills and practices performed in EMS remain based on little more than cultural acceptance rather than research-proven medicine. This month's CE column is dedicated to debunking such myths regarding care of the trauma patient and explaining true best practices for these patients. Myth #1: Never Insert Nasal Airways in Head-Injured Patients The myth explained: While the placement of nasal airways, nasal gastric tubes and nasal intubations is common in emergency medicine, EMS classrooms have long taught that whenever a head injury is sus- pected, particularly a basilar skull fracture, placing anything in the nares is likely to violate the soft bone of the cribriform plate (skull) and penetrate the cra- nium, rather than being placed in the airway. The Evidence A comprehensive review on the use and indica- tions for nasopharyngeal airways was published in a 2005 Journal of Emergency Medicine. This review acknowledged it is widely taught that skull fractures are a contraindication for NPA placement; it went on to identify only two case reports, as of 2005, in all of published medicine. One report was released in 1991 in Anesthesiology, and the other in the Journal of Trauma in 2000. 1 These authors concluded placing an NPA through the skull is extremely rare and is likely associated with improper technique as well as injuries that already have significant morbidity and mortality. Exploring best practices for prehospital trauma care By Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, Sean M. Kivlehan, MD, MPH, NREMT-P, & Scott R. Snyder, BS, NREMT-P © Jones and Bar tlet t Learning. Cour tesy of MIEMSS. CONTINUING EDUCATION This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1 CEU. OBJECTIVES • Identify several preconceived assumptions about trauma patient care and interventions • Identify the clinical evidence refuting the avoidance of nasopharyngeal airways in trauma care • Describe the limitations of lidocaine in RSI, the golden hour, and extrication and immobilization strategies • Explain the current evidence- based best practices for hemorrhage control and patient spine stabilization CONTINUING EDUCATION To take the CE test that accompanies this article and receive 1 hour of CE credit accredited by CECBEMS, go online to www.rapidce.com . Test costs $6.95. Questions? E-mail editor@EMSWorld.com.