This will permit some patients to sit up on the Perifosine chemical structure ambulance stretcher and

be taken to a low acuity or ambulatory area of the ED, rather than being left on a backboard in a high acuity or trauma area. Paramedics will record their findings on a simple Paramedic Data Form and in their paramedic ambulance care report. Ongoing education a) Study Champions will be identified among the EMS service. These “champions” will be paramedics who will serve as a local resource for the participating paramedics. The champion will be responsible for initial training, continuing education, and trouble-shooting issues brought up by the Inhibitors,research,lifescience,medical paramedics. They also helped recruitment significantly during the validation study. b) Continuing education will be provided to all paramedics at least every six months and will be done by study champions in the Erlotinib HCl format of small group sessions, such as during daily morning briefings, while the paramedics are Inhibitors,research,lifescience,medical on duty. c) Newsletters will be developed and distributed to all study paramedics on a monthly basis. These will include tips on assessment and feedback on enrollment. d) Local study champions will monitor

staff turnover and ensure that new paramedics are trained for the study in a timely fashion. Outcome measures and data collection Data collection The following outcome Inhibitors,research,lifescience,medical data will be Inhibitors,research,lifescience,medical collected by dedicated study personnel who will review daily patient logs, ED patient records, diagnostic imaging reports, and in-patient records. All participating paramedics will complete a Paramedic Data Form at the time of each patient assessment as well as document patient care on their province wide Ambulance Call Reports. Additional study data will be recorded on a Case Record Form. All outcomes

will be collected during the run-in and evaluation periods, but the run-in data will not be used in the final analysis (this run-in phase may be shortened if no issues are identified). Measures of safety (primary study outcomes) a) Number of Inhibitors,research,lifescience,medical missed cervical spine GSK-3 injuries, i.e. number of clinically important c-spine injuries (as defined previously) identified in patients who have had their c-spine cleared by paramedics. We will know the presence of fracture or cervical spine injury from review of diagnostic imaging reports in the patient record. We also propose to institute a strategy of surveillance to identify the uncommon occurrence of a fracture missed because no radiography was ordered. ED Patient Visit Logs at each receiving hospitals will be monitored for 30 days to identify return visits by patients who do not undergo radiography during their initial ED visit. In addition, we will review the Neurosurgery Patient Logs at our regional neurosurgical centre (The Ottawa Hospital, Civic Campus).