We expect that 20 enrolled PFI-2 concentration patients will have clinically important cervical spine injury. For clinical impact, we anticipate that as much as 40% of all patients assessed could be transported without

full cervical spine immobilization. Discussion We can expect paramedic use of the CCR to ultimately lead to improved efficiency for EMS systems, Inhibitors,research,lifescience,medical hospital EDs, and the Canadian health care system. Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization devices, decreasing the time spent in the field immobilizing patients before transport, and increasing paramedic field availability for the next patient from faster transfer of care to the ED personnel. While 1.3 million injury patients Inhibitors,research,lifescience,medical are transported each year by paramedics, the vast majority are low-risk and do not need cervical immobilization. This study is an essential step extending the responsibility of effective triage of trauma patients to paramedics across Canada. Most Canadian paramedics currently do not evaluate Inhibitors,research,lifescience,medical patients for potential c-spine injury, a task that is exclusively done by physicians. Our previous studies have determined the safety and effectiveness of the rule when used by physicians and nurses,

but what remains unknown is safety and efficiency of patient care that would follow evaluation of the c-spine by paramedics. We believe that use of the CCR has Inhibitors,research,lifescience,medical the potential to increase the autonomy of the paramedic profession in managing the very common low-risk trauma patients. We expect the results of this efficacy study to be valuable and applicable to paramedics throughout all of Canada. We hope to plan a future implementation trial study that would focus on effectiveness in widespread Canadian locations. Our partners have not only expressed their support for this study, they have clearly indicated their intent to Inhibitors,research,lifescience,medical use the findings to change policies and guidelines

within their organizations. These changes will eventually impact paramedic practice in all EMS services across Canada as well as in other countries. Competing interests The authors declare that they have no competing interests. Authors’ contributions CV conceived the study and obtained funding. MC helped draft and edit the manuscript. AK obtained ethics approval. JM drafted many and edited the medical directive and revised the methodology critically for important intellectual content. GW assisted with the methodology and revised it critically for important intellectual content. IS contributed significantly to the conception of the study and to the application for funding. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/11/1/prepub Acknowledgements This study is funded by the Canadian Institutes for Health Research (grant #102597).