EBQ:Prehospital Spine Immobilization: Difference between revisions
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Clinical Question
Which patients require spine immobilization (Cervical or Thoracic/Lumbar) in the prehospital environment
=NAEMSP Position Statement
The National Association of EMS Physicians and the American College of Surgeons Committee on Trauma advises the targeted use of backboards with emphasis on high risk patients.[1]
Immobilization NOT Necessary in the Following:
- Normal level of consciousness (Glasgow Coma Score GCS 15)
- No spine tenderness or anatomic abnormality
- No neurologic findings or complaints
- No distracting injury
- No intoxication
Immobilization the following patients:
- Blunt trauma and altered level of consciousness
- Spinal pain or tenderness
- Neurologic complaint (e.g., numbness or motor
weakness)
- Anatomic deformity of the spine
- High-energy mechanism of injury and any of the
following:
- Drug or alcohol intoxication
- Inability to communicate
- Distracting injury
"Whether or not a backboard is used, attention to spinal precautions among at-risk patients is paramount. These include application of a cervical collar, adequate security to a stretcher, minimal movement/transfers, and maintenance of inline stabilization during any necessary movement/ transfers." -NAEMSP[1]
Potential Harm with C1-C2 injuries
In the presence of severe injury, collar application resulted in 7.3 mm +/- 4.0 mm of separation between C1 and C2 in a cadaver model[2]
Self Extrication vs Provider Extrication
Conventional extrication techniques record up to four times more cervical spine movement during extrication than controlled self-extrication (Rigid Collar and patient then self extricating).[3]
Penetrating Trauma
Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma.[4][5]
Intubating with Cervical Collar
There is significant decreases in mouth opening when the cervical collar is left in place. In-line stabilization should be used for intubation with the cervical collar removed.[6]
Sources
- ↑ 1.0 1.1 National Association of EMS Physicians and American College of Surgeons Committee on Trauma. EMS Spinal Precautions and the Use of the Long Backboard. Prehospital Emergency Care 2013;17:392-393 PDF
- ↑ Ben-Galim, P et al. Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010 Aug;69(2):447-50. PMID: 20093981
- ↑ Dixon, M et al. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Emerg Me J. 2014 Sep;31(9):745-9.
- ↑ Haut, ER et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010 Jan; 68(1):115-20. PMID: 20065766.
- ↑ Vanderlan, WB et al. Increased risk of death with cervical spine immobilization in penetrating cervical trauma. Injury. 2009 Aug;40(8):880-3. PMID: 19524236.
- ↑ Goutcher, CM et al. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005 Sep;95(3):344-8. PMID: 16006487.