View source for EBQ:Prehospital Spine Immobilization

==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.<ref name="NAEMSP"> 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 [http://www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf PDF]</ref>

'''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<ref name="NAEMSP"></ref>

==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<ref>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</ref>

==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).<ref>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. </ref>

==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.<ref>Haut, ER et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010 Jan; 68(1):115-20. PMID: 20065766.</ref><ref>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.</ref>

==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.<ref>Goutcher, CM et al. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005 Sep;95(3):344-8. PMID: 16006487.</ref>


==Sources==
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