EBQ:Prehospital Spine Immobilization - Revision history

Danbot: Added all standard JC sections

2026-03-21T22:51:53Z

Added all standard JC sections

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	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>		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>


			==Conclusion==
			*Evidence does not support routine prehospital spinal immobilization for all trauma patients
			*Immobilization may cause harm including increased pain, respiratory compromise, pressure ulcers, and aspiration risk
			*Selective spinal motion restriction based on validated clinical criteria is recommended

			==Major Points==
			*There are no randomized controlled trials demonstrating benefit of prehospital spinal immobilization
			*Backboards cause pain, skin breakdown, and respiratory restriction, particularly in elderly patients
			*Cervical collars do not fully immobilize the cervical spine and may increase ICP in head-injured patients
			*The evidence supports a shift from "spinal immobilization" to "spinal motion restriction"
			*Clinical decision rules (NEXUS, Canadian C-spine) can safely identify patients who do not need immobilization

			==Study Design==
			*Evidence review and position paper summarizing available literature on prehospital spinal immobilization
			*Reviewed observational studies, biomechanical data, and comparison studies

			==Population==
			*Prehospital trauma patients with potential spinal injury
			*Includes both blunt and penetrating trauma mechanisms

			==Interventions==
			*Spinal immobilization techniques reviewed: long spine board, cervical collar, head blocks, strapping
			*Alternative approaches: self-extrication, vacuum mattress, selective immobilization protocols

			==Outcomes==
			*No studies demonstrate neurological benefit from prehospital spinal immobilization
			*Documented harms of immobilization include: pain, respiratory restriction (up to 15% reduction in FVC), pressure injury, aspiration risk
			*Penetrating trauma: immobilization associated with increased mortality in one large observational study
			*Selective immobilization protocols successfully identify patients who can be safely cleared in the field

			==Criticisms==
			*Absence of evidence of benefit is not the same as evidence of absence; ethical constraints prevent RCTs
			*The medicolegal implications of not immobilizing remain a barrier to practice change
			*Clinical decision rules were validated in the ED, not the prehospital setting, limiting direct applicability
			*Changing longstanding EMS protocols requires significant training and cultural change

			==Funding==
			*Not applicable (evidence review)

	==References==		==References==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:43Z

Text replacement - "Category:Neuro" to "Category:Neurology"

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	[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:~~Neuro~~]]		[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:Neurology]]

Rossdonaldson1: /* Sources */

2015-11-19T08:31:52Z

Sources

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	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:Neuro]]		[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:Neuro]]

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Ostermayer at 19:46, 11 December 2014

2014-12-11T19:46:53Z

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	[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:Neuro]]		[[Category:EBQ]][[Category:Trauma]][[Category:EMS]][[Category:Neuro]]

			[[Category:Featured]]

Drjeffrogers at 19:24, 11 December 2014

2014-12-11T19:24:41Z

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Drjeffrogers at 19:24, 11 December 2014

2014-12-11T19:24:09Z

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	Which patients require spine immobilization (Cervical or Thoracic/Lumbar) in the prehospital environment		Which patients require spine immobilization (Cervical or Thoracic/Lumbar) in the prehospital environment

	===NAEMSP Position Statement==		==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>		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>

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	*Blunt trauma and altered level of consciousness		*Blunt trauma and altered level of consciousness
	*Spinal pain or tenderness		*Spinal pain or tenderness
	*Neurologic complaint (e.g., numbness or motor		*Neurologic complaint (e.g., numbness or motor weakness)
	weakness)
	*Anatomic deformity of the spine		*Anatomic deformity of the spine
	*High-energy mechanism of injury and any of the		*High-energy mechanism of injury and any of the following:
	following:		***Drug or alcohol intoxication
	*Drug or alcohol intoxication
	*Inability to communicate		*Inability to communicate
	*Distracting injury		**Distracting injury

	"Whether or not a backboard is used, attention		"Whether or not a backboard is used, attention

Drjeffrogers: Created page with "==Clinical Question== Which patients require spine immobilization (Cervical or Thoracic/Lumbar) in the prehospital environment ===NAEMSP Position Statement== The National Ass..."

2014-12-11T19:23:06Z

Created page with "==Clinical Question== Which patients require spine immobilization (Cervical or Thoracic/Lumbar) in the prehospital environment ===NAEMSP Position Statement== The National Ass..."

New page

==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==
<references/>

[[Category:EBQ]]