Skip to main content

Spinal immobilization including cervical immobilization is no longer widely recommended for ALL trauma patients.

spinal immobillization not longer recommendedSpinal immobilization including cervical immobilization is no longer widely recommended for ALL trauma patients.


In fact, the American College of Emergency Physicians (ACEP) has come out with a new statement that is against the use of long backboards by EMS (click here to access):
“Backboards should not be used as a therapeutic intervention or as a precautionary measure either inside or outside the hospital or for inter-facility transfers.” 

Backboards or spinal boards are transport devices, not immobilization devices. The spinal board is hard, but our spine has curvatures, and immobilizing them can aggravate spinal injuries on certain segments (besides risk of pressure sores, etc).

The UK Faculty of Prehospital Care has also similarly discourages spinal immobilization. Click here: http://emj.bmj.com/content/30/12/1067.full.pdf+html 

Spinal immobilization by itself is not harmless and has the following disadvantages:
  1. Time intensive to apply, thus delaying transport time to definitive care
  2. May create or aggravate ‘difficult airway’ scenarios
  3. Have been shown to increase mortality 2 fold in penetrating injuries (Haut et al 2010)
  4. Cause pressure ulcers
  5. Very uncomfortable, especially during transfers for X-rays, etc, increased length of stays in our departments.
  6. The cervical collar increases ICP because of decreased venous return due venous compression of the neck
Read this article for better understanding:

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review
Available at:
http://online.liebertpub.com/doi/abs/10.1089/neu.2013.3094

Two podcasts you should listen to:
1) http://foamcast.org/2015/04/02/episode-26-the-spinal-cord/
(This one will give you a good review of differentiating spinal shock vs neurogenic shock, as well as different types of SCI)

2) http://emergencymedicinecases.com/backboard-and-collar-nightmares-emergency-medicine-update-conference/

Bottomline:
  1. An awake patient can probably protect his spine and back better than any of our gadgets can; and should be allowed to self-extricate and lie on the trolley.
  2. A patient who is not fully conscious or fulfill NEXUS criteria should have the neck immobilized - either with good fitting cervical collar or other means for manual stabilization (pillows, blankets).

Comments

Post a Comment

Popular posts from this blog

State of emergency medical services in Nigeria

EMERGENCY MEDICAL SERVICES (LASEMS AND LASAMBUS) EMERGENCY MEDICAL SERVICES (LASEMS AND LASAMBUS) Increasing urbanization and industrialization of Lagos State has led to an appreciable increase in the number of road traffic, industrial and marine accidents and medical emergencies, hence the strengthening of the inherited base hospital care i.e. Lagos State Emergency Medical Service (LASEMS) and establishment of the pre-hospital care service i.e. Lagos State Ambulance Service (LASAMBUS) in March 2001. Both services run on a 24/7 basis and have led to significant improvement in the response time and quality of care with attendant improvement in morbidity and mortality rates occasioned by medical emergencies. These services cover: • Awareness campaign on the preventive aspect of medical emergencies including home/road traffic/industrial accidents; and how to access services. • Training of personnel in pre-hospital and hospital-based management of trauma and medical emergencies, and effec...
Post a Comment
Read more

Algorithms for Advanced Cardiac Life Support 2017

Algorithms for Advanced Cardiac Life Support 2017 https://www.acls.net/aclsalg.htm Oct 6, 2017 Version control:  This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. One of the crucial components of effective ACLS training is a familiarity with the major algorithms for different patient and/or provider scenarios. As a free resource for our visitors, this page contains links to sample algorithms for the main AHA Advanced Cardiac Life Support cases.  See our website terms . Compatible part number: 90-1013, 90-1010.     New!  We now sell laminated 8.5"x11"  crash cart algorithm cards  ( $60  $40 set of 8) and  24"x36" wall posters  ($80 set of 9). Cardiac Arrest Algorithm This c...
Post a Comment
Read more

ABCDE OF RESUSCITATION

The ABCDE approach to resuscitation  The ABCD of resuscitation, plays a vital role in assessing your patient,  this is your initial assessment: A.......Airway and Cervical immobilization  B...... Breathing and Ventilation  C.......Circulation and hemorrhage control  D.......Disability and Neurological deficit E...... Environment and Exposure  First of all make sure that the scene is safe, wear the necessary PPEs Airway When you go to the patient tap for response, "hello can you hear me" if the patient is conscious and vocalising that indicates that the airway is patent, apply cervical collar for a trauma patient with suspected c-spine trauma. Breathing check for breathing, look listen and feel , check for use of accessory muscle and count respiration which is from 12-20c/m, auscultate the chest for lung sound, check Spo2 if need be deliver oxygen. Circulation Look at the colour hands and digit are they blue(cyanosis) or pink, check ...
1 comment
Read more