Spinal Care

Table of Contents

(Adapted from an evidence-based guideline created using the National Prehospital Evidence-Based Guideline Model Process)

Aliases

None noted

Patient Care Goals

  1. Select patients for whom spinal motion restriction (SMR) is indicated
  2. Minimize secondary injury to spine in patients who have, or may have, an unstable spinal injury
  3. Minimize patient morbidity from the use of immobilization devices

Patient Presentation

Inclusion criteria

Traumatic mechanism of injury

Exclusion criteria

No recommendations

Patient Management

Assessment

  1. Assess the scene to determine the mechanism of injury
    1. Mechanism alone should not determine if a patient requires spinal motion restriction – however, mechanisms that have been associated with a higher risk of injury are:
      1. Motor vehicle crashes (including automobiles, all-terrain vehicles, and snowmobiles)
      2. Axial loading injuries to the spine
      3. Falls greater than 10 feet
    2. Assess the patient in the position found for findings associated with spine injury:
      1. Mental status
      2. Neurologic deficits
      3. Spinal pain or tenderness
      4. Any evidence of intoxication
      5. Other severe injuries, particularly associated torso injuries

Treatment and Interventions

  1. Place patient in cervical collar if there are any of the following:
    1. Patient complains of midline neck or spine pain
    2. Any midline neck or spinal tenderness with palpation
    3. Any abnormal mental status (including extreme agitation)
    4. Focal or neurologic deficit
    5. Any evidence of alcohol or drug intoxication
    6. Another severe or painful distracting injury is present
    7. Torticollis in children
    8. A communication barrier that prevents accurate assessment
    9. If none of the above apply, patient may be managed without a cervical collar
  2. Patients with penetrating injury to the neck should not be placed in a cervical collar or other spinal precautions regardless of whether they are exhibiting neurologic symptoms or not.
    1. Doing so can lead to delayed identification of injury or airway compromise, and has been associated with increased mortality
  3. If extrication is required:
    1. From a vehicle: After placing a cervical collar, if indicated, children in a booster seat and adults should be allowed to self-extricate. For infants and toddlers already strapped in a car seat with a built-in harness, extricate the child while strapped in his/her car seat
    2. Other situations requiring extrication: A padded long board may be used for extrication, using the lift and slide (rather than a logroll) technique
  4. Helmet removal
    1. If a football helmet needs to be removed, it is recommended to remove the face mask followed by manual removal (rather than the use of automated devices) of the helmet while keeping the neck manually immobilized – occipital and shoulder padding should be applied, as needed, with the patient in a supine position, in order to maintain neutral cervical spine positioning
    2. Evidence is lacking to provide guidance about other types of helmet removal
  5. Do not transport patients on rigid long boards, unless the clinical situation warrants long board use. An example of this may be facilitation of immobilization of multiple extremity injuries or an unstable patient where removal of a board will delay transport and/or other treatment priorities. In these situations, long boards should ideally be padded or have a vacuum mattress applied to minimize secondary injury to the patient
  6. Patients should be transported according to the East Central Regional TCD Plan for Trauma[Appendix X]
  7. Patients with severe kyphosis or ankylosing spondylitis may not tolerate a cervical collar. These patients should be immobilized in a position of comfort using towel rolls or sand bags

Notes – Spinal Care