Spinal Immobilization

The preservation of integrity of the spinal column and the enclosed spinal cord is of paramount importance in the field. Cervical spine stabilization and airway assessment are performed simultaneously. Manual stabilization of the neck is not released until the patient has been transferred and securely strapped to a board. The length of boards used (whether short, long, or both) depends on the initial position in which the patient is found by the first responder or EMT.

Carrying boarded patients takes a heavy toll on the backs of EMTs and paramedics. Evaluation of the boarded patient is expensive and time-consuming in the emergency department because of the need to "clear the spine." Not all trauma victims require spinal immobilization for transport. The medical director should develop protocols or guidelines to avoid unnecessary field immobilization. 18 For example, a patient with no neck pain or tenderness (neck pain must be defined liberally and includes stiffness or "feels funny"), not in the extremes of age (below 10 or above 65), with no altered sensorium (no drugs or alcohol present and no head injury), and with no distracting injuries (e.g., long bone fracture or abdominal or chest injury) does not routinely require immobilization because there is an extraordinarily low probability of neck injury. Ideal guidelines for prehospital personnel necessarily would have virtually 100 percent sensitivity with acceptable specificity for cervical spine injuries.

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