Long Spine Board Immobilization, an Overused Pre-hospital Intervention

Patients, that have suffered blunt or penetrating trauma that is significant enough to cause spinal injury, have always been treated by Emergency Medical Services with full spinal immobilization. Most textbooks for paramedics and EMTs stress the importance of procuring manual c-spine immobilization, followed by c-collar application, and then placed on a spinal board with the patient’s head secured to the spinal board. This management of trauma patients has long been the industry standard, but studies that prove patients benefit from the procedure are lacking and some studies have shown that spinal immobilization can actually be detrimental to patients. While true spinal cord trauma is a devastating injury its actual incidence is extremely low. In a study that examined one million trauma victims, only 2% had true spinal cord damage and of that 2%, only 1% had neurological deficits of any kind. Moreover, there is little data to suggest that our efforts at spinal immobilization are even effective. (Santa Cruz County EMS Integration Authority, 2012, para. 2) If only 2% of one million trauma victims had a true spinal cord injury that means 998,000 patients received full spinal immobilization that was unnecessary when only 2,000 warranted spinal immobilization. The use of long board spinal restriction as a precautionary measure should be reconsidered. Studies conducted by Chang et al. (2010) concluded that patients that suffered from penetrating trauma that were treated with spinal immobilization actually had higher mortality rates. The study suggests that the difficulty of controlling the patient’s airway and decreased respiratory drive caused by the supine position of the patient could be contributing factors in the mortality rates... ... 609-615. Chang, D. C.,Efron, D. T., Haut,E. R., Haider, A. H., Kalish, B. T.,Kieninger, A. N., & Stevens, K. A., (2010). Spine immobilization in penetrating trauma: more harm than good? Journal of Trauma-injury Infection and Critical Care, 68(1), 115-120. Hamel, M. G. (2014). How Lee County (Fla.) EMS implemented a new paradigm of cervical spine management. Journal of Emergency Medical Services, 14(1), 62-63. Hauswald, M. (2013). A re-conceptualisation of acute spinal care. Emergency Medicine Journel, 30(9), 720-723. McHugh, T. P., & Taylor, J. P. (2009). Unnecessary out-of-hospital use of full spinal immobilization. Academy of Emergency Medicine, 5(3), 278-280. Santa Cruz County EMS Integration Authority. (2012). New thinking on spinal immobilization. Retrieved from http://www.acphd.org/media/311913/santa%20cruz-%20new%20thinking%20about%20spine%20injures.pdf