General Approach to All Patients

Spinal Immobilization - Indications

Determining the need for spinal immobilization requires a careful assessment of the patient's:

  • Mechanism of injury
  • Mental status and ability to recognize the presence of spinal injury symptoms
  • Physical complaints and overall condition

The following algorithms (Blunt and Penetrating Trauma) can be used to assist paramedics in making the most appropriate decision about the need for spinal Immobilization.

Blunt Trauma with Concerning Mechanism of Injury

Concerning mechanism of injury defined as:

  • Any mechanism that produces a violent impact on the head, neck, torso or pelvis
  • Incidents that produce sudden acceleration or deceleration, including lateral bending forces
  • Any fall, especially in the elderly
  • Ejection or fall from a moving mode of transportation

Immobilize if any of the following exist:

  • Altered level of consciousness or inability to communicate:
    • Abnormal GCS
    • Evidence of significant intoxication
    • Dementia
    • Speech or hearing impairment
    • Age (young children)
    • Language barrier
  • Complaints suggestive of spinal injury:
    • Spinal pain or tenderness, including paraspinal musculature
    • Neurologic deficit or complaint, including parasthesia, paralysis or weakness
    • Anatomical deformity of the spine
  • Distracting Injuries:
    • Long bone fractures
    • Joint dislocations
    • Abdominal or thoracic pain, or obvious visceral injury
    • Large lacerations, degloving injuries or crush injuries
    • Serious burns
    • Any injury producing acute functional impairment

♦IF IN DOUBT, IMMOBILIZE♦

Penetrating Trauma

Immobilize if any of the following exist:

  • Altered level of consciousness
  • Any neurological deficits* or complaints
    • Test motor function in both upper and lower extremities (entire extremity)
    • Test sensation in both upper and lower extremities (start proximal and work towards hands and feet)
    • Ask about numbness or tingling in extremities

* Examples are numbness, focal weakness, focal sensory deficit, parasthesias. Identifying the presence of neurological signs and symptoms requires careful assessment and history taking.

♦IF IN DOUBT, IMMOBILIZE♦

Other Situations

  • Spinal precautions can be maintained by application of a cervical collar and securing patient firmly to the stretcher without a long backboard if all 4 of these criteria are met:
    • Patient is ambulatory at the scene
    • Patient does not demonstrate an altered level of consciousness or inability to communicate
    • Patient does not have complaints suggestive of spinal injury
    • Patient does not have distracting injuries
  • Immobilize all patients with the following conditions:
    • High voltage electrical injuries (does not include Taser use)
    • Shallow water drowning or diving injuries
  • If spinal immobilization is indicated but refused by the patient:
    • Advise the patient of the indication for immobilization, and the risks of refusing the intervention
    • If the patient allows, apply the cervical collar even if backboard is refused
    • Maintain spinal alignment as best as can be achieved during transport
    • Clearly document refusal of immobilization
  • If spinal immobilization is indicated but the patient cannot tolerate supine position:
    • Apply all elements of spinal immobilization that the patient will tolerate
    • Maintain spinal alignment as best as can be achieved during transport
    • Clearly document the clinical condition that interfered with full immobilization

Blunt Trauma Flowchart

Penetrating Trauma Flowchart