References

Abram S, Bulstrode C Routine spinal immobilization in trauma patients: What are the advantages and disadvantages?. Surgeon. 2010; 8:(4)218-22 https://doi.org/10.1016/j.surge.2010.01.002

Ahn H, Singh J, Nathens A Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma. 2011; 28:(8)1341-61 https://doi.org/10.1089/neu.2009.1168

Bridgwater: Class Professional Publishing; 2013

Brown JB, Bankey PE, Sangosanya AT, Cheng JD, Stassen NA, Gestring ML Prehospital spinal immobilization does not appear to be beneficial and may complicate care following gunshot injury to the torso. J Trauma. 2009; 67:(4)774-8 https://doi.org/10.1097/TA.0b013e3181b5f32e

Byrne DW, Salzberg CA Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord. 1996; 34:(5)55-263 https://doi.org/10.1038/sc.1996.46

Chiles BW, Cooper PR Current concepts: acute spinal injury. N Engl J Med. 1996; 334:(8)514-20 https://doi.org/10.1056/NEJM199602223340807

Connor D, Greaves I, Porter K, Bloch M Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J. 2013; 30:(12)1067-9 https://doi.org/10.1136/emermed-2013-203207

Cooke MW Use of the spinal board within the accident and emergency department. J Accid Emerg Med. 1998; 15:(2)108-9

Dixon M, O'Halloran J, Hannigan A, Keenan S, Cummins NM Confirmation of suboptimal protocols in spinal immobilisation?. Emerg Med J. 2015; 32:(12)939-45 https://doi.org/10.1136/emermed-2014-204553

Dunn LT Raised intracranial pressure. J Neurol Neurosurg Psychiatry. 2002; 73:i23-7 https://doi.org/10.1136/jnnp.73.suppl_1.i23

French DD, Campbell RR, Sabharwal S, Nelson AL, Palacios PA, Gavin-Dreschnack D Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration. J Spinal Cord Med. 2007; 30:(5)477-81

Hamer S, Collinson G, Gray JMA, 2nd edn. Edinburgh: Elsevier Health Sciences; 2005

Hauswald M, Ong G, Tandberg D, Omar Z Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998; 5:(3)214-19 https://doi.org/10.1111/j.1553-2712.1998.tb02615.x

Jin PFK, Goslings JC, Luitse J, Ponsen KJ A retrospective study of five clinical criteria and one age criterion for selective prehospital spinal immobilization. Eur J Trauma Emerg Surg. 2007; 33:(4)401-6 https://doi.org/10.1007/s00068-007-6197-3

Kwan I, Bunn F Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subject. Prehosp Disaster Med. 2005; 20:(1)47-53 https://doi.org/10.1017/S1049023X00002144

Kwan I, Bunn F, Roberts I Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001; (2) https://doi.org/10.1002/14651858.CD002803

Lee BB, Cripps RA, Fitzharris M, Wing PC The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2013; 52:(2)110-6 https://doi.org/10.1038/sc.2012.158

Leonard JC, Mao J, Jaffe DM Potential adverse effects of spinal immobilization in children. Prehosp Emerg Care. 2012; 16:(4)513-18 https://doi.org/10.3109/10903127.2012.689925

Lin HL, Lee WC, Chen CW Neck collar used in treatment of victims of urban motorcycle accidents: over-or underprotection?. Am J Emerg Med. 2011; 29:(9)1028-33 https://doi.org/10.1016/j.ajem.2010.06.003

Miller DJ, Butterworth JF, Gudeman SK Further experience in the management of severe head injury. J Neurosurg. 1981; 54:(3)289-99 https://doi.org/10.3171/jns.1981.54.3.0289

Paterek E, Isenberg DL, Salinski E, Schiffer H, Nisbet B Characteristics of trauma patients overimmobilized by prehospital providers. Am J Emerg Med. 2015; 33:(1)121-2 https://doi.org/10.1016/j.ajem.2014.10.034

Peery CA, Brice J, White WD Prehospital spinal immobilization and the backboard quality assessment study. Prehosp Emerg Care. 2007; 11:(3)293-7 https://doi.org/10.1080/10903120701348172

Porth CM, Matfin GPhiladelphia, PA: Lippincott Williams and Wilkins; 2008

Ramasamy A, Midwinter M, Mahoney P, Clasper J Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury. 2009; 40:(12)1342-5 https://doi.org/10.1016/j.injury.2009.06.168

Sheerin F, de Frein R The occipital and sacral pressures experienced by healthy volunteers under spinal immobilization: a trial of three surfaces. J Emerg Nurs. 2007; 33:(5)447-50 https://doi.org/10.1016/j.jen.2006.11.004

Stone MB, Tubridy CM, Curran R The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med. 2010; 17:(1)100-102 https://doi.org/10.1111/j.1553-2712.2009.00624.x

Vanderlan WB, Tew BE, McSwain NE Increased risk of death with cervical spine immobilisation in penetrating cervical trauma. Injury. 2009; 40:(8)880-3 https://doi.org/10.1016/j.injury.2009.01.011

Wyndaele M, Wyndaele JJ Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord. 2006; 44:(9)523-9 https://doi.org/10.1038/sj.sc.3101893

pre-hospital

literature review

injury

patient care

injury

trauma

prehospital

Is full pre-hospital spinal immobilisation best for the patient? A review of current controversies

02 April 2016

Features

02 April 2016

Volume 8 · Issue 4

ISSN (print): 1759-1376

ISSN (online): 2041-9457

Abstract

Spinal immobilisation has long been an accepted part of pre-hospital care. There is, however, a lack of evidence that spinal immobilisation is effective in reducing spinal cord injury (SCI). The aim of this article is to review a broad range of literature in relation to spinal immobilisation and consider some of the current controversies.

Despite a lack of high-quality research, following a comprehensive literature search, 13 pieces of primary research and 4 pieces of secondary research were identified. The literature identified a number of potential controversies relating to the principal effectiveness of immobilisation, side effects of immobilisation and patient outcome in comparison to non-immobilised patients. Given these areas of controversy, many of which are of fundamental importance, it seems logical that further high-quality research is required to establish whether spinal immobilisation is effective or otherwise.

The Association of Ambulance Chief Executives (AACE) (2013)Clinical Practice Guidelines provide a clear algorithm for practitioners when considering whether spinal immobilisation of a patient is warranted. However, they further state that ‘suspicion of thoracic and lumbar injury despite a cleared cervical spine warrants full immobilisation.’ Consequently, the onus of any clinical decision made is firmly based on the individual practitioner's judgement. Additionally, Connor et al (2013) assert in a consensus statement on behalf of the Faculty of Pre-hospital Care that ‘a change is needed from a policy of immobilising necks, as much for the protection of the clinician as for that of the patient.’ They also state thatlong spinal boards should only be used as an extrication device and that a clear algorithm should be adopted for identifying spinal cord injury (SCI).

Both AACE (2013) and Connor et al (2013) recognise that spinal immobilisation has a basis in history of logical principles as opposed to evidence-based practice. Although there is some historical literature supportive of spinal immobilisation (Chiles and Cooper, 1996), a key review of current literature on spinal immobilisation (Kwan et al, 2001) stated that there was a lack of high-quality primary research in the area, and that the effects of spinal immobilisation were unclear in relation to both reducing SCI and reducing mortality.

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

CPD Focus
Develop your career
Stay informed

Or continue by

Signing in with your registered email address

Cervical spine injury

Spinal cord injury

Spinal cord trauma

Spinal immobilisation

Trauma