Complications from pre-hospital immobilisation

This case report involves a 67-year-old-woman involved in a motor vehicle collision with an isolated complaint of minor hip pain. Pre-hospital personnel responding in the traditional manner quickly immobilized the patient in a cervical collar and long spine board in preparation for transport to a trauma centre. The patient developed progressively worsening respiratory distress while en route to the Emergency Department after immobilization. For unknown reasons, the patient's underlying medical conditions and deterioration were not recognized despite worsening vital signs and continued complaints of shortness of breath. She ultimately required intubation and admission to the Intensive Care Unit likely as a result of unnecessary immobilization. There is little evidence to show that routine spinal immobilization in the pre-hospital environment improves outcomes regardless of whether there is a true spinal injury or not. However, spinal immobilization has been found to cause pain, tissue injury, anxiety and decreased pulmonary function. This case report demonstrates the important role that pre-hospital providers have in deciding whether or not to immobilize a patient and that the consequences of unnecessary immobilization can be life-threatening.

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