What makes clinicians decide to use spinal immobilisation? A review of the literature

This article will examine and critically analyse existing literature surrounding patient immobilisation following a suspected or confirmed acute neck injury. In particular, literature on the use of a cervical collar and head blocks and the use of clinician decision tools will be critically analysed. A review has been conducted using several databases: CINAHL, PubMed, SwetsWise, Cochrane, MEDLINE, Embase, and the National Research Register. Search terms included ‘cervical collars’ and ‘immobilisation’. To ensure the inclusion of the most relevant research the search timeframe was limited to 1995 to the present day.

Pre-hospital spinal immobilisation is broadly applied in patients at risk of cervical spine injury, as recommended in resuscitation guidelines such as the Advanced Trauma Life Support Student Course Manual (American College of Surgeons, 2008), Prehospital Trauma Life Support (National Association of Emergency Medical Technicians, 2010) and the UK Ambulance Services Clinical Practice Guidelines (Joint Royal Colleges Ambulance Liaison Committee, 2013). The UK incidence of spinal cord trauma is estimated as 10–15 per million people each year (Benger and Blackham, 2009). Hasler et al (2012), whose study is based on a prospective data collection of the Trauma Audit and Research Network from 1988 to 2009, found that 3.5% of 250 584 trauma patients had a resulting spinal injury after spinal cord trauma. Hasler et al (2012) used data of a substantial size, meaning the findings would be strengthened by further dissemination, such as by a patient's presenting injuries, age or mechanism of injury, to further interpret the proportion of spinal injuries incurred.