Spinal immobilization including cervical immobilization is no longer widely recommended for ALL trauma patients

Spinal immobilization including cervical immobilization is no longer widely recommended for ALL trauma patients.

In fact, the American College of Emergency Physicians (ACEP) has come out with a new statement that is against the use of long backboards by EMS (click here to access):

“Backboards should not be used as a therapeutic intervention or as a precautionary measure either inside or outside the hospital or for inter-facility transfers.” 

Backboards or spinal boards are transport devices, not immobilization devices. The spinal board is hard, but our spine has curvatures, and immobilizing them can aggravate spinal injuries on certain segments (besides risk of pressure sores, etc).

The UK Faculty of Prehospital Care has also similarly discourages spinal immobilization. Click here: http://emj.bmj.com/content/30/12/1067.full.pdf+html 

Spinal immobilization by itself is not harmless and has the following disadvantages:

1. Time intensive to apply, thus delaying transport time to definitive care
2. May create or aggravate ‘difficult airway’ scenarios
3. Have been shown to increase mortality 2 fold in penetrating injuries (Haut et al 2010)
4. Cause pressure ulcers
5. Very uncomfortable, especially during transfers for X-rays, etc, increased length of stays in our departments.
6. The cervical collar increases ICP because of decreased venous return due venous compression of the neck

Read this article for better understanding:

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review
Available at:
http://online.liebertpub.com/doi/abs/10.1089/neu.2013.3094

Two podcasts you should listen to:
1) http://foamcast.org/2015/04/02/episode-26-the-spinal-cord/
(This one will give you a good review of differentiating spinal shock vs neurogenic shock, as well as different types of SCI)

2) http://emergencymedicinecases.com/backboard-and-collar-nightmares-emergency-medicine-update-conference/

Bottomline:

1. An awake patient can probably protect his spine and back better than any of our gadgets can; and should be allowed to self-extricate and lie on the trolley.
2. A patient who is not fully conscious or fulfill NEXUS criteria should have the neck immobilized - either with good fitting cervical collar or other means for manual stabilization (pillows, blankets).