Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a “standard” predicated on a lack of evidence. What evidence DO we have regarding spinal immobilization? And how should we restrict spinal movement of polytrauma patients based on that evidence? Tune in to another eye-opening podcast episode where we are joined by air medical director, Dr. Mike Hudson, who has been leading the way in U.S. spinal motion restriction (SMR) techniques.
Brochure Links
Spinal Motion Restriction
Guest
Dr. Mike Hudson is double-boarded in Emergency Medicine and Emergency Medical Services. He has served as Classic Air Medical ‘s Medical Director for 11 years and Tucson Fire’s Medical Director for 2 years. In addition to medicine, he has a special interest in martial arts including boxing, Krav Maga (brown belt), Muay Thai, and Ju Jitsu.
Benger et al. Why do we put cervical collars on conscious trauma patients? SJTREM, 2009.
Prehospital use of cervical collars in trauma patients – a critical review, J Neurotrauma, 2013. Co-written by
THE CURSE OF THE CERVICAL COLLAR | http://www.scancrit.com/2013/10/10/cervical-collar/
Stone et al. The Effect of Rigid Cervical Collar on Internal Jugular Vein Dimensions, Acad Emerg Med, 2010.
Mobbs et al. Effect of cervical hard collar on intracranial pressure after head injury, ANZ J Surg, 2002.
Hauswald et al. Out-of-hospital Spinal Immobilization: Its Effect on Neurologic Injury, Acad Emerg Med, 1998.
Emerg Med J. 2013 Dec;30(12):1067-9. doi: 10.1136/emermed-2013-203207. Pre-hospital spinal immobilisation: an initial consensus statement. Connor D, Greaves I, Porter K, Bloch M; consensus group, Faculty of Pre-Hospital Care.
Peleg et al. Extrication Collars Can Result in Abnormal Separation Between Vertebrae in the
Presence of a Dissociative Injury, J Trauma, 2010.
Lador et al. Motion Within the Unstable Cervical Spine During Patient Maneuvering: The Neck Pivot-Shift Phenomen, J Trauma, 2011.
Acad Emerg Med. 1998 Mar;5(3):214-9. Out-of-hospital spinal immobilization: its effect on neurologic injury. Hauswald M1, Ong G, Tandberg D, Omar Z.
James CY, Riemann BL, Munkasy BA, Joyner AB: Comparison of Cervical Spine Motion During Application Among 4 Rigid Immobilization Collars. J Athl Train. 2004, 39 (2): 138-145.
Papadopoulos MC, Chakraborty A, Waldron G, Bell BA: Exacerbating cervical spine injury by applying a hard collar. BMJ. 1999, 319: 171-172.
Ho AM, Fung KY, Joynt GM, Karmakar MK, Peng Z: Rigid cervical collar and intracranial pressure of patients with severe head injury. Journal of Trauma, Injury Infection and Critical Care. 2002, 53 (6): 1185-8. 10.1097/00005373-200212000-00028.
Bauer D, Kowalski R: Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1983, 17 (9): 915-918. 10.1016/S0196-0644(88)80671-1
Bandiera G, Stiell IG, Wells GA, Clement C, De Maio V, Vandemheen KL, Greenberg GH, Lesiuk H, Brison R, Cass D, Dreyer J, Eisenhauer MA, Macphail I, McKnight RD, Morrison L, Reardon M, Schull M, Worthington J, on behalf of the Canadian C-Spine and CT Head Study Group: The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med. 2003, 42 (3): 395-40. 10.1016/S0196-0644(03)00422-0
Blackham, J. et al. (2009) ‘Clearing’ the cervical spine in conscious trauma patients, Trauma, vol. 11, pp. 93-109
Maiman DJ, Sances A, Jr., Myklebust JB, et al. Compression injuries of the cervical spine: a biomechanical analysis. Neurosurgery. 1983;13(3):254-260.
Dixon M, O’Halloran J, Cummins NM. Biomechanical analysis of spinal immobilisation during prehospital extrication: a proof of concept study. Emergency medicine journal: EMJ. 2014;31(9):745-749.
APLS trauma update 2015, chapter 13
Prehospital cervical spinal immobilization after trauma. Neurosurgery. Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE. Hurlbert R John, et al.
New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based Christian Maschmann, Elisabeth Jeppesen, Monika Afzali Rubin & Charlotte Barfod Scandinavian Journal of Trauma, Resuscitation and Emergency Medicinevolume 27, Article number: 77 (2019)
Michigan Department of Community Health.(2014) Adult Treatment Protocols, Spinal Injury Assessment. Retreived from: http://www.ocmca.org/wp-content/uploads/2016/08/1-20-Spinal-Injury-Assessment.pdf
Michigan Department of Community Health.(2014) General Precautions, Spinal Precautions. Retrieved from: http://www.ocmca.org/wp-content/uploads/2016/08/5-27-Spinal-Precautions.pdf
Nationa Association of EMS Physicians and American College of Surgeons Committee on Trauma. EMS Spinal Precautions and the use of the Long Backboard. Prehospital Emergency Care. 17(3), 392-393, doi: 10.3109/10903127.2013.773115
Rahman, J. (2015, December 3). Spinal Motion Restriction. Retrieved from: https://www.youtube.com/watch?v=9MzkZ271wdc
Swartz, E.E., Tucker, S.W., Nowak. M., Roberto, J., Hollingworth, A., Decoster, A.,….Mihalik, J.P. (2018). Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction [Abstract]. Prehospital Emergency Care. 22, doi: 10.1080/10903127.2018.1431341
Underbrink, L., Dalton, A., Leonard, J,. Bourg, B.W., Blackmore, A., Valverde, H.,…..Hopgood, D. (2018). New Immobilization Guidelines Change EMS Critical Thinking in Older Adults with Spine Trauma [Abstract]. Prehospital Emergency Care. 6, 1-8, doi: 10.1080/10903127.2017.1423138
Wampler, D.A., Pineda, C., Polk, J., Kidd, E., Leboeuf, D., Flores, M.,….Cooley, C. (2016). The Long Spine Board Does Not Reduce Lateral Motion During Transport- A Randomized Healthy Volunteer Crossover Trail. The American Journal of Emergency Medicine. 34(4), 717-721, doi:10.1016/j.ajem.2015.12.078
White, C.W., Domeier, R.M., Millin, M.G.,Standards and Clinical Practice Committee, National Association of EMS Physicians. (2014). EMS spinal precautions and the use of the long backboard – resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Prehospital Emergency Care. 18(2):306-14. doi: 10.3109/10903127.2014.884197