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EMS Long Spine Board Immobilization Milland K; Al-Dhahir MAStatPearls-/-ä 2024[Jan]; ä (ä): äBlunt traumatic injuries are the leading cause of spinal cord injuries in the United States, with an annual incidence of approximately 54 cases per million population and about 3% of all blunt trauma admissions to the hospital. Although spinal cord injuries represent only a small percentage of blunt trauma injuries, they are among the largest contributors to morbidity and mortality. As a result, in 1971, the American Academy of Orthopedic Surgeons proposed using a cervical collar and a long spine board for spinal motion restriction for patients with suspected spinal injuries, which was based entirely on the mechanism of injury. At the time, this was based on consensus rather than evidence. In the decades since spinal motion restriction, using a cervical collar and long spine board has become the standard in prehospital care. It can be found in several guidelines, including the Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) guidelines. Despite their widespread use, the efficacy of these practices has been called into question. In one international study comparing those who underwent spinal motion restriction to those who did not, the study found that those who did not receive routine care with spinal motion restriction had fewer neurologic injuries with disability. However, it should be noted that these patients were not matched for the severity of the injury. Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion. In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries. There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines. As a result of these and other studies, newer guidelines recommend limiting the use of long spine board spinal motion restriction to those with a concerning mechanism of injury or concerning signs or symptoms as described later in this article and limiting the duration that a patient spends immobilized.ä |
