For over four decades and with little or no data to back it up, EMS fully immobilized all patients involved in major traumatic incidents in order to prevent neurological damage from a potential spine injury. The premise underlying this practice was that a major traumatic event could injure the patient's spine and subsequent spinal movement would result in a cord injury, and full external spinal immobilization would prevent said movement. This precept is seen as false and spine management in both urban and wilderness environments has changed—or is in the process of changing—accordingly. Read on to see how and why this transformation has taken place...and what the current spine management guidelines are for wilderness and remote locations.
In 1998, Professor Mark Hauswald (Department of Emergency Medicine, University of New Mexico) released a five-year retrospective study comparing trauma patients in Malaysia with those seen in a US hospital. None of the 120 patients seen at the University of Malaya were immobilized during transport while all 334 patients seen at the University of New Mexico were.
The study showed a significantly higher rate of neurologic injury in the immobilized group.
In 2012, Dr. Hauswald released another article on the biomechanics and pathophysiology of spinal injures that challenged existing spinal immobilization theory. In his article Dr. Hauswald asserts that most spinal injuries are biomechanically stable, that the majority of those few patients with unstable spinal injuries will already have spinal cord damage as a result of the forces imparted during the traumatic event, and that pre-hospital immobilization will not affect either patient's outcome. This means that cord and neurological injury can only be caused by a second traumatic event where new force is applied to the injured area, and movement within the patient's normal range of motion is safe.
Increased research over past decade and a half—primarily due to Hauswald's work—has clearly shown that spinal immobilization:
Here's what else we know (or think we know):
So how should we treat patients in a wilderness or remote locations? The treatment goal is to prevent a spinal cord injury.
To that end:
Assume a patient has a Spine Injury when the MOI is Trauma or Unknown; support VPU patient’s spine during Basic Life Support. Begin the focused spine assessment (FSA) only after you have completed all three triangles of the Patient Assessment System to ensure the patient is reliable.
Treatment Principles for Spine & Spinal Cord Injuries
Lifting & Moving Guidelines for Voice-responsive, Pain-responsive, and U Patients
Litter Packaging Guidelines for Non-ambulatory Patients
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