So, do we have to put every trauma patient into a collar and on a backboard? Probably not, but the practice is go ingrained in our EMS culture that it happens with high frequency.
There was a landmark article in the New England Journal of Medicine by Jerome Hoffman in 2000 that looked at 34,000 patients to develop a rule set for clinical clearance of the cervical spine. The absence of the following criteria place the patient into a low probability of injury and did not require imaging:
- the absence of tenderness at the posterior midline of the cervical spine
- the absence of a focal neurologic deficit
- a normal level of alertness
- no evidence of intoxication
- absence of clinically apparent pain that might distract the patient from the pain of a cervical-spine injury
If the above patients did not require any form of imaging, then those same patients would not require spinal immobilization.
The topic of reviewing and reconsidering how we handle prehospital spinal immobilization is rising and there are several recent articles challenging the status quo.
In the March edition of JEMS, there was an article entitled “Research Suggests Time for Change in Prehospital Spinal Immobilization“. EMSWorld has the following articles: “Evidence Against Backboards“, and “Does Spinal Immobilization Help Patients“.
According to Dr. Bledsoe’s review of the literature, he states that there is no evidence that backboards immobilize the spine, backboards can cause pain, make airway management more difficult, impair respirations, and place the patient at risk of aspiration. Additionally, there is no evidence that backboards improve patient outcomes. Dr. Bledsoe is similarly critical of cervical collar usage.
- The application of NEXUS or Canadian C-Spine criteria to prehospital patients can identify those that do not need a C-collar.
- Understand that there is no significant evidence that the use of backboards improves patient outcomes, and we should work to reduce their usage.