It’s not something that’s always worth doing “just in case.” It’s not risk free, comfortable or even practical. And, now, recent research from the Washington University School of Medicine suggests that it may not even do such a good job of keeping the patient’s head still.
Does anyone else agree that we’ve seen enough bad news about c-spine now that we can stop the massive overuse that plagues our industry? Can we start evaluating people and deciding who does and doesn’t meet criteria for spinal immobilization. Please?
Consider that c-spine:
- Increases aspiration risk
- Makes airway management more difficult
- Increases intracranial pressure
- Increases the incidence of pressure sores
- Is expensive.
- Increases combativeness in drunk patients
- Is time consuming to put people in.
- Is difficult to remove without lumbar movement.
- Frequently fails to achieve a neutral alignment.
And now, this latest research suggests that we’re also causing quite a bit of movement when we c-spine using our most common in-the-car methods. (Something most EMS providers have been painfully aware of for a long time.)
The study used an infrared video motion capture system to analyze cervical movement during for different extraction scenarios. The patient was allowed to self extricate without any immobilization. Then the patient self extricated with a cervical collar in place. Third, the patient was removed by two medics head first. And finally the driver was removed head first with a KED.
Most field providers can already guess which technique moved the spine the least. We’ve known it for a long time. The patient who had the c-collar placed and then was allowed to extricate themselves and lay down on the board had the least amount of cervical movement.
Smart research like this is exactly what we need to final overhaul this flawed treatment modality.