Spinal Immobilation Guidelines - November 2000
How many times have you immobilized a patient from an MVA that had no neck or back pain, and you really didn’t see the great need in boarding them up? Many of the patients we immobilize may not need it: we’re just being cautious. Caution is a good thing, but we know that being immobilized is uncomfortable, and in some cases, dangerous. The danger comes in when the patient vomits, even a small amount, and they aspirate. The result is aspiration pneumonia; it adds to the hospital stay and complicates recovery. Recent studies from out west indicate that patients with spinal injuries always have neck or back pain. Those without static pain will find it painful to move their head from side to side or up and down. The only problem with assuming that if the patient is pain-free they don’t have a spinal injury is if they have something going on that masks the pain. For instance; if the patient is intoxicated, or under the influence of pain killing medications, they may not feel spinal injury pain. The same thing goes if they have a separate major injury. We all know that a femur fracture, or pelvis fracture are very painful. That severe pain, or any other severe pain, may distract the patient’s feeling of pain in their spine.
With all of this in mind, the trend across the country is to carefully examine patients to determine if they truly need to be immobilized before subjecting them to it. Locally, we will begin doing this at the paramedic level. The thought behind this is that if the paramedics can figure it out, anyone else will surely be able to as well! Seriously; Dr. Horine and the Audit and Review panel wanted to try this procedure with paramedic level folks first, then allow other levels to use it if we don’t have any problems.
Here is how we establish if a patient needs to be immobilized:
- The patient must be alert and oriented, not drunk or under the influence of pain-killing medications.
- All of the following must be within normal limits:
- ABC’s
- Vitals
- Mental Status
- Skin
- Neck
- Heart
- Lungs
- Abdomen
- Back
- Extremities
- Neurological Function.
- There must not be any major injury that would distract the patient’s awareness to pain.
- There must not be significant traumatic mechanism of injury (ie: major intrusion in an MVA or fall from a great height).
- Palpate the entire length of the spine, the spinous processes of all of the vertebrae.
- Any point tenderness means that we will immobilize the patient.
- Check the patient’s head/neck range of motion.
- Side to side
- Up and down (all unassisted)
The decision to immobilize is up to the paramedic. You won’t be faulted for erring on the side of caution.
BE SURE to document all of your findings on the call report! If you do not immobilize a patient that has been involved in a spinal-injury potential mechanism of injury, you MUST document why!