Spinal Motion Restriction in the Trauma Patient-Spinal Motion Restriction in the Trauma Patient

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The American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have issued a joint position statement on spinal motion restriction (SMR) in trauma patients. The consensus statement represents the collective positions of these organizations and has been endorsed by several national stakeholder organizations. The guidance is intended for use by EMS personnel, EMS medical directors, emergency physicians, trauma surgeons, and nurses to improve the care of trauma victims.<br /><br />Key points of consensus include:<br />- Unstable spinal injuries can lead to severe neurological injuries if there is excessive movement of the injured spine.<br />- While current techniques limit motion of the spine, they do not provide true immobilization, so using the term "spinal motion restriction" rather than "spinal immobilization" is preferred.<br />- SMR can be achieved using devices such as backboards, scoop stretchers, vacuum splints, or ambulance cots to which the patient is safely secured.<br />- Indications for SMR following blunt trauma include altered level of consciousness, neck or back pain and/or tenderness, focal neurologic signs and/or symptoms, anatomic spine deformity, distracting circumstances or injury, or any similar injury that impairs the ability to perform a reliable examination.<br />- SMR, when indicated, should apply to the entire spine to minimize the risk of noncontiguous injuries. An appropriately-sized cervical collar is essential for SMR, and the head, neck, and torso should be kept in alignment.<br />- There is no role for SMR in penetrating trauma.<br />- For pediatric patients, age alone should not be a factor in decision-making for spinal care. A cervical collar should be applied if the patient has neck pain, torticollis, neurologic deficit, altered mental status, or was involved in a high-risk motor vehicle collision or has substantial torso injury. Padding may be necessary to avoid excessive cervical spine flexion.<br /><br />The consensus statement also provides recommendations for patient transfers, device removal, and care of children with SMR.<br /><br />Overall, the joint position statement offers updated and uniform guidance on SMR in the trauma patient, addressing various aspects of spinal motion restriction and providing clear recommendations for its implementation.

Meta Tag

spinal motion backboard

spinal motion spinal immobilization

spinal motion cervical collar

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Keywords

American College of Surgeons Committee on Trauma

American College of Emergency Physicians

National Association of EMS Physicians

spinal motion restriction

trauma patients

consensus statement

EMS personnel

EMS medical directors

emergency physicians

trauma surgeons