Pre-hospital spinal immobilisation: an initial consensus statement

© Gary Wilson/ Pre-hospital Research Forum

Emerg Med J 2013;30:1067-1069 

This paper reviews the current evidence available on the practice of spinal immobilisation in the prehospital environment. Following this, initial conclusions from a consensus meeting held by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in March 2012 are presented.

The consensus meeting held by the Faculty of Pre-hospital Care aimed to clarify the practice of immobilisation. Preliminary discussions highlighted salient points that required discussion. The conclusions of the consensus group are:

1. The long spinal board is an extrication device solely. Manual-in-line stabilisation is a suitable alternative to a cervical collar.

2. An immobilisation algorithm may be adopted although the content of this remains undefined.

3. There may be potential to vary the immobilisation algorithm based on the conscious level of the patient.

4. Penetrating trauma with no neurological signs does not require immobilisation.

5. ‘Standing take down’ practice should be avoided.

6. In a conscious patient with no overt drugs or alcohol on board and with no major distracting injuries, the patient, unless physically trapped should be invited to self-extricate and lie on the trolley cot. Likewise, for the non-trapped patient who has self-extricated, they can be walked to the vehicle and then laid supine, examined and if necessary immobilised.

7. Further research into effective, practical and safe immobilisation practice, and dissemination of this, is required.

http://emj.bmj.com/content/30/12/1067.abstract

From the FPHC (full text):

http://www.fphc.co.uk/content/Portals/0/Documents/2013-12%20Spinal%20Consensus%20COMPLETE.pdf