Changes in cervical spine immobilisation protocols

There is a need to rethink the traditionally held belief that all trauma patients should automatically receive full spinal immobilisation. Earlier studies had attributed pre-hospital neurological deterioration to a failure to immobilise the spine. More recent studies have however failed to support this link. This doesn’t mean that the earlier studies were incorrect, but rather that more extensive research is needed before a decisive protocol can be developed for the patient immobilisation. Until such time, full body immobilisation must still be considered as an important treatment protocol, and the use of cervical collars under certain conditions is still advised.

Cervical collars present additional challenges in using the optimal protocol for a patient. We find that they are often not an ideal fit for all patients, and that even when they do fit a patient favourably they still allow for an undesirable amount of cervical spine movement, and as such are not a complete cervical spine immobilisation tool. Also, if cervical collars are applied too tightly to a patient, they can compress the jugular veins, which can lead to substantially increased intracranial pressure – a serious concern in patients with confirmed or suspected head injuries.

As part of the overall patient assessment, the following factors should be considered when deciding on the immobilisation methods to be used:

  • In an unstable patient with blunt trauma, time is of the essence and rapid transportation to hospital should be the priority. In such instances, the use of a cervical collar only, while limiting movement on a stretcher, can be considered.
  • In a patient with a penetrating traumatic wound and unstable circulation there is very little evidence to suggest that use of spinal immobilization is of any benefit, and rapid transportation without the application of immobilisation techniques can be considered.

It needs to be highlighted that reduced immobilisation techniques should only be applied to patients that are in a critical condition.

In patients that are stable, the following considerations should be taken:

  • Patients who show signs of head injuries or increased intracranial pressure should not be immobilised with the use of a cervical collar. Full body immobilisation using a device like a vacuum mattress should still be applied. A spine board and head blocks can also be used for short immobilisation periods, but the use of a vacuum mattress is preferred.
  • In stable patients who show no signs of a head injury or increased intracranial pressure, the use of a proper fitting cervical collar is still recommended as part of a full body immobilisation protocol that also includes the use of a vacuum mattress or spine board and head blocks.

We strongly recommend that the reader familiarises themselves with the attached article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine on The Development of a New Emergency Medicine Spinal Immobilization Protocol, as well as any further literature available to this effect before deciding to apply any new cervical spine treatment methods in their regular patient care procedures.