Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

What is Good Spinal Immobilization – Part I

With an unstable fracture, Is all movement harmful?

Obviously not.

If all movement were harmful, then we would only have good outcomes when the patient has not moved even slightly prior to EMS arrival, and EMS did not allow any movement after arrival, and EMS did not cause any movement after arrival. Is that what EMS does?

Only in our dreams.

Therefore, if not all movement is bad for patients with unstable spinal fractures, shouldn’t we be trying to figure out what movement is not bad?

I think it is clear that preventing all movement is not good. I have given some examples of cases where prevention of head movement could result in increasing pressure on the unstable fractured vertebra.[1],[2]

Is our goal trying to prevent pressure on unstable fractured vertebrae that is forceful enough to worsen injuries?

Or are we just trying to create a false impression of doing something useful?

Isn’t this just one more EMS make work fraud for EMS bureaucrats to obsess over?

If we have any interest in patient outcomes, can we defend the current practice of strapping people to boards?

There are good physical and biomechanical reasons why immobilization immediately after the injurious event has little effect. Movement within the spine’s normal range of motion requires little energy and is hence unlikely to result in significant energy deposition to the cord. Even the force generated across the spine by hanging a completely unimmobilized 4-kg head off the end of a stretcher is only equal to approximately 40 N, which is orders of magnitude less than that experienced during the original event.[3]

N = Newtons (Newton or meter-kg/sec2, 1 N = 0.225 pounds of force).

To be continued in Part II.

Footnotes:

[1] Spinal Immobilization Harm
Rogue Medic
Article

[2] More Spinal Immobilization Harm
Rogue Medic
Article

[3] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]

.

Comments

  1. Not only have you begun to expand your final thought from another of your posts, but done so rather well. Kudos…and please continue.