Are you required to backboard a patient who was shot in the neck no matter how the patient is presenting? 
That is the entire question that was asked at The Paramedic’s Edge.
There are really several questions being asked.
1. If there is a minor injury, with no neurological deficits, is there any reason to immobilize the patient?
Many responded with variations of – We don’t know where the bullet is, so we must immobilize the patient.
That would make sense – if there were any reason to believe that backboards and/or collars do anything to keep bullets from moving, or if they did anything to protect the spine from bullet injuries.
2. If there are life-threatening injuries to the neck, how will application of a collar help?
3. If the airway is severely compromised, will a collar and board make things better?
4. Why do we think that a simple splint is the correct treatment for a potential injury to a complex series of bones and joints?
I do not know the position of ITLS (International Trauma Life Support Courses), but PHTLS (PreHospital Trauma Life Support) has made their position clear on this.
Present prehospital management of penetrating injuries to the head, neck, and torso is based on the premise that the spine is injured until proven otherwise and full immobilization will prevent further propagation of any injury. A review of the trauma literature does not support this practice.
What is the policy of PHTLS on immobilization for penetrating injuries?
- There are no data to support routine spine immobilization in patients with penetrating trauma to the neck or torso.
- There are no data to support routine spine immobilization in patients with isolated penetrating trauma to the cranium.
- Spine immobilization should never be done at the expense of accurate physical examination or identification and correction of life-threatening conditions in patients with penetrating trauma.
- Spinal immobilization may be performed after penetrating injury when a focal neurologic deﬁcit is noted on physical examination although there is little evidence of beneﬁt even in these cases.
This is very interesting.
There are no data to support routine spine immobilization in patients with penetrating trauma to the neck or torso.
What about the absence of data to support routine spine immobilization in patients with
penetrating blunt trauma to the neck or torso or anywhere else?
Spine immobilization should never be done at the expense of accurate physical examination or identification and correction of life-threatening conditions in patients with penetrating trauma.
But immobilization is more important than life when it is for blunt trauma?
Spinal immobilization may be performed after penetrating injury when a focal neurologic deﬁcit is noted on physical examination although there is little evidence of benefit even in these cases.
Where is this little evidence of benefit?
The authors spend some time describing the different levels of evidence, but where is the evidence that spinal cord injury due to blunt trauma is prevented, or lessened, with backboards and EMS collars?
Here is the only place the authors appear to give a reference supporting the use of backboards and EMS collars for blunt trauma.
Although blunt spinal column injuries will occasionally produce unstable vertebral injuries, which may result in subsequent neurologic propagation if not managed appropriately in the ﬁeld, this has not been demonstrated to be the case with penetrating trauma.1 
Does the referenced paper actually support the use of backboards and EMS collars for blunt trauma?
All but two patients had complete injuries at admission. One patient with incomplete injury and another that was neurologically intact had early complete cervical cord injuries after cervical immobilization.
The patients got worse after cervical immobilization?
Four of the ﬁve patients in the early group (mean age 56 years) developed neurologic worsening during application of cervical immobilization less than 24 hours after injury.
Neurologic deterioration during the application of cervical immobilization is not evidence that immobilization with backboards and EMS collars improves outcomes.
In the other patient with ankylosing spondylitis the injury progressed from C5 to C3 ASIA A CSCI during traction and immobilization. The third patient had an incomplete central cord injury (C4 ASIA D) after a fall. In the emergency department, the patient was extremely agitated and would not remain recumbent while immobilized in a rigid cervical collar. The injury quickly ascended to a C4 complete CSCI with the patient’s selfmanipulation of his neck. The fourth patient was an obese woman with a C8 ASIA A severe central cord injury after a fall whose injury ascended to a C5 ASIA A level after halo vest placement because her body habitus precluded adequate immobilization.
The best than can be said about immobilization for blunt trauma based on this paper is –
We need to figure out what we are doing.
The status quo is more of a status FUBAR.
The paper is from a regional spine center, so these are not a bunch of Yahoos.
Back to the original question – Should we be using backboards and EMS collars on patients with penetrating trauma?
The more important question is Should we be using backboards and EMS collars on patients with any trauma?
I don’t see any evidence to justify this intervention.
 Prehospital spine immobilization for penetrating trauma–review and recommendations from the Prehospital Trauma Life Support Executive Committee.
Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE.
J Trauma. 2011 Sep;71(3):763-9; discussion 769-70. doi: 10.1097/TA.0b013e3182255cb9. Review. No abstract available.
PMID: 21909006 [PubMed - indexed for MEDLINE]
 The cause of neurologic deterioration after acute cervical spinal cord injury.
Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):340-6.
PMID: 11224879 [PubMed - indexed for MEDLINE]
Stuke, L., Pons, P., Guy, J., Chapleau, W., Butler, F., & McSwain, N. (2011). Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations From the Prehospital Trauma Life Support Executive Committee The Journal of Trauma: Injury, Infection, and Critical Care, 71 (3), 763-770 DOI: 10.1097/TA.0b013e3182255cb9
Harrop, J., Sharan, A., Vaccaro, A., & Przybylski, G. (2001). The Cause of Neurologic Deterioration After Acute Cervical Spinal Cord Injury Spine, 26 (4), 340-346 DOI: 10.1097/00007632-200102150-00008