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Spinal Motion Restriction Guidelines

Written by Vivian Lei

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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 offered a joint consensus statement on spinal motion restriction (SMR) in trauma patients.

Why does this matter?
Trauma patients with unstable spinal column injuries can suffer significant neurological injury due to excessive movement of the spine. The goal of SMR in the trauma patient is to minimize unwanted movement of the potentially injured spine. This is the first time these three groups have developed a joint statement on this topic.

Highlights of the Guidelines

  • SMR can be achieved with a backboard, scoop stretcher, vacuum splint, ambulance cot, or other similar device to which a patient is safely secured.

  • Indications for SMR following blunt trauma:

    • Acutely altered level of consciousness (e.g., GCS <15, evidence of intoxication)

    • Midline neck or back pain and/or tenderness

    • Focal neurologic signs and/or symptoms (e.g., numbness or motor weakness)

    • Anatomic deformity of the spine

    • Distracting circumstances or injury (e.g., long bone fracture, degloving, or crush injuries, large burns, emotional distress, communication barrier, etc.) or any similar injury that impairs the patient’s ability to contribute to a reliable examination

  • SMR should apply to the entire spine. This necessitates the use of an appropriately sized cervical collar.

  • Patients should be removed from a long backboard, scoop stretcher, or vacuum mattress as soon as possible after arrival at the hospital.

  • There is no role for SMR in penetrating trauma.

  • SMR in children should not be based on age alone despite possible communication barriers.

  • The rate of contiguous multilevel injury in children is extremely low at 1%. The rate of noncontiguous multilevel injury in children is thought to be equally as low.

  • Cervical collars should be applied in pediatric patients for the following findings:

    • Complaint of neck pain

    • Torticollis

    • Neurologic deficit

    • Altered mental status including GCS <15, intoxication, and other signs (agitation, apnea, hypopnea, somnolence, etc.)

    • Involvement in a high-risk motor vehicle collision, high impact diving injury, or substantial torso injury

  • Minimize time spent on backboards. Additional padding under the shoulders may be necessary in young children to avoid substantial cervical spine flexion due to the increased head size to body ratio compared to adults.

Source
Spinal Motion Restriction in the Trauma Patient – A Joint Position Statement.  Prehosp Emerg Care. 2018 Aug 9:1-3. doi: 10.1080/10903127.2018.1481476. [Epub ahead of print]

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Reviewed by Clay Smith 

3 Comments

  1. As an ER doc, EMS Physician and a member of the National Association of EMS Physicians, I would advocate that in your highlights of the Guidelines you missed this very important point: backboards do not equal SMR.

    Yes, SMR is important. But as a whole, EMS guidelines are restricting (some systems even prohibiting) the use of backboards during transport. Backboards should be used as extrication devices as needed but for transport to the hospital keeping a patient in SMR with a cervical collar and gurney has been shown to decrease the risks associated with backboards (increased pain, decreased tidal volumes, increased rate of imaging) and is just as effective in immobilizing the spine.

    This is important because though this position statement was released, it did not change the position on backboard use. Your readers should expect their patients to arrive to the ED in SMR, but less of them will be on backboards!

  2. Dorothy, how would they ever get the patient to the gurney from the location they were found at or from the backboard they used for extrication?

    Hospital beds are wide, so you can roll the patient off, but the few times I have tried rolling a patient off a backboard while they were still on the paramedic gurney has been pretty…rough….especially with all their straps getting caught under patient as someone tries to pull them out, jostling the patient.

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