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Spinal Immobilisation

Spinal immobilisation involves the use of a number of devices and strategies to stabilise the spinal column after injury and thus prevent spinal cord damage. This is widely used in trauma patients with suspected spinal cord injury or patients involved in significant trauma in the pre-hospital setting.

Manual in line protection should be instituted immediately. It is often the case that more pressing needs over-ride immobilisation, like airway management and profuse haemorrhage. The application of definitive immobilisation techniques should not take precedence over life-saving procedures.

If the neck is not in the neutral position, an attempt should be made to achieve alignment. If the patient is awake and co-operative, and it does not greatly increase pain, you should get them to actively move their neck into line. If unconscious or unable to co-operate this is done passively. If there is any neurological deterioration or resistance to movement the procedure should be abandoned and the neck splinted in the current position.

Rescue boards are the primary device used in extrication from vehicles. Repeated transfers to and from the board may compromise spinal protection and induce a significant amount of spinal movement. Recent studies have shown that pressure sores can start to develop as little as 45 minutes from the time a patient is placed on a rescue board. If you use this device as your primary immobilisation tool then bear this in mind.  It suggested that you note the time your patient is placed on a rescue board so as hospital staff are better able to make an assessment as to when it should be removed.

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There has been a trend recently to move away from these boards in favour of orthopaedic stretchers with head blocks. Research findings are responsible for this trend.

Tip!
Use oxygen at high flow with all patients you suspect of having a spinal injury. Oxygen has been shown to reduce spinal cord oedema and so the possibility of damage to the cord.

Tip!
Use two bags of 500ml saline as head immobilisers if you haven't anything that will fit. This is especially handy for kids. Use tape to strap across the forehead over the two bags of saline.

Tip!
Remember other injuries are very likely. If a cervical spine fracture is found:

  • 50% have a fracture at an adjacent level.

  • 15% have a fracture in another part of the cervical spine.

  • 10% Have fractures in thoracic / lumbar spine.

All information in this section is for guidance and advice only and is assumed to be correct at the time of publishing. Check with your local training department before carrying any of the procedures in this section. The Paramedic Resource Centre cannot be held responsible for any error or omission in any page on this site.

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