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.