Education forum handout on spinal immobilisation evidence

1. Spinal Immobilisation and Extrication
 Most injuries to the cervical spine are due to motor vehicle accidents
 Estimated that up to 20 000 cases of spinal cord injuries occur annually in Northern Europe and the USA
 Estimated that up to one-quarter of spinal cord injuries may be significantly worsened during transport or early treatment
hence recommendation for full immobilization
 Current evidence base for spinal immobilisation techniques during prehospital extrication is poor
Review articles
Dixon et al (2013) EMJ – Biomechanical analysis of spinal immobilisation during prehospital extrication: a
proof of concept study. [PMID: 23811859]
 11-camera motion-capture system was used to track markers on the head, neck, and trunk on patients extricated from a
real car. Volunteers were healthy EMS personnel.
 Standard extrication techniques can record up to four times more cervical spine movement during extrication than
controlled self-extrication
Shafer et al (2009) West J Emerg Med – Cervical spine motion during extrication: a pilot study. [PMID:
19561822]
 Six-camera motion-capture system was used to track markers on the head, neck, and trunk on patients extricated from a
mock car. Volunteers were healthy EMS personnel.
 Least movement of the cervical spine was in subjects who had a cervical collar applied and were allowed to simply get out of
the car and lie down on a stretcher
 Extricating the driver/subject head-first by standard technique to a long spine board was associated with significant cervical
spine motion
Engsberg et al (2013) J Emerg Med Cervical Spine Motion during Extrication[PMID: 23079144]
 Camera motion-capture system was used to track markers on the head, neck, and trunk on patients extricated from a mock
car
 There was a decrease in movement for all motions when the driver exited the vehicle unassisted with cervical collar
protection, compared to exiting unassisted and without protection. However, no movement reduction was observed in an
event (i.e., Recline on board) with both paramedic assistance and protection.