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Well, one cat's outta the bag. In the continued debate over the efficacy of prehospital spinal immobilization, it would appear from a study published the January 2010 issue of the Journal of Trauma that prehospital spinal immobilization doubles the risk of death for certain patients. Researchers at Johns Hopkins looked at 45,284 penetrating trauma patients in the National Trauma Data Bank. Of these, patients who received prehospital spinal immobilization consistently had double the mortality of those who did not receive this time consuming and potentially compromising treatment in the field. Curiously, 30 of the 45,284 patients who were shot or stabbed actually had spinal injuries (0.01%). Yet, further analysis demonstrated it took immobilizing only 66 patients to result in one death; saving one life with spinal immobilization took 1,032 backboard jobs. Hmmm, that translates to causing more than 15 deaths in order to save one life. Jeepers! Not very hard to see why the authors concluded that prehospital spinal immobilization results in higher mortality in patients with penetrating trauma and should not be routinely used. Another example of dumb stuff we gotta do. Hopefully, changes are coming.

Mike McEvoy
EMS Editor - Fire Engineering

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Comment by Karen M. Myers on July 31, 2010 at 3:43am
I am a brand new EMT and this goes against my training but it makes a lot of sense. I will be interested to see what comes of this in the future. I am glad it has now been brought to my attention.
Comment by John K. Murphy on May 24, 2010 at 7:32pm
Interesting facts. Change of training or increased diagnotic training for the EMT's or PM's?
Comment by Shaun on April 20, 2010 at 9:46am
If you take A PHTLS class it is right there in the text for penatrating trauma. If no neurological damage is done during the time of insult, there is a low chance for a spinal injury and board and collar are not needed
Comment by Alan M Glogovsky on April 2, 2010 at 3:42am
I think most of the patients are boarded because responders would rather over treat a pt and avoid any possible acusations of mis treatment. I've been to plenty of call where there has been no damage or the patient has a scratch where you need a microscope to find it. I would love to see changes in this but i don't think anything will change soon
Comment by Russ Chapman on March 23, 2010 at 3:35pm
Mike

What was the reason? Airway management? Allowing a PT to sit up so fluids in lungs will drop down? I agree with you. I was an inner city medic for over 20 years. I constantly sat GSW pts up, unless there was parastesia. This is very interesting.
Comment by Scot Sabins on February 12, 2010 at 8:13pm
Here in Maine, we did participated in a study directed by a local medical director & we have had for about 6 or 8 years a protocol which allows us to not backboard & collar a patient because of the potential injuries we were causing to our patients. It took a while to get used to it nut now it is second nature to go through the protocols & rule out a spinal injury. We can also call our local medical control if we have any questions. You can view the State of Maine protocols on the State website.

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