Every year, between 1million and 5 million people receive spinal immobilization. Of those, between 2% and 5% have a cervical spine injury. Only 1% to 2% have an unstable cervical spine injury; and finally, only 0.5% to 1% have an unstable cervical spine injury without spinal cord damage. (EMSWorld, November 1, 2012) Therefore, up to 99% of all spinal immobilization procedures are unneeded. Typically, spinal immobilization is applied in all trauma scenarios, particularly those scenarios with trauma to the head, neck or back. EMS professionals apply these precautions in the vague hope that it may help, however, the most common reason is CYA.
What EMS professionals don’t think about during the process of spinal immobilization is the potential harm in applying these precautions to patients that don’t require them. An evaluation of the safety and effectiveness of several alternatives to the application of blind immobilization shows that there are more comfortable, easy to use processes available to qualified pre-hospital medical providers.
The reason that spinal immobilization is applied is to prevent permanent damage to the spinal cord. The only way for a pre-hospital provider to prevent spinal cord damage that has not already occurred is to stabilize an unstable fracture. The primary concern here is spinal cord damage in the region of the cervical spine. Damage in this location leads to several deficits that can be extremely detrimental to the future health of the patient. An injury to the spinal cord in the region of C1-C4 is typically fatal. However if a patient does survive, it can lead to quadriplegia or tetraplegia, inability to breathe without mechanical ventilatory assistance, inability to speak, inability to control bladder or bowel function, and will always require 24 hour a day personal care. (Spinalinjuries101)
Patients with spinal cord injuries between C5-C8 will usually survive, however this region is not without it’s detriments when injured. As with a C1-C4 injury, there are several common deficits. Typically there is some to total paralysis in the hands, wrists, trunk and legs, breathing is weakened and there is difficulty with controlling the bladder and bowels. The lower in the spine the injury is, the lower the chances of needing assistive personal care, and almost always these patients are in power wheelchairs, and some are able to drive an adapted car. (Spinalinjuries101)
The defining and common trait among these is an unstable fracture of the cervical spine. So, what exactly is an unstable fracture?
An unstable fracture, of any bone, is one in which the fractured bone, or the bone fragments from that fracture, are in a position in which it is possible for them to move around and cause harm to the surrounding tissues. Obviously, this a highly dangerous scenario when the spinal cord is involved. There are multiple types of cervical fractures, and not all of them are of the immediate concern warranted by an unstable...