Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Original research

Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers

Authors: Michael Kreinest, Bernhard Gliwitzky, Svenja Schüler, Paul A. Grützner, Matthias Münzberg

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Login to get access

Abstract

Background

In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined.
The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel.

Methods

A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol.

Results

Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol.

Discussion

Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support.

Conclusions

The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular.
Literature
1.
Davis JW, Hoyt DB, McArdle MS, Mackersie RC, Eastman AB, Virgilio RW, Cooper G, Hammill F, Lynch FP. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma. 1992;32:660–5. discussion 665–666.CrossRefPubMed
2.
Wölfl CG, Bouillon B, Lackner CK, Wentzensen A, Gliwitzky B, Groß B, Brokmann J, Hauer T. Prehospital Trauma Life Support® (PHTLS®). Der Unfallchirurg. 2008;111:688–94.CrossRefPubMed
3.
4.
Toscano J. Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia. 1988;26:143–50.CrossRefPubMed
5.
Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma. 1987;27:445–7.CrossRefPubMed
6.
Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5:214–9.CrossRefPubMed
7.
Abram S, Bulstrode C. Routine spinal immobilization in trauma patients: what are the advantages and disadvantages? Surgeon. 2010;8:218–22.CrossRefPubMed
8.
Sundstrom T, Asbjornsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31:531–40.CrossRefPubMedPubMedCentral
9.
Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Australas Emerg Nurs J. 2015;18:118–37.CrossRefPubMed
10.
Deasy C, Cameron P. Routine application of cervical collars--what is the evidence? Injury. 2011;42:841–2.CrossRefPubMed
11.
Askins V, Eismont FJ. Efficacy of five cervical orthoses in restricting cervical motion. A comparison study. Spine (Phila Pa 1976). 1997;22:1193–8.CrossRef
12.
McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15:50–3.CrossRefPubMed
13.
James CY, Riemann BL, Munkasy BA, Joyner AB. Comparison of Cervical Spine Motion During Application Among 4 Rigid Immobilization Collars. J Athl Train. 2004;39:138–45.PubMedPubMedCentral
14.
Horodyski M, DiPaola CP, Conrad BP, Rechtine 2nd GR. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41:513–9.CrossRefPubMed
15.
Chandler DR, Nemejc C, Adkins RH, Waters RL. Emergency cervical-spine immobilization. Ann Emerg Med. 1992;21:1185–8.CrossRefPubMed
16.
Hostler D, Colburn D, Seitz SR. A comparison of three cervical immobilization devices. Prehosp Emerg Care. 2009;13:256–60.CrossRefPubMed
17.
Stone MB, Tubridy CM, Curran R. The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med. 2010;17:100–2.CrossRefPubMed
18.
Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27:647–9.CrossRefPubMed
19.
Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17:135–7.CrossRefPubMed
20.
Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med. 1991;17:504–5.CrossRefPubMed
21.
Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56:511–3.CrossRefPubMed
22.
Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72:389–91.CrossRefPubMed
23.
Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17:915–8.CrossRefPubMed
24.
Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344–8.CrossRefPubMed
25.
Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012;29:104–7.CrossRefPubMed
26.
Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26:31–6.CrossRefPubMed
27.
Chan D, Goldberg R, Tascone A, Harmon S, Chan L. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med. 1994;23:48–51.CrossRefPubMed
28.
Chan D, Goldberg RM, Mason J, Chan L. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med. 1996;14:293–8.CrossRefPubMed
29.
Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards. Prehosp Emerg Care. 2010;14:419–24.CrossRefPubMed
30.
Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72 Suppl 2:22–34.CrossRefPubMed
31.
32.
White CC, Domeier RM, Millin MG. EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18:306–14.CrossRefPubMed
33.
Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60 Suppl 1:82–91.CrossRefPubMed
34.
35.
Connor D, Greaves I, Porter K, Bloch M. Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J. 2013;30:1067–9.CrossRefPubMed
36.
Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE, 3rd, Chang DC. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010;68:115–20. discussion 120–111.CrossRefPubMed
37.
Vaillancourt C, Stiell IG, Beaudoin T, Maloney J, Anton AR, Bradford P, Cain E, Travers A, Stempien M, Lees M, et al. The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Ann Emerg Med. 2009;54:663–671.e661.CrossRefPubMed
38.
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. Jama. 2001;286:1841–8.CrossRefPubMed
39.
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.CrossRefPubMed
40.
Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. 2001;38:17–21.CrossRefPubMed
41.
Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006;61:161–7.CrossRefPubMed
42.
Meldon SW, Brant TA, Cydulka RK, Collins TE, Shade BR. Out-of-hospital cervical spine clearance: agreement between emergency medical technicians and emergency physicians. J Trauma. 1998;45:1058–61.CrossRefPubMed
43.
Barkana Y, Stein M, Scope A, Maor R, Abramovich Y, Friedman Z, Knoller N. Prehospital stabilization of the cervical spine for penetrating injuries of the neck - is it necessary? Injury. 2000;31:305–9.CrossRefPubMed
44.
Armstrong BP, Simpson HK, Crouch R, Deakin CD. Prehospital clearance of the cervical spine: does it need to be a pain in the neck? Emerg Med J. 2007;24:501–3.CrossRefPubMedPubMedCentral
45.
Lin HL, Lee WC, Chen CW, Lin TY, Cheng YC, Yeh YS, Lin YK, Kuo LC. Neck collar used in treatment of victims of urban motorcycle accidents: over- or underprotection? Am J Emerg Med. 2011;29:1028–33.CrossRefPubMed
46.
Boissy P, Shrier I, Briere S, Mellete J, Fecteau L, Matheson GO, Garza D, Meeuwisse WH, Segal E, Boulay J, Steele RJ. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 2011;21:80–8.CrossRefPubMed
47.
Connell RA, Graham CA, Munro PT. Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma? Injury. 2003;34:912–4.CrossRefPubMed
48.
Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE. Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma. 2011;71:763–9. discussion 769–770.CrossRefPubMed
49.
Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976). 1999;24:1839–44.CrossRef
50.
Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32:461–9.CrossRefPubMed
51.
Vaillancourt C, Charette M, Kasaboski A, Maloney J, Wells GA, Stiell IG. Evaluation of the safety of C-spine clearance by paramedics: design and methodology. BMC Emerg Med. 2011;11:1.CrossRefPubMedPubMedCentral
52.
Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol. 1990;155:465–72.CrossRefPubMed
53.
Dunn TM, Dalton A, Dorfman T, Dunn WW. Are emergency medical technician-basics able to use a selective immobilization of the cervical spine protocol?: a preliminary report. Prehosp Emerg Care. 2004;8:207–11.PubMed
54.
Burton JH, Harmon NR, Dunn MG, Bradshaw JR. EMS provider findings and interventions with a statewide EMS spine-assessment protocol. Prehosp Emerg Care. 2005;9:303–9.CrossRefPubMed
55.
Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM. Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care. 1997;1:11–5.CrossRefPubMed
56.
Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46:123–31.CrossRefPubMed
57.
Domeier RM, Evans RW, Swor RA, Hancock JB, Fales W, Krohmer J, Frederiksen SM, Shork MA. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehosp Emerg Care. 1999;3:332–7.CrossRefPubMed
58.
Hanson JA, Blackmore CC, Mann FA, Wilson AJ. Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening. AJR Am J Roentgenol. 2000;174:713–7.CrossRefPubMed
59.
Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, Zimmermann H, Lecky F. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J. 2011;20:2174–80.CrossRefPubMedPubMedCentral
60.
Bortsov AV, Platts-Mills TF, Peak DA, Jones JS, Swor RA, Domeier RM, Lee DC, Rathlev NK, Hendry PL, Fillingim RB, McLean SA. Pain distribution and predictors of widespread pain in the immediate aftermath of motor vehicle collision. Eur J Pain. 2013;17:1243–51.CrossRefPubMedPubMedCentral
61.
Agrawal A. Cervical spine clearance: a review and understanding of the concepts. JNMA J Nepal Med Assoc. 2008;47:244–50.PubMed
62.
Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care. 1999;3:1–6.CrossRefPubMed
63.
Myers LA, Russi CS, Hankins DG, Berns KS, Zietlow SP. Efficacy and compliance of a prehospital spinal immobilization guideline. Int J Emerg Med. 2009;2:13–7.CrossRefPubMedPubMedCentral
64.
Anderson PA, Muchow RD, Munoz A, Tontz WL, Resnick DK. Clearance of the asymptomatic cervical spine: a meta-analysis. J Orthop Trauma. 2010;24:100–6.CrossRefPubMed
Metadata
Title
Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers
Authors
Michael Kreinest
Bernhard Gliwitzky
Svenja Schüler
Paul A. Grützner
Matthias Münzberg
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0267-7

Other articles of this Issue 1/2016

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016 Go to the issue

Original research

Myocardial function at the early phase of traumatic brain injury: a prospective controlled study

Original research

The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming

Review

Effectiveness of non invasive external pelvic compression: a systematic review of the literature

Original research

A randomised controlled trial of cognitive aids for emergency airway equipment preparation in a Paediatric Emergency Department

Original research

Post-traumatic acute kidney injury: a cross-sectional study of trauma patients

Original research

Initial assessment and treatment of refugees in the Mediterranean Sea (a secondary data analysis concerning the initial assessment and treatment of 2656 refugees rescued from distress at sea in support of the EUNAVFOR MED relief mission of the EU)