Spinal Motion Restriction

May 7, 2019

Host:

Floyd Besserer - Emergency Physician, Critical Care Paramedic and Medical Consultant to BCEHS for the Northern Interior Region

Guests:

Ole Olson - Critical Care Paramedic and Paramedic Practice Leader with BCEHS

Jan Trojanowski - Emergency Physician, Intensivist and BCEHS Medical Director for the Vancouver Coastal Region

Episode Description:

Dr. Floyd Besserer hosts Ole Olson and Jan Trojanowski to discuss the recent changes to the BCEHS guidelines for spinal motion restriction. Criteria regarding specific populations, such as geriatric and pediatric patients, are discussed. Considerations for cervical and thoracolumbar spinal injuries are reviewed, including the NEXUS criteria. This episode also describes the challenges of the clam shell, with key points on the role of backboards and spinal immobilization from the consensus statement of the The American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP). Lastly, Dr. Besserer touches on the importance of proper documentation, with some brief points on good practices suggested by the Canadian Medical Protective Association.

Show Notes:

Points to Remember: 

• NEXUS criteria applies to spinal injuries above the clavicles for patients ages 16-65.
• For patients > 65 years of age, minor mechanisms (fall from a standing height) can result in major spinal injuries and requires SMR.
• Consider alternatives such as towels or foam blocks to immobilize pediatric spinal injuries if the hard collar is not tolerated.
• Avoid sitting patient up or raising head of stretcher if patient passes the NEXUS criteria but a thoracolumbar spine injury is still suspected.
• Include all relevant information in documentation, such as mechanism of injury, extrication history, timing of application and reasoning for why patient was or was not placed in SMR.

NEXUS Criteria Mnemonic: Say No to NSAID

N Neurologic deficit

S Spinal tenderness

A Altered level of consciousness

I Intoxication

D Distracting injury

References:

BCEHS Handbook: Adult Spinal Motion Restriction

https://handbook.bcehs.ca/clinical/trauma/adult-spinal-motion-restriction-smr/

BCEHS Handbook: Pediatric Spinal Motion Restriction

https://handbook.bcehs.ca/clinical/pediatrics/pediatric-spinal-motion-restriction-smr/

National Association of EMS Physicians: Spinal Motion Restriction in the Trauma Patient – A Joint Position Statement

https://naemsp.org/home/news/spinal-motion-restriction-in-the-trauma-patient-%E2%80%93/