Pre-hospital Spinal Motion Restriction Guidelines Adult (>16 Years Old) Trauma Patients

NOTS Trauma Center: Maintain manual in-line spinal stabilization until completing a patient assessment 216.778.7850  Patients with only , regardless of whether Reference: deficits are present, should not be placed in SMR  NAEMSP and ACS COT Position  Assume spinal motion restriction is indicated until proven otherwise Statement- EMS and  When in doubt, utilize full spinal motion restriction the Use of the Long Backboard (12-2012)  NEXUS and Canadian C-spine Rule

Patients exhibiting:  and altered level of consciousness Full Spinal Motion Restriction  Any level spinal pain/tenderness and/or significant findings (crepitus, YES  A variety of methods deformity or other irregular findings during palpation of the spine) can be used to achieve  Neurological complaint (i.e. numbness, tingling, motor weakness, etc) full SMR. Page 2 of the  High-energy mechanism of and the presence of: guideline outlines some o Drug or alcohol impairment acceptable methods o Inability to communicate o Distracting injury o Inability to ambulate

NO Patients exhibiting: Limited Spinal Motion  Cervical pain/tenderness during palpation without neurological Restriction findings YES  A variety of methods can  Patients must have: be used to achieve o Normal level of consciousness (GCS = 15) limited SMR. Page 2 of o Ability to communicate the guideline outlines o Ability to ambulate some acceptable

o No drug or alcohol impairment methods o No distracting

 NO

Patients exhibiting: No Spinal Motion Restriction  No spine tenderness or anatomic abnormality YES is indicated  Patients must have:  Special considerations o Normal level of consciousness (GCS = 15) are listed on Page 2 of o Ability to communicate this guideline. Review o Ability to ambulate special considerations o No drug or alcohol impairment that may apply o No distracting injuries 

High Risk Factors:

See bottom High Risk Factors at the bottom of page 2

“right patient, right place, right time” Adopted 03/16 Methods of Achieving Spinal Motion Restriction Adult (>16 Years Old) Trauma Patients

NOTS Trauma Triage Center: Penetrating Trauma without other mechanism of injury (with or 216.778.7850 without deficits ) - Spinal Motion Restriction not indicated Reference:

Appropriate full spinal motion restriction can be achieved using ANY one of the  NAEMSP and ACS COT Position Statement- EMS Spinal Precautions and following options: the Use of the Long Backboard (12-2012)  or towels and blankets minimizing the movement of  NEXUS and Canadian C-spine Rule the cervical spine AND: o A long backboard or Reeves (with sheet under the patient) with voids padded appropriately secured with a High Risk/Suspicion minimum of three straps OR  Document pertinent o A (with sheet under patient) molded to positive and/or negative patient’s body to minimize motion OR findings supporting the o Laying supine on a firm mattress as warranted by assessment, need for full SMR provided efforts are made to reduce spinal motion  If clinical indications

warrant (i.e. respiratory In cases where there is concern that full SMR increases pain or symptoms, distress), may place secure in a position of comfort (with or without c-collar, long board, etc.) patient with longboard or

Reeves in reverse Providers must document pertinent positive and/or negative findings Trendelenberg position supporting the above decision up to 30 degrees. Pad

voids below device.

Appropriate cervical motion restriction can be achieved using ANY one of the following options:  Cervical collar or towels and blankets minimizing the movement of Moderate/Low risk/Suspicion the cervical spine  Document pertinent  Patient’s may be transported in a supine or semi-fowler’s position positive and/or negative depending on the individual patient need findings supporting the need for limited SMR Providers must document pertinent positive and/or negative findings supporting the above decision

Consider High Risk Factors: EMS Provider Judgment:  Patients > 65 years of age, specifically patients with obvious head  If unsure of appropriate trauma (hematoma, lacerations, abrasions, etc.), consider cervical level of SMR, always make motion restriction determination to protect  Osteoporosis or ankylosing spondylitis (inflammatory disease which the patient can fuse the spine, reducing flexibility)  Evaluate SMR patients  Chronic steroid use before and after restriction  Axial loading and document  Inability to ambulate

“right patient, right place, right time”