Prehospital care of spinal injuries: a historical quest for reasoning and evidence
The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization.
An extensive search throughout historical literature and recent evidence based studies was conducted.
The history of treating spinal injuries dates back to prehistoric times. Descriptions of prehospital spinal immobilization are more recent and span two distinct periods. First documentation of its use comes from the early 19th century, when prehospital trauma care was introduced on the battlefields of the Napoleonic wars. The advent of radiology gradually helped to clarify the underlying pathology. In recent decades, adoption of advanced trauma life support has elevated in-hospital trauma-care to an high standard. Practice of in-hospital spine immobilization in case of suspected injury has also been implemented as standard-care in prehospital setting. Evidence for and against prehospital immobilization is equally divided in recent evidence-based studies. In addition, recent studies have shown negative side-effects of immobilisation in penetrating injuries.
Although widely implementation of spinal immobilization to prevent spinal cord injury in both penetrating and blunt injury, it cannot be explained historically. Furthermore, there is no high-level scientific evidence to support or reject immobilisation in blunt injury. Since evidence in favour and against prehospital immobilization is equally divided, the present situation appears to have reached something of a deadlock.
KeywordsSpine Immobilization Prehospital Trauma Emergency
Advanced Trauma Life Support
Cervical spine injury
European Trauma Course
National Emergency X-Radiography Utilization Study
Prehospital Trauma Life Support
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 2.Bernhard M, Gries A, Kremer P, Bottiger BW (2005) Spinal cord injury (SCI)—prehospital management. Resuscitation 66(2):127–139. https://doi.org/10.1016/j.resuscitation.2005.03.005 CrossRefPubMedGoogle Scholar
- 9.Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA, J Am Med Assoc 286(15):1841–1848CrossRefGoogle Scholar
- 10.Thies KC, Deakin CD, Lott C, Robinson D, Sabbe MB, Arafat R, Brattebo G, Lippert FK, Rommens PM, Voiglio EJ (2014) The European Trauma Course–trauma teaching goes European. Resuscitation 85(1):19–20. https://doi.org/10.1016/j.resuscitation.2013.06.027 CrossRefPubMedGoogle Scholar
- 18.National Association of Emergency Medical Technicians (U.S.). Pre-Hospital Trauma Life Support Committee, American College of Surgeons. Committee on Trauma (2011) PHTLS: prehospital trauma life support, Military 7 edn. Mosby Jems/Elsevier, St. LouisGoogle Scholar
- 19.Kreinest M, Gliwitzky B, Schuler S, Grutzner PA, Munzberg M (2016) Development of a new emergency medicine spinal immobilization protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med 24:71. https://doi.org/10.1186/s13049-016-0267-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Kornhall DK, Jorgensen JJ, Brommeland T, Hyldmo PK, Asbjornsen H, Dolven T, Hansen T, Jeppesen E (2017) The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med 25(1):2. https://doi.org/10.1186/s13049-016-0345-x CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Adams F (1939) The genuine works of hippocrates (translated from the Greek). Williams & Wilkins, Baltimore, pp 231–242Google Scholar
- 26.Kaviraj K (1911) Sushutra Samhita. Calcutta II(100):284–285Google Scholar
- 35.McSwain NE, Vomacka RW (1990) Prehospital trauma life support. American college of surgeonsGoogle Scholar
- 46.White CCT, Domeier RM, Millin MG (2014) 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. Prehospital Emerg Care 18(2):306–314. https://doi.org/10.3109/10903127.2014.884197 CrossRefGoogle Scholar
- 48.Maughan PH, Ducruet AF, Elhadi AM, Martirosyan NL, Garrett M, Mushtaq R, Albuquerque FC, Theodore N (2013) Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery. Neurosurgery 73(2):271–281. https://doi.org/10.1227/01.neu.0000431468.74591.5f (discussion 281–272) CrossRefGoogle Scholar