Prehospital spinal care: It is time to reconsider and revise

In their commentary “Not Yet Time to Abandon Cervical Collars in Blunt Trauma”1 Baron and Scalea argue that since there are no randomized trials of cervical motion restriction we should “immobilize” place collars on (all?) blunt trauma patients until they arrive the hospital. These recommendations longer “standard care.” Prehospital providers have been safely clearing low-risk for decades.2, 3 It apparently does not require a medical degree apply five-step algorithms. is certainly prudent continue deliver spine specific care high-risk can be fully evaluated treated but many traditional methods—cervical collars, slippery “backboards,” mechanical immobilization uncooperative or seizing patients, standing backboards, forceful head stabilization during airway management irrational obsolete ways doing this.4 The goal spinal minimize energy deposition (work) at injury site—this simply Newtonian physics. Restricting movement may accomplish this. Although do restrict so by redistributing force hence other parts body. This clearly desirable if redistribution actual site. also act as lever such increase lower thorax. direct evidence harm from immobilization, benefit either epidemiologic it harmful.5 Classic methods distractive spine, make more difficult, preclude access anterior neck, upper Prolonged hard surface hurts will eventually cause tissue necrosis. real, theoretical, problems effect all just few with treatable injuries. needs maximize long-term outcomes minimizing deterioration due inadequate inappropriate care. protected through selective care, careful transport, management, sedation when necessary, use lateral restraints, which absorb rather than redistribute energy.4