The EMS standard of care for blunt trauma patients has been to fully immobilize the spine before transporting to an emergency department. This is such a common practice that it is frequently applied to victims of penetrating trauma prior to transport.
A recent study in the Journal of Trauma calls this practice in question, and suggests that it may increase mortality! The authors reviewed data in the National Trauma Data Bank, looking at information on penetrating trauma patients. They found that approximately 4% of these patients underwent spine immobilization.
Review of mortality statistics found that the mortality in non-immobilized (7%) doubled to 14% in the immobilized group!
The authors also found that medics would have to fail to immobilize over 1000 patients to harm one who really needed it, but to fully immobilize 66 patients who didn’t need it to contribute to 1 death.
Although this type of study can’t definitely show why immobilization in these patients is bad, it can be teased out by looking at related research. Even the relatively short delays caused by applying collars and back boards can lead to enough of a delay to definitive care in penetrating trauma patients that it could be deadly. The assumption in all of these patients is that they are bleeding to death until proven otherwise.
A number of studies have suggested that a “limited scene intervention” to prehospital care is best. The assumption is that the most effective treatment can only be delivered at a trauma center, so rapid transport with attention to airway, breathing and circulation is the best practice.
While interesting, some real-life common sense should be applied by all medics who treat these types of patients. The reality is that it is nearly impossible to destabilize the spine with a knife, so all stab victims can be transported without a thought to spine immobilization. Gunshots can damage the spine and spinal cord, so if there is any doubt that the bullet passed nearby, at least simple precautions should be taken to minimize spine movement.
Reference: Spine Immobilization in Penetrating Trauma: More Harm Than Good? Haut et al, Johns Hopkins. J Trauma 68(1): 115-121, 2010.