Wilderness and Rescue Medicine 8th Edition

Chapter 15: Spine Injury

Stabilizing the spine has been a standard of care in trauma management for emergency medical services (EMS) since the early 1970s. The chief concern was similar to that with other musculo- skeletal trauma: an unstable injury to the bones and ligaments of the spinal column could exacer- bate injury to the surrounding soft tissue. In the case of the spine, the soft tissue of greatest concern is the spinal cord and its associated blood supply. In the conventional EMS setting, it was protocol to align, stabilize, and package a patient in all situa- tions where there is a mechanism for spine injury (MOI). This was considered a “better safe than sorry” practice that was perpetuated for decades with little acknowledgment of the associated risks.

In recent years, however, the practice has been used much more selectively, especially in the wilderness or technical rescue setting where full-body stabilization can substantially increase the complexity of medical care, evacuation, and risk to rescuers and the patient. In most juris- dictions pre-hospital providers have been given the responsibility and freedom to identify those patients for whom this risk is clearly justified, and to avoid increasing risk where there is little or no benefit. This judgment is based on the severity of spine injury, critical system problems, environ- mental factors, available resources, and the dif- ficulty of evacuation. The goal is to reduce risk to the entire patient and the rescue effort as well as to the spine itself. The term positivemechanismof injury (MOI) describes any event that could cause damage to the spinal column or cord. A 6-meter fall onto a rock ledge is a positive MOI. A stiff neck from sleeping on a rock ledge is not. For less straight- forward injuries, the MOI is based on the scene size-up, description of the event, and presence of other injuries. There is a significant association between traumatic brain injury and spine injury. Severe chest and abdominal trauma should also raise the suspicion of associated spine injury. If you believe that enough force was involved, it is a positive MOI.

General Principles

Spinal Column and Cord Structure: • spinal column • spinal cord Function:

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• support and protection • CNS communication Problem: • low-risk column injury • high-risk column or cord injury

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