3-2 SELECTIVE SPINAL PROTECTION

The following protocol is designed to selectively exclude patients from unnecessary and potentially harmful, spinal precautions when a low index of suspicion of injury and reassuring assessment is present.

For patients with a potential spinal injury, perform routine trauma assessment while manually stabilizing the cervical spine.

1. If any of the following apply to the patient, spinal protection is indicated:
   1. Significant mechanism of injury?
   2. Altered level of consciousness?
   3. Neuro exam: Does the patient have any focal neurologic deficit (either transient or sustained)?
   4. Spinal exam:  Point tenderness over spinous process(es) or pain during Range of Motion exam?
   5. >65 y/o or <5 y/o?
   6. Evidence of impairment by drugs/alcohol?
   7. Are painful distracting injuries present?
2. If the answer is NO to all of the above questions, spinal protection may be deferred.
   1. All deferred spinal protection shall have the criteria listed above documented in the patient care report.  When in doubt use spinal protection.
3. Mechanisms suggestive of a potential spinal injury include, but are not limited to:
   1. Fall from a height 2X the patient’s height, or any fall with evidence of striking head.
   2. Blunt trauma.
   3. MVC with > 30mph velocity differential
   4. Any trauma where the patient was thrown (auto vs. pedestrian, explosion, etc.)
   5. Lightning or high voltage electrical injury.
   6. Axial loading injury (diving impact, trauma to top of head)
4. Distracting injury:  Any pain sufficient to interfere with the patient’s ability to cooperate with the assessment, including both medical and traumatic etiologies.

If SPINAL PROTECTION is indicated:

1. Manually keep head, neck, and spine midline.  Explain procedure to the patient.  Assess CMS.  Stabilize the neck with a well fitted cervical collar, hard blocks, blanket rolls, or other stabilization techniques.  Patients who are already walking or standing should be laid directly on the ambulance stretcher and secured to the stretcher with seatbelts.
2. Backboards and scoop stretchers are designed for and should only be used as extrication tools to move patients.  Once extricated and moved, patients should be taken off the backboard/scoop stretcher if possible and placed directly on the ambulance stretcher.  It is acceptable to leave a patient on a backboard/scoop stretcher for transport, but every effort should be made to secure the patient to the stretcher and not the backboard/scoop stretcher.
3. Decisional patients have the right to refuse aspects of treatment including spinal protection.  If the patient refuses spinal protection after being informed of possible permanent paralysis, do not attempt spinal protection and document the patient’s refusal in the patient care report.

Patients with Penetrating Trauma:

Patients with penetrating traumatic injuries should only have spinal protection used if a focal neurological deficit is noted during the physical exam.