A study analysing the practice of spinal motion restriction (SMR) between 2009 and 2019 has been published in a recent issue of the journal Academic Emergency Medicine (AEM), and sheds light on the trends and evolution of SMR practices within an urban, North American emergency medical services (EMS) agency.
Key findings from the study—titled “Patterns of change in prehospital spinal motion restriction: a retrospective database review”—include a significant decrease in the prehospital use of cervical immobilisation and backboards between 2009 and 2019.
There was also a decline in the combination of cervical immobilisation and backboard use, which decreased from 31% to 12% over the study period. This decline was not attributed to protocol changes but rather appeared to be part of a secular trend, particularly evident in cases involving minor mechanisms of trauma.
International training guidelines teach the treatment of potential spine injuries as a core skill in both the emergency department and the prehospital environment. Over the past decade, however, these guidelines have been substantially revised. Past practice—termed ‘spinal immobilisation’ (SI)—most often positioned patients at risk of spine injury supine on a long, rigid backboard and immobilised them with straps, a rigid cervical collar, and head blocks.
More recently, SMR has addressed the adverse effects of immobilisation, as well as the limitations of its potential benefits. SMR also typically allows more leeway in treatment options depending on patient presentation. But, despite widespread adoption of the principles of SMR, practices and specific guidelines vary.
The lead author of this article is Neil McDonald (University of Manitoba, Winnipeg, Canada). McDonald et al conclude that the decreasing trend in SI/SMR treatment needs to be investigated elsewhere. Ongoing research at their EMS practice is also set to investigate how these treatment trends may affect patient outcomes.