EMS Immobilization Techniques

Emergency medical services (EMS) personnel remain the first-line responders for the majority of out-of-hospital emergencies, including trauma situations. The ATLS guidelines (advanced trauma life support), developed in the 1980s, remain the gold standard for assessing and prioritizing the management of life-threatening injuries in a time-efficient, logical manner. Immobilization of the spine has been an essential part of the teaching in addition to pelvic binders and splinting of long bone fractures. Different types of medical equipment have been developed to enhance effectiveness and ease of application, while also providing flexibility and vital access for the management of airway and other procedures.  The need for spinal immobilization is determined during scene assessment and patient evaluation. Consider spinal immobilization when the mechanism of injury creates a high index of suspicion for head or spinal injury. Altered mental status and neurologic deficit are also indicators that spinal immobilization should be considered. The traditional ATLS teaching for adequate spinal immobilization of a patient in a major trauma situation is a well-fitted hard collar with blocks and tape to secure the cervical spine, in addition to a backboard to protect the rest of the spine. Other devices currently in use are the scoop stretcher and the vacuum splint. The Kendrick extrication device protects the spine while the casualty is in a seated position during rapid extrication from a vehicle or other situations with limited access, allowing a full backboard. This, however, still requires the EMS to pay attention to limiting cervical spine movement using in-line mobilization until fitted. The 10 edition of the ATLS guidelines and the consensus statement of the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, National Association of EMS Physicians (NAEMSP) states that in the situation of penetrating trauma, there is no indication for spinal movement restriction this in keeping with a retrospective study of the American trauma data bank showed a very low number of unstable spinal injuries needing surgery in the context of penetrating trauma. The study also demonstrates that the number needed to treat to achieve a potential benefit was far higher than the number needed to harm, at 1032 compared with 66. However, in the case of significant blunt trauma, the restrictions continue to be indicated in the following situations: Low Glasgow coma scale or evidence of alcohol and drug intoxication. Midline tenderness in the back of the cervical spine. Obvious spinal deformity. The presence of other distracting injuries .