Spinal Injuries in Motor Vehicle Accidents

Robert Blanchard

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Not all spinal injuries receive the immediate care they need at the scene of an accident. It may be helpful to understand the procedures that emergency personel should go through when presented with a possible spinal injury.

Paramedics and first responders ascribe to the basic tenet of "do no harm." Their routine protocol is to use spinal immobilization for patients with major traumatic injuries, patients whose mechanism of injury is not clear, and patients who may have experienced some trauma. Of course, the initial focus is on cervical spine injuries, and they routinely apply a cervical spine immobilization device, typically a rigid plastic cervical collar. They use a logroll technique when transferring the patient onto a long spine board or rescue board, which avoids unnecessary movement. Once on a spine board, the patient is secured and prepared for transport. Even patients with no spinal tenderness or neurologic deficits are transported in this fashion. The goal of routine spinal immobilization protocols is to avoid injuries during transport and during the prehospital phase.

Once in the hospital, remove the patient from the board as soon as practical. Prolonged use may be uncomfortable and even counterproductive because uncomfortable patients may start moving on the board. Some patients develop skin breakdown and decubitus ulcers, even after 1 hour of use. Controlled transfer, use of a sliding board or scoop system, and the logroll technique can prevent further injury. Adequate personnel are needed to facilitate these transfers.

Once in the Emergency Room, focus the initial assessment and stabilization of patients with spine injuries on the ABCs and patient immobilization. As part of the initial assessment and stabilization, the airway may need to be secured using rapid-sequence intubation and spinal stabilization. Once the ABCs algorithm is satisfied, focus attention on the secondary survey. Quite often, these patients are victims of multiple traumas. Associated injuries, such as brain, thoracic, or abdominal injuries, take precedence. The neurologic examination helps determine the presence of deficits. In the presence of neurologic deficits, hypotension and bradycardia may indicate neurogenic shock.