The ambulance arrived and the crew accepted your verbal and written SOAP note. They confirmed your findings of upper back and spine pain with good CSM x4 in an alert patient with stable vital signs that are within normal limits. They replaced your improvised collar with a commercial soft collar and with your assistance lifted (BEAM’ed) the patient onto their cot. They secured the patient with the cot straps and a set of head blocks, loaded him into the ambulance, and drove away. Anticipating that your friend would be immobilized with backboard, hard cervical collar, and head blocks you were taken aback by this care.
Although the patient is reliable, sober, not distracted, and has good CSM x4 they also have spine pain and tenderness and based on these findings, there was no reason to perform a focused spine assessment.
After a decade-long anticipatory phase of questioning the need for and merits of the spine immobilization protocols that have been standard urban EMS practices since the early 1970’s (backboard, hard cervical collar, and head blocks for even the suspicion of a spine mechanism of injury) the last few years has seen dramatic and rapid spread of new protocols.
The incentive for changing practice standards is the absence of studies showing spinal immobilization prevents further injury and the presence of studies that show that our spinal immobilization practices are possibly causing harm. We worried for decades that movement of an injured the spine would worsen the condition. There is no data to support this fear. Paranoia and rigid immobilization are making way for careful handling and comfortable patient packaging. Language is changing from spine immobilization to spine protection.
The new approaches to spine care are evolving and vary among services. Over time they will probably settle into a new set of standards. Highlights of the changes are:
Less reliance on cervical collars:
Backboards are reverting to being the extrication tool that they were originally designed to be: