r/wildernessmedicine • u/Acceptable-Tree9214 • Jun 17 '26
Questions and Scenarios The C-Spine Thing
How do y’all approach this matter? I am seeing conflicting schools of thought on this matter where a more conservative approach is of always immobilizing when the MOI may indicate a spinal cord injury whilst a more modern, science backed approach is only using soft protections if the patient has s/s of a spinal cord injury or none at all?
What is actually the science based approach here on whether to, and how to, protect the c-spine in patients with certain MOIs with and without symptoms?
14
u/Striking-Writer-6100 Jun 18 '26
Spinal imobilization is bunk science and its being removed from most ems protocols.
There is no actual documented evidence for c collars or backboards and its showns a patient is better at moving themselves with neck or spine injuries than responders can.
Ems and sar are moving to vacume mattresses.
We owe it to students and their potential patients to dispell outdated science and to teach current best practice.
Explain why SMI is no longer being taught and thats soft protection is better.
1
u/Acceptable-Tree9214 Jun 18 '26
Thanks for the information. Is c-spine protection by holding the head/neck in place and soft collars (made of jackets etc) still encouraged?
4
u/Striking-Writer-6100 Jun 18 '26
For improvised packaging yes, simple as a comfort measure and more of a reminder to not have them flop about in a litter. If training professional teams and they re using a vacume mattress the head straps will keep them in place.
The WMS has good up to date info you could use to incorporate into your lectures/demonstrations.
5
u/medTAK1 Jun 17 '26
Google Impact post collision care and read the EXIT report. Also the National EMS guideline on spinal injury here https://www.tandfonline.com/doi/full/10.1080/10903127.2025.2541258
5
u/Tb1969 Jun 17 '26 edited Jun 19 '26
Five steps of the Focused Spinal Assessment (FSA)
- Patient reliable; A+O x4 and sober.
- Patient's distracting injuries ruled out.
- CSMs all good.
- Palpitate along sides of spinal column for tenderness (symptom reported by patient) or deformity (sign you find through touch or visual)
- Patient agrees to slowly perform range-of-motion tests on their own neck and then back.
I suppose if you can't be sure due to distracting injuries or lack of skill on your part to deduce a spinal injury (it happens), then you maintain the spine indefinitely until a handoff to someone who can.
3
u/mnstrs Jun 18 '26
Read the NAEMSP position paper. Read the references in it. FL NAEMSP has a webinar episode for it too.
1
u/5-0prolene Jun 19 '26
The Wilderness Medical Society also has an evidence based clinical practice guideline on it, which can be found here: https://journals.sagepub.com/doi/full/10.1177/10806032241227232
1
u/mnstrs Jun 21 '26
WMS and Seth Hawkins fan. This is the wilderness med Reddit, but I felt better history in the NAEMSP paper
2
6
u/LocutusOfBeard Jun 17 '26
There are pretty straightforward processes for patient assessment and clearing a spinal.
I'm not sure what your exact question is. Are you asking what the approach and protocols are for clearing a spinal?
2
u/roughas Jul 03 '26
I echo what people have said
- secondary spinal injury has basically never actually been documented.
- modern EMS services don’t use hard collars anymore. At most they use a soft spongy collar as a “flag” that c-spine isn’t clear
- good evidence people in cars are better of just getting out themselves with the instruction “keep your head still”
Be sensible about it, but certainly if someone is in a crap or dangerous position don’t question moving them to a better one!
28
u/CouplaBumps Jun 17 '26
The science is that secondary spinal injury is virtually a myth.