If your loved one has ever been in an accident, you’d know all about the confusion that comes with the various procedures that the paramedics follow. And, while it’s difficult to fully understand all these different procedures, knowing a little about them can allay any possible apprehensions that you might have.
Spinal motion restriction is one such procedure, generally employed while transferring the patient from one unit to another.
Understanding The Term: Spinal Motion Restriction
Spinal motion restriction involves maintaining the spine in proper anatomic alignment and minimizing its movement. It is an important part of treating rare, traumatic spinal cord injuries. Since the mortality rate associated with these injuries is high, preventing the spine from moving too much is considered crucial.
Historically, doctors were afraid of the occurrence of delayed paralysis and the possibility of any missed cervical spine fractures when it came to spinal injuries. And, this drove them to undertake spinal motion restriction on all trauma patients that were to move out of the hospital setting as a standard practice.
Today, however, the use of this treatment method is limited to only certain specific cases. And, in order to restrict movement, long backboards, cervical collars, head blocks, straps, and other devices might be used.1
It is important to note that some professionals tend to use the term “spinal immobilization” in the place of “spinal motion restriction.” However, complete immobilization is not possible, especially during transfers and equipment removal, which is why most experts have been pushing to use the term “motion restriction” instead.2
Injuries That Require Spinal Motion Restriction
Spinal motion restriction might be required in patients who’ve endured injuries due to blunt force trauma as well as any of the following complications
- Inability to communicate
- Altered level of consciousness
- Drug or alcohol intoxication
- Pain or tenderness in the spinal column
- Neurological complaints such as numbness or motor weakness
- Spinal deformity
Additionally, distracting injuries like fractures and burns might need this treatment procedure. During the process of the treatment, the patient in an appropriately-sized C collar, given support with blocks underneath their heads to prevent movement, placed on a stretcher in a supine (horizontal) position, and then transported.3
Generally, patients are asked questions to assess if they’ve been experiencing any pain or tenderness near their spinal column. They are then guided through a series of neck movements to detect any midline pain. The absence of pain in both these situations often rules out the need for spinal restriction.4
Complications Related To Spinal Motion Restriction
Recent research has found that spinal motion restriction might do more harm than good if employed for anything other than the circumstances mentioned above.5 Some of the complications associated with spinal motion restrictions are
- Respiratory impairment
- Restriction in blood supply to tissues (tissue ischemia). This causes dizziness, heart palpitations, and swelling of the feet and abdomen.
- Increased pressure inside the skull (intracranial pressure). This is believed to lead to decreased mental function, headache, and dizziness.
In addition to these, experts have now placed the use of long backboards, specifically, under scrutiny. This is because they are believed to lead to a series of complications such as
- Agitation and anxiety
- Body sores caused due to excessive pressure
Besides these, backboards might lead to invalid or altered results during the physical examination, since the patient’s position is altered to be in a perfect posture. This, in turn, might lead to a delay in treatment.
This is why experts stress on the need for medical staff to train themselves enough to know when to avoid spinal motion restriction. Additionally, some researchers believe that regular training programs, targeted at understanding this procedure reduce the usage of backboards and push the paramedics to try alternative methods of maintaining spine precautions.6
Despite knowing the risks that spinal motion restriction, especially long backboards could cause, statistics show that millions
of patients continue to receive spinal immobilization each year in the United States. This is despite the fact that most of them show no evidence of spinal injuries. Interventions are being made by experts to educate and train paramedics about the accurate ways to use emergency medical services.7
While it might be difficult to keep the details of a spinal motion restriction technique in mind during an emergency situation, you could ask the paramedics to do a thorough test before going ahead with any procedures, so as to reduce the risk of any complications. That said, considering the increased awareness around this technique, you can rest assured that the paramedics will only restrict spinal movement if they suspect a spinal injury.
|↑1||National Registry of EMT’s Resource Document on Spinal Motion Restriction/Immobilization. National Registry Of Emergency Medical Technicians.|
|↑2||Sports medicine experts applaud new spine injury guidelines. Baylor College Of Medicine.|
|↑3||Spinal Motion Restriction. Kitsap County Emergency Medical Services (EMS) and Trauma Care Council.|
|↑4||Neurological Emergency/Spinal Motion Restriction (SMR). Emergency Medical Services Agency, Los Angeles County.|
|↑5||EMS Management of Patients with Potential Spinal Injury. American College Of Emergency Physicians.|
|↑6||Morrissey, James F., Elsie R. Kusel, and Karl A. Sporer. “Spinal motion restriction: an educational and implementation program to redefine prehospital spinal assessment and care.” Prehospital Emergency Care 18, no. 3 (2014): 429-432.|
|↑7||Long Backboard Use for Spinal Motion Restriction. Emergency Nurses Association.|