By Art Hsieh
EMS1 Advisor
This article and study reinforces how evidence-based medicine changes practices that we have taken for granted. In this case, the American College of Surgeons has advocated for several years that a patient who has experienced penetrating trauma and does not have signs and symptoms of neurologic deficit does not need spinal immobilization. While this position may be controversial, studies like these show that not only is it not necessary, it can in fact be detrimental to the patient’s outcome.
Speaking of spinal immobilization, similar conclusions have been drawn about blunt trauma mechanisms. Mechanism of Injury should not be the sole point of “proof” for cervical spine immobilization. The large, multicenter NEXUS study demonstrated that by using a protocol based on presenting neurologic signs and symptoms (spine pain, numbness, peripheral weakness), evidence of an intoxicant such as alcohol, and the presence of a distracting injury. One could safely rule out the presence of a cervical spine injury without an X-ray. In addition, there have been studies to show that the simple act of immobilization can result in pain, soft tissue injury, and possibly longer-term effects.
The take-away message is this: no procedure we do in EMS is benign. Studies like this are important to help us understand how we can help our patients and not hurt them in the process.
Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects.