Characteristics of Trauma Patients With Potential Cervical Spine Injuries Underimmobilized by Prehospital Providers

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Study Design.

This study was a retrospective chart review to determine characteristics of patients under-immobilized by prehospital providers.


Our goal was to examine the characteristics of patients who met the criteria for spinal immobilization but were inappropriately cleared.

Summary of Background Data.

Many emergency medical services (EMS) use selective spinal immobilization (SSI) based on the NEXUS criteria. However, there is been research examining patients who are under-immobilized by EMS.


This was a retrospective chart review over 18 months of a single EMS service. We reviewed all charts dispatched as “motor vehicle crash” (MVC) or “fall”. We then determined, whether the patient met the criteria for SSI under Pennsylvania protocols, which mirror the NEXUS criteria.


Our EMS system responded to 1151 falls and MVCs over the study period. Seventy-six patients were immobilized leaving 1075 patients who had clinical clearance of their cervical spine. Of these patients, 4/1075 (0.3%) were considered to be under-immobilized. All 4 of these patients had intoxication or altered mentation mentioned in their charts. Two of these patients had CT scans of their cervical spine, with both being negative. One patient eloped from the ED before any imaging, and 1 patient was clinically cleared.


EMTs are very proficient in following the SSI guidelines with an under-immobilization rate of approximately 0.3% in our study. However, all patients who were under-immobilized were under the influence of alcohol. There were no patients who were not immobilized and had cervical spine injuries. This was a limited chart review involving only 2 dispatch categories. EMTs should be cautious while evaluating patients with possible spinal injuries who are under the influence of alcohol.


Level of Evidence: 4

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