Prehospital Management of Spinal Cord Injuries

Prehospital Management of Spinal Cord Injuries

Michael G. Millin et al.
 Prehospital Emergency Care, August 2025
 DOI: 10.1080/10903127.2025.2541258

🛑 Conclusion

  • No high-quality evidence supports SMR or spinal immobilization as standard of care.

  • Post-injury movement is not well-supported as a cause of delayed spinal cord injury.

  • Hypoperfusion may play a more significant role than movement.

  • Backboards and full-body splints should only be used during active extrication.

  • Routine collar and backboard use post-extrication should be reconsidered.

đźš‘ Practice-Changing Implications for EM and EMS

  • Reassess protocols for prehospital spinal precautions—especially collar use in isolated trauma.

  • Educate EMS crews on shifting toward evidence-informed SMR practices.

  • Prioritize early perfusion support over immobilization as a target for neuroprotection.

  • Consider removing backboards early in ED, especially in low-risk patients.

🔍 Methods

  • Comprehensive literature review (PubMed, Embase, CINAHL, Web of Science, back to 1900)

  • Part of NAEMSP’s Trauma Compendium Series

  • Total manuscripts screened: 3,944

  • Included in analysis: 115

đź“Š Key Findings

  • 14 studies explored the pathophysiology of delayed neurological injury:

    • Only 2 case series linked post-injury movement with delayed neuro deficit.

    • 8 retrospective studies associated hypoperfusion (not movement) with worsening neuro outcomes.

  • 55 studies documented harms of spinal immobilization, including:

    • Respiratory compromise

    • Increased ICP

    • Pressure ulcers

    • Increased scene and ED time

    • Patient discomfort/agitation

  • 58 studies reviewed the effectiveness of immobilization:

    • Zero studies showed definitive benefit of backboards or collars in preventing neuro injury.

Millin, M.G., Innes, J.C., King, G.D., Abo, B.N., Kelly, S.M., Knoles, C.L., Vezzetti, R., White, C.C., Yee, A. and Gallagher, J.M., 2025. Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries–A NAEMSP Comprehensive Review and Analysis of the Literature. Prehospital Emergency Care, (just-accepted), pp.1-24.

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