Bonner County EMS System Patient Care Treatment Guidelines-Trauma and Environmental EmergenciesTrauma Guidelines: Suspected C-Spine Injury-6002

SUSPECTED C-SPINE INJURYPrehospital Decision Tree for Implementing Spinal Immobilization

NSAIDS: Neurologic exam, Significant Mechanism, Alertness, Intoxication, Distracting Injury, Spinal Exam

SUBJECTIVE History of falls, ejection, abrupt

deceleration crashes Arthritis, cancer or osteoporosis Ingestion of drugs or alcohol Recent painful injury

OBJECTIVE Exam for focal neuro deficit, alertness Test range of motion: chin to chest,

extend neck up (look up) and turn head side to side without spinal process pain

Evaluate neck, spine and extremities Evidence for intoxication

ASSESSMENT Significant mechanism includes

high-energy events such as ejection, high falls, abrupt deceleration crashes

Range of motion should not be assessed if midline point tenderness over spinal processes

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Neuro Exam: Any focal deficit?-----------------------------------------------------YES--------Look for focal deficits such as tingling, reduced strength, extremity numbness

NO

Significant (high energy) mechanism of Injury?-----------------------------------YES--------

NO

Alertness: Any alteration in patient?-----------------------------------------------YES--------Is pt not oriented to person, place, time, situation, and any new changes?

NO

Intoxication: any evidence?---------------------------------------------------------YES--------Impaired decision making ability?

NO

Distracting Injury: Any painful Injury that might distract the patient from the pain of a C-spine injury?----------------------------------YES--------

E1

Spinal exam: Point tenderness over the spinal process or pain with neck range of motion?------------------------------------------------YES------- NO

Spinal Immobilization Not Required Spinal Immobilization Required

A2

1EMR and 2 EMT providers may perform these procedures if credentialed with the appropriate OM.The decision to NOT implement spinal immobilization is the responsibility of the highest level EMS Provider present. The Provider must document decision in PCR. Patients with penetrating trauma to the head and neck or torso and no spinal injury should not be immobilized. A rigid cervical collar with the patient firmly secured to an EMS stretcher may be _______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/01/14 final 5/14/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Trauma and Environmental EmergenciesTrauma Guidelines: Suspected C-Spine Injury-6002

most appropriate for patients found ambulatory, for prolonged transport of patients or when a backboard is not indicated. Consider immobilization in any patient with arthritis, cancer, or other underlying spinal or bone disease. If use of the backboard is associated with more pain, agitation (often with children) or respiratory compromise, its use may be contraindicated.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/01/14 final 5/14/2023 page 2 of 2