Indications: altered, intoxicated, midline spinal pain or tenderness, focal deficit, distracting injury.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A driver is walking at the scene and has midline neck tenderness after a rear-end collision. The preferred way to begin spinal motion restriction is to:
Answer: A. An ambulatory patient moving under his own control produces less spinal movement than being lowered or rolled, so current practice applies a collar and lets him sit on the stretcher and lie back. A standing takedown and a log roll add movement; the bench seat skips restriction altogether.
Question 2 of 5
An elderly patient with a fixed forward curve of the spine needs spinal motion restriction. You should:
Answer: A. A spine that has been curved for years cannot be flattened without tearing what holds it, so voids are filled with padding and the patient is immobilized in the shape they live in. Straightening them, or using straps to do it, can injure a cord that was intact, and leaving them unsecured removes the protection entirely.
Question 3 of 5
A patient with a suspected spinal injury is walking around the scene when you arrive. You should:
Answer: A. Walking proves nothing about the spine; unstable injuries have been walked on. Stopping the movement and assessing is the only way to decide what is needed. Skipping the exam because they are already flat loses the findings that justify your care, and continued movement adds risk for no benefit.
Question 4 of 5
A helmeted football player with a suspected spinal injury is breathing normally. You should:
Answer: A. Helmet and shoulder pads were fitted together and hold the head in a neutral position; taking one away tips the neck. Both stay unless the airway cannot be managed, and then they come off together. Removing only one creates the very misalignment immobilization exists to prevent.
Question 5 of 5
While an apneic patient with a suspected spinal injury is being ventilated, the head is kept in line by:
Answer: A. A collar limits movement but does not prevent it, and sealing a mask means pulling on the very jaw and face that move the neck, so a pair of hands holds the head for as long as the ventilation lasts. Body straps hold the trunk rather than the head, and weighted objects beside the head slide with the board and take the head with them.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Indications: altered, intoxicated, midline spinal pain or tenderness, focal deficit, distracting injury.
- Manual stabilization first, then a sized cervical collar and a firm surface or scoop.
- Check pulse, motor and sensation in all four extremities before and after immobilizing.
- Long backboards are for extrication, not for lying on during transport.
- Penetrating trauma without a neurologic deficit does not need spinal motion restriction.
Field priorities
- Airway beats the collar: use a jaw thrust and reposition if the airway is compromised.
- Keep the head, neck and torso in line during every move.
- Pad elderly and small patients to keep neutral alignment.
Coaching the patient
- Remove a helmet only when it blocks airway care or does not fit snugly.
Red flags: act now
- Low blood pressure with a slow pulse and warm skin (neurogenic shock)
- New numbness or weakness
- Loss of bowel or bladder control
Spinal Injury & Motion Restriction: FAQs
What are the priority actions for Spinal Injury & Motion Restriction in the field?
Airway beats the collar: use a jaw thrust and reposition if the airway is compromised. Keep the head, neck and torso in line during every move. Pad elderly and small patients to keep neutral alignment.
What findings in Spinal Injury & Motion Restriction change your plan or your transport decision?
Low blood pressure with a slow pulse and warm skin (neurogenic shock). New numbness or weakness. Loss of bowel or bladder control.
What do I need to know about Spinal Injury & Motion Restriction for the NREMT?
Indications: altered, intoxicated, midline spinal pain or tenderness, focal deficit, distracting injury. Manual stabilization first, then a sized cervical collar and a firm surface or scoop. Check pulse, motor and sensation in all four extremities before and after immobilizing. Long backboards are for extrication, not for lying on during transport.
What should the crew communicate or document for Spinal Injury & Motion Restriction?
Remove a helmet only when it blocks airway care or does not fit snugly.
