SMR

Question 1

Consider SMR for any pt with with potentiel Spine or spinal card injure based on what MOI (9)

Answer 1

1. Any trauma associated with complaints of neck or back pain
2. Sports accidents (impaction, falls)
3. Diving incidents and submersion injuries
4. Explosions, other types of forceful acceleration/ deceleration Injuries
5. Falls (e.g. stairs)
6. Pedestrians struck
7. Electrocution
8. Lightening strike
9. Penetrating trauma to the head, neck or torso

Question 2

If pt has MOI that meets SMR criteria, determine if they exhibit ANY of what risk criteria (9)

Answer 2

1. Neck or back pain
2. Spine tenderness
3. Neurologic signs or symptoms
4. Altered LOC
5. Suspected drug or alcohol intoxication
6. Distracting painful injuries
7. Anatomic deformity of the spine
8. High energy MOI
9. Age of 65 or over including falls from standing height

Question 3

What are high energy MOI examples ( 6)

Answer 3

1. Fall from elevation greater than 3 feet / 5 stairs
2. Axial load to the head (e.g. diving accident)
3. High speed MVC ( 100km/hr of more), rollover, ejection
4. Hit by bus or large truck
5. Motorized / ATV recreational vehicles collision
6. Bicyclist struck or collision

Question 4

If pt meets criteria of paragraph 1 (MOI) but none of the risk criteria of paragraph 2 what do you do?

Answer 4

Do not apply SMR

Question 5

If Pt has MOI and risk criteria what do you do

Answer 5

apply cervical collar only

• attempt to minimize spinal movement
• secure the Pt to the stretcher with stretcher straps

Question 6

Spinal boards and adjustable break away stretchers may be indicated for

Answer 6

use to minimize spinal movement during extraction

Question 7

If pt has penetrating trauma to head neck or torso what are ALL of the criteria needed so no spinal collar is needed? (must meet all 6)

Answer 7

1. no spine tenderness
2. no neurologic s& s
3. no altered LOC
4. no evidence of drug or alcohol intoxication
5. no distracting painful injury
6. no anatomic deformity of the spine

Question 8

This standard is to identify what

Answer 8

• pt where MOI in combo w/ & absence of risk criteria mean a spinal injury does not have to be considered
• it does not allow PCP to clear c spine for blunt trauma pts

Question 9

SMR does not mean paramedic has cleared the spine for blunt trauma pts. what must be done at all time?

Answer 9

manage pt to minimize spinal movement at all times

Question 10

what should be documented on ACR before and after SMR (when possible)

Answer 10

neurologic status

Question 11

What are spinal boards or adjustable breakaway boards primarily concidered

Answer 11

extraction/ lifting devices

-goal is to remove pt from device as soon as it is safe to do so

Question 12

How do you get Pt from back board onto stretcher once in the ambulance

Answer 12

if sufficient personnel are present, Pt should be log rolled from the extraction device to stretcher

Question 13

How long can a pt be kept on spinal board or breakaway stretcher if it is safer of more comfortable for pt

Answer 13

<30 mins

Question 14

What specific pts should be secured to back board or breakaway stretcher

Answer 14

Suspected pelvic fracture

Question 15

What position can you place a pt with SMR

Answer 15

semi-sitting
supine
(pt comfort / clinical condition)

Question 16

What do you do if pt is unresponsive / uncooperative

Answer 16

apply manual c spine until appropriate SMR applied

Question 17

C collar should be applied when

Answer 17

prior to movement if possible

Question 18

If Pt in MVC and still in vehicle w/ isolated neck or back pain but no neurologic signs or indications of major trauma how do you get them out of car

Answer 18

Self-extricate using stand, turn and pivot onto the stretcher
-Paramedic should coach Pt to maintain neutral spinal alignment

Question 19

Should SMR be reassessed on paramedics arrival if first responder already put pt on spinal board or break away stretcher?

Answer 19

yes assess as per BLS standard

Question 20

Pt w/ inter-facility transfers w/ SMR can have SMR modified based on

Answer 20

sending physician

Question 21

Pts who are markedly agitated, combative or confused and not following instruction to reduce spinal movement what do you do

Answer 21

Apply SMR to the best of your ability and secure PT to the stretcher with stretcher straps
-DOCUMENT the circumstances and why unable to apply SMR to pt