Spinal Motion Restriction Procedure

Question 1

If there is potential for spinal injury from blunt trauma mechanism and any of THESE symptoms, you must perform SMR

Answer 1

• Any altered mental status (GCS < 15) including possible
  intoxication from alcohol or drugs, agitation
• Pediatric patients may demonstrate altered mental
  status with agitation, apnea, hypopnea, or
  somnolence.
• Midline neck or back pain and/or tenderness.
• Focal neurologic signs and/or symptoms (ie. weakness,
  tingling, or numbness).
• Anatomic deformity of the spine.
• Torticollis (self-splinting or painful rotation/tilt of the neck).
• Unreliable patient interaction including distraction from
  painful injury or distressing circumstances.
• Communication/language barrier that prevents accurate
  assessment.
• Lack of cooperation or contribution during exam.

Question 2

SMR high risk patient characteristics

Answer 2

• Meets Field Trauma Triage mechanism criteria
• Age >65
• Axial load injuries (diving injuries, spearing tackle),
• Sudden acceleration/deceleration, lateral bending forces to
  neck/torso

Question 3

Low risk patients meet all the following characteristics

Answer 3

• Minor mechanism - equavalent to simple rear end collision
• No neck pain on scene
• No midline cervical tenderness
• Ambulatory on scene at any time

Low risk characteristics have not been studied in pediatric patients are should not be used alone to determine need for SMR

Question 4

If they are low risk, then what?

Answer 4

They may be transported without the use of a
cervical collar or any other means to restrict
spinal motion.

Question 5

Do you have to spine board SMR patients?

Answer 5

Patients who meet any high-risk criteria require SMR but do NOT require the use of a long spine board.

• SMR may be achieved by use of a scoop stretcher, vacuum splint, or ambulance stretcher with the
  patient safely secured.
• LSB should be reserved for extrication. Effort should be mae to remove the patient form this form of
  rigid device as soon as possible.
• These patients should not be transported in the sitting position.

Question 6

What’s important with SMR in kids?

Answer 6

Pad the shoulders and voids.