The latest Wilderness Medical Society Guidelines for spinal cord protection have been released (SCP Guidelines). The results are nothing short of dramatic. If you have been a victim of a traumatic injury over the past 50 years, you have been quickly placed in a cervical collar and strapped to a backboard to “protect your spine”. Countless patients have been tortured (ok, maybe a little overly dramatic but…) for hours on end as they waited for their spines to be “cleared”.
This practice guideline simplifies the use of rigid cervical collars and immobilization all the way down to–don’t use them.
For decades, there has been a growing debate about the utility of the cervical collar for the immobilization of patients in the pre-hospital setting. Take note, this is only in the pre-hospital setting. For those patients who have an identified spinal instability who will be undergoing or have undergone surgery, there is an entirely different set of guidelines and uses for the cervical collar.
Let us further confine the discussion here to the wilderness setting by way of example.
You and a friend find yourselves in the mountains of Georgia hiking along a moderate to difficult trail with some steep terrain. Your friend turns to look at an interesting bird flying through the forest canopy and loses his footing sliding off and down the steep embankment. You rush to the edge of the trail to watch as he turns over and over, falling head over heels down the 100-foot slope. Quickly, you slide down the embankment and find yourself at your partner’s side. He is awake and alert, cursing vigorously at his misstep.
You ask, “Are you alright?”
Sitting up, he replies, “Yes.” As he carefully bends his neck to the left, right, back, and front with no indication of pain of any type.
Throughout the last half-century, any physician or provider with the slightest knowledge of emergency medicine would have fainted at the thought of letting a patient go through the maneuvers described above. If asked about what should have taken place, they would tell you the patient had to be immobilized. Immediately upon arriving on the scene, the uninjured party should have counseled their companion to remain still, lie completely flat on the ground, and not move their neck.
After all, there could be an unnoticed and unidentified spinal cord injury.
We must protect the spinal cord.
Given the guidelines as presented in this paper, the patient above has cleared himself. Being alert and able to safely and without pain mobilize the neck in a full range of motion (without distracting injury) rules out a spinal cord injury. In some instances, it may be desired to provide some form of non-rigid cervical spine motion restriction. However, the rigid cervical collar has been shown to cause more harm than good.
Whether a healthcare provider or a weekend warrior, I recommend visiting the site above to check out the guidelines. It may give you the confidence to help your friend in need to safely ambulate out of the wilderness rather than waiting hours to be rescued when it is not necessary and may prove harmful.
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