Spinal Immobilisation: A Literature Review
A review of the literature regarding spinal immobilisation has been undertaken using databases for PubMed, MEDLINE, CINAHL, OVID and Cochrane EBM. Reviews were electronically searched using the subject headings “spinal injuries”, “spinal immobilisation” and “management of spinal injuries”. The results generated by the search were limited to English language articles and reviewed for relevance to the topic. The aim of this literature review is to compare and contrast the views on spinal immobilisation and to achieve a better knowledge of evidence based practice.
According to Chiles and Cooper (1996) spinal injury should always be suspected in patients with severe systemic trauma, patients with minor trauma who report spinal pain or have sensory or motor symptoms, and patients with an impaired level of consciousness after trauma. According to Caroline (2008) the primary goal of spinal immobilisation is to prevent further injuries. Good initial and acute management is crucial no matter the degree of damage (Sheerin and Gillick, 2004). The purpose of immobilisation in suspected spinal trauma is to maintain a neutral position and avoid displacement and secondary neurological injury (Vickery, 2001). Means of immobilisation include holding the head in the midline, log rolling the person, the use of backboards and special mattresses, cervical collars, sandbags and straps (Kwan, Bunn & Roberts 2009). The Advanced Life Support Group supports the use of the long spinal board (backboard) for spinal immobilisation, despite knowledge of pressure problems and poor immobilisation in some patient groups. The spinal board was originally developed as an extrication device using its smooth surface to allow a person to be slid out of a vehicle. However, it is difficult to remove the patient from the board in the field and therefore the patient is most commonly transported to the A & E department on the spinal board (Cooke, 1998). There is considerable variation in the best technique for pre-hospital cervical spine immobilisation (Vickery, 2001). Some have advised the use 1 to 1.5 inches of padding under the head as standard, others have advised that judgement on the use of padding be based on visual inspection (Butman, McSwain & McConnell, 1986). Conversely, several trauma texts recommend placing the patient directly against the spinal board (McSwain, 1989). In the United Kingdom, the vacuum mattress is predominately used by mountain rescue teams as it is believed to provide better overall protection of an injured casualty and is perceived to be safer and easier to transport over the terrain encountered in these situations (Herzenberg, Hensinger and Dederick, 1989). In a recent study by Luscombe and Williams (2002), it was shown that the vacuum mattress prevents significantly more movement in the longitudinal and lateral planes when subjected to a gradual tilt. Perceived comfort levels are significantly better with the vacuum mattress that with the backboard. Chan, Goldburg & Mason (1996) reviewed the use of the long spinal board and its association with pressure injury, unsatisfactory immobilisation and positioning, and the pain that it can cause (Chan, Goldburg & Tascone, 1994). A study by Lovell and Evans (1994) indicated that while a casualty resides on a backboard it may possibly lead to pressure sores in those who have sustained injury to the spinal cord. The amount of time casualties remain on backboards can exacerbate the problems of pain and pressure. Ambulance journeys and waits in accident and emergency may be lengthy and there may be long distances involved in getting to hospital (Lerner & Moscati, 2000). In addition to pressure injury and poor immobilisation, the backboard may be the cause of pain even in otherwise healthy patients, leading to unnecessary investigations, radiographs and potential ambiguity regarding the cause of pain (Chan, Goldburgh & Mason,...
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