Cervical spine immobilization during extrication of the awake patient: a narrative review

Abstract

Techniques for extricating vehicle occupants after road-traffic collisions have evolved largely through fear of worsening a cervical spine injury, rather than being evidence-based. Recent research has looked at the safety of allowing the alert patient to self-extricate, rather than being assisted with equipment such as long spinal boards and semirigid cervical collars. This review aims to elucidate whether it is safe to allow an alert, ambulant patient to self-extricate from a vehicle with minimal or no cervical spine immobilization. A literature search was conducted looking for papers that discussed cervical spine motion during extrication from a vehicle. Five papers were yielded, and their methodology, results and limitations were assessed. Motion capture studies suggest that a patient who is allowed to self-extricate from a vehicle will move their cervical spine no more than a patient who is extricated by traditional methods, and may move their neck up to four times less. Furthermore, an alert patient with a neck injury will demonstrate a self-protection mechanism, ensuring injuries are not worsened. Evidence is now building that self-extrication in alert patients with minimal or no cervical spine immobilization is safe. Self-extrication should become more commonplace, conferring not only a potential safety benefit but also advantages in time to definitive care and resource use.

2020 International Consensus on First Aid Science With Treatment Recommendations

“…The ScopRev also identified a narrative review of cervical spine motion during vehicle extrication. 223 This review included 1 small series using high-speed infrared motion-detection cameras 224 that measured less cervical spine motion in conscious injured adults who self-extricated without a cervical collar compared with cervical spine motion during extrication with traditional equipment, including a cervical collar (mean movement 13.33 AE 2.67 from the neutral inline position compared with 18.84 AE 3.46 ).…”

Self-extrication and selective spinal immobilisation in a polytrauma patient with spinal injuries

“…Retrospective analysis has demonstrated an increase in time to extrication associated with professional rescue from a vehicle when compared with self-extrication. 6,7 In this case, had the patient remained in the vehicle when she began to physiologically deteriorate, management may have been challenging and controlled extrication added to time on scene, increased hypothermia and delaying time to hospital in the context of significant polytrauma.…”

First aid

“…Im Jahr 2019 führte die Arbeitsgruppe für Erste-Hilfe eine umfassende Überprüfung der Literatur über Maßnahmen zur Bewegungsbeschränkung der Halswirbelsäule durch. Insgesamt wurden 3958 Aufzeichnungen durchgesehen, von denen sechs als relevant identifiziert wurden [201][202][203][204][205][206]. Diese Studien beinhalteten drei, die über die Eigenschaft berichteten, die Bewegung der Halswirbelsäule in unterschiedlichem Maße einzuschränken [202,205,206].…”

“…Eine kleine Kohortenstudie [204] berichtete über die Entwicklung falscher zentraler Halswirbelsäulenbeschwerden durch die Verwendung einer Halskrause und eines starren Rückenbretts. Eine Literaturübersicht [201] aus fünf Studien berichtete, dass wache Verletzte effektive Selbstimmobilisierungs-und Schutzmechanismen aufwiesen. Darüber hinaus berichteten sie, dass ein Verletzter, der sich eigenständig aus einem Fahrzeug befreit, seinen Hals bis zu viermal weniger bewegt als ein Verletzter, der mit traditionellen Methoden befreit wird.…”