Spinal motion restriction: an educational and implementation program to redefine prehospital spinal assessment and care.

INTRODUCTION: Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard.

OBJECTIVE: The training of paramedics and emergency medical technicians on the principals of spine motion restriction (SMR) will decrease the use of backboards.

METHODS: The training for SMR emphasized the need to immobilize those patients with a significant potential for an unstable cervical spine fracture and to use alternative methods of maintaining spine precautions for those with lower risk. The training addressed the potential complications of the use of the unpadded backboard and education was provided about the mechanics of spine injuries. Emergency medical services (EMS} personnel were taught to differentiate between the critical multisystem trauma patients from the more common moderate, low kinetic energy trauma patients. A comprehensive education and outreach program that included all of the EMS providers (fire and private), hospitals, and EMS educational institutions was developed.

RESULTS: Within 4 months of the policy implementation, prehospital care practitioners reduced the use of the backboard by 58%. This was accomplished by a decrease in the number of patients considered for SMR with low kinetic energy and the use of other methods, such as the cervical collar only.

CONCLUSION: The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions.