A - PREHOSPITAL AND EMERGENCY
When immobilizing the spine, tailor the approach to the individual's specific circumstances. Specific attention should be paid to patients in whom there is an obvious pre-injury deformity of the spine (e.g., in patients with ankylosing spondylitis) where comfortable positioning in the patient’s pre-injury alignment should be a priority.
The use of spinal immobilization devices may be difficult (for example, in individuals with short or wide necks or individuals with a pre-existing deformity) and could be counterproductive (for example, increasing pain, worsening neurological signs and symptoms). In uncooperative, agitated, or distressed individuals, think about letting them find a position where they are comfortable with manual in-line spinal immobilization. (Adapted from NICE 2016, p.8; Level B)
When carrying out full in-line spinal immobilization in adults, manually stabilize the head with the spine in-line using the following stepwise approach:
- fit an appropriately sized semi-rigid collar unless contraindicated by:
- a compromised airway
- known spinal deformities, such as ankylosing spondylitis (in these cases, keep the spine in the individual's current position).
- reassess the airway after applying the collar
- place and secure the individual on a scoop stretcher
- secure the individual with head blocks and tape, ideally in a vacuum mattress.
(NICE 2016, p.8; Level C)