A - PREHOSPITAL AND EMERGENCY

Emergency personnel or first responders should carry out or maintain full in-line spinal immobilization if:

1. a high-risk factor for cervical spine injury is identified and indicated by the Canadian C spine rule, or,
2. a low-risk factor for cervical spine injury is identified and indicated by the Canadian C spine rule, and the individual is unable to actively rotate their neck 45 degrees left and right, or,
3. indicated by one or more of the factors:
   1. age 65 years or older and reported pain in the thoracic or lumbosacral spine
   2. dangerous mechanism of injury (fall from a height of greater than 3 metres, axial load to the head or base of the spine – for example, falls landing on feet or buttocks, high-speed motor vehicle collision, rollover motor accident, lap belt restraint only, ejection from a motor vehicle, an accident involving motorized recreational vehicles, bicycle collision, horse riding accidents)
   3. pre-existing spinal pathology (i.e., ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis), or known or at risk of osteoporosis – for example, steroid use
   4. suspected spinal fracture in another region of the spine
   5. abnormal neurological symptoms (paraesthesia or weakness or numbness)
   6. on examination:
      1. abnormal neurological signs (motor or sensory deficit)
      2. new deformity or bony midline tenderness (on palpation)
      3. bony midline tenderness (on percussion)
      4. midline or spinal pain (on coughing)
   7. on mobilization (sit, stand, step, assess walking): pain or abnormal neurological symptoms (stop if this occurs)

Do not carry out or maintain full in-line spinal immobilization if:

1. they have low-risk factors for cervical spine injury as identified and indicated by the Canadian C spine rule
2. they do not have any of the following factors:
   1. age 65 years or older and reported pain in the thoracic or lumbosacral spine
   2. dangerous mechanism of injury (fall from a height of greater than 3 metres, axial load to the head or base of the spine – for example, falls landing on feet or buttocks, high-speed motor vehicle collision, rollover motor accident, lap belt restraint only, ejection from a motor vehicle, an accident involving motorized recreational vehicles, bicycle collision, horse riding accidents)
   3. pre-existing spinal pathology (i.e., ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis), or known or at risk of osteoporosis – for example, steroid use
   4. suspected spinal fracture in another region of the spine
   5. abnormal neurological symptoms (paraesthesia or weakness or numbness)
   6. on examination:
      1. abnormal neurological signs (motor or sensory deficit)
      2. new deformity or bony midline tenderness (on palpation)
      3. bony midline tenderness (on percussion)
      4. midline or spinal pain (on coughing)
   7. on mobilization (sit, stand, step, assess walking): pain or abnormal neurological symptoms (stop if this occurs)