Emerg Med J 30:720-723 doi:10.1136/emermed-2012-201847
  • Original article

A re-conceptualisation of acute spinal care

  1. Mark Hauswald
  1. Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Professor Mark Hauswald, Department of Emergency Medicine, University of New Mexico, MSC 08 4620, 1 UNM, Albuquerque, NM 87131-0001, USA; mhauswald{at}
  • Accepted 10 August 2012
  • Published Online First 8 September 2012


The emergency care of patients who may have spinal injuries has become highly ritualised. There is little scientific support for many of the recommended interventions and there is evidence that at least some methods now used in the field and emergency department are harmful. Since prospective clinical trials are not likely to resolve these issues I propose a reconceptualisation of spinal trauma to allow a more rational approach to treatment. To do this I analyse the basic physics, biomechanics and physiology involved. I then develop a list of recommended treatment variations that are more in keeping with the actual causes of post impact neurological deterioration than are current methods. Discarding the fundamentally flawed emphasis on decreasing post injury motion and concentrating on efforts to minimise energy deposition to the injured site, while minimising treatment delays, can simplify and streamline care without subjecting patients to procedures that are not useful and potentially harmful. Specific treatments that are irrational and which can be safely discarded include the use of backboards for transportation, cervical collar use except in specific injury types, immobilisation of ambulatory patients on backboards, prolonged attempts to stabilise the spine during extrication, mechanical immobilisation of uncooperative or seizing patients and forceful in line stabilisation during airway management.

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