Article Text

Download PDFPDF
Prehospital clearance of the cervical spine: does it need to be a pain in the neck?
  1. B P Armstrong1,
  2. H K Simpson1,
  3. R Crouch2,
  4. C D Deakin3
  1. 1Emergency Department, Basingstoke & North Hampshire Foundation Trust (formerly North Hampshire Hospital Trust), Basingstoke, UK
  2. 2Emergency Department, Southampton University Hospital NHS Trust, Southampton, UK
  3. 3South Central Ambulance Service—Hampshire Division, Highcroft, Winchester, UK
  1. Correspondence to:
 MrB P Armstrong
 Emergency Department, Basingstoke & North Hampshire Foundation Trust (formerly North Hampshire Hospital Trust), Aldermaston Road, Basingstoke RG24 9NA, UK; bruce.armstrong{at}


Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations.

  • c-spine, cervical spine
  • CSI, cervical spine injury
  • ED, emergency department

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: BPA, HKS and CDD are members of the South Central Ambulance Service (Hampshire Division), Clinical Advisory Group.