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Confirmation of suboptimal protocols in spinal immobilisation?
  1. Mark Dixon1,
  2. Joseph O'Halloran2,3,
  3. Ailish Hannigan4,
  4. Scott Keenan5,
  5. Niamh M Cummins6
  1. 1Paramedic Studies Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  2. 2Physical Education and Sport Sciences Department, University of Limerick, Limerick, Ireland
  3. 3Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
  4. 4Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  5. 5Fire and Rescue Service, Limerick City and County Council, Limerick, Ireland
  6. 6Centre for Prehospital Research, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  1. Correspondence to Mark Dixon, Paramedic Studies Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland; mark.dixon{at}


Background Spinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication.

Objective The objective of this study was to establish, using biomechanical analysis which technique provides the minimal deviation of the cervical spine from the neutral in-line position during extrication from a vehicle in a larger sample of variable age, height and mass.

Methods A crew of two paramedics and four fire-fighters extricated 16 immobilised participants from a vehicle using six techniques for each participant. Participants were marked with biomechanical sensors and relative movement between the sensors was captured via high-speed infrared motion analysis cameras. A three-dimensional mathematical model was developed and a repeated-measures analysis of variance was used to compare movement across extrication techniques.

Results Controlled self-extrication without a collar resulted in a mean movement of 13.33° from the neutral in-line position of the cervical spine compared to a mean movement of 18.84° during one of the equipment-aided extrications. Two equipment-aided techniques had significantly higher movement (p<0.05) than other techniques. Both height (p=0.003) and mass (p=0.02) of the participants were significant independent predictors of movement.

Conclusions These data support the findings of the proof of concept study, for haemodynamically stable patients controlled self-extrication causes less movement of the cervical spine than extrications performed using traditional prehospital rescue equipment.

  • first responders
  • prehospital care
  • spinal
  • Trauma
  • emergency department

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