Does Stabilizing the Spine Help or Hurt Trauma Victims?
Reported January 14, 2010
(Ivanhoe Newswire) — The time-consuming, on-scene medical intervention of immobilizing the spines of shooting and stabbing victims before they are taken to the hospital appears to double the risk of death, compared to immediately transporting patients to a trauma center.
The findings by Johns Hopkins researchers suggest that pre-hospital spine immobilization for these kinds of patients provides little benefit and may lethally delay proven treatments for what are often life-threatening injuries. Wounds from guns and knives are often far from the spine, yet patients are routinely put in a cervical collar and secured to a board, according to the investigators.
“If you’re twice as likely to die, that seems like a bad thing to do,” study leader Elliott R. Haut, M.D., assistant professor of surgery at the Johns Hopkins University School of Medicine, was quoted as saying. “We like to use interventions that preserve life.”
Haut says he hopes that as a result of his study, Maryland will consider changing that part of its protocol that requires spine immobilization for nearly all shooting and stabbing victims. The researchers caution, however, that spine immobilization has been shown to effectively save lives and reduce disability from injuries sustained in car crashes and similar events.
One finding that Haut said startled his team was that gunshot or stab wound victims with the most minor injuries appeared to be at greater risk of death if time is spent on pre-hospital immobilization.
“The patients who are very, very severely injured from their penetrating trauma are going to die no matter what you do,” said Haut. “But if someone is stabbed in the lung or shot in the liver, what we do for them and how fast we do it makes a huge difference. That time difference in getting them to the hospital for treatment may make the difference between life and death.”
EMTs and others who immobilize gunshot and stab wound patients do not intend to do harm, Haut emphasized, but a cervical collar may, for example, conceal an injury to the trachea or make inserting a breathing tube more difficult. Recent studies have also called into question the merits of other pre-hospital protocols, such as universal intravenous fluid administration.
Haut and his colleagues looked at records from more than 45,000 patients with penetrating trauma included in the National Trauma Data Bank from 2001 to 2004. They calculated that the chance of benefiting from spine immobilization in those cases was 1 in 1,000, while potentially 15 additional people died for every 1,000 shooting or stabbing victims immobilized before being taken to the hospital.
Haut concluded, “The idea of putting a board and collar on everybody is probably not the way to go.”
SOURCE: Journal of Trauma, January 2010
