Just published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine as an open-access article: The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury by Kornhall et al.

The result of a critical review of the available evidence by a multidisciplinary group of clinicians, these guidelines wrestle with many of the dogmas that haunt prehospital management of potential spinal injuries. This especially applies to the indiscriminate use of hard collars and full spinal immobilization. As with many other medical “truths”, current practice is characterized by low-grade evidence yet curiously strong recommendations. It´s both commendable and highly necessary that some of these dogmas are challenged.

The recommendation for immobilization still stands for patients with a higher degree of suspicion of injury. However, the authors sensibly introduce a more selective approach, allowing for more on-scene evaluation by pre-hospitalists before deciding to strap the patient down. Using, among other tools, the NEXUS-criteria the clinician can single out low-risk patients and conceivably spare them spinal immobilization and c-spine collars. The authors also acknowledge the significant negative effects of both hard collars and strapping down patients supine which, in my opinion, has been downplayed in discussions till now.

Well worth a read and could possibly start the ball rolling for other pre-hospital services to liberalize and customize their practice.