Code 3 Workshop

Paramedic Education
Home/All lessons/Trauma/Spinal Motion Restriction Decisions
Lesson

Spinal Motion Restriction Decisions

10 min Trauma Skip to quiz

Objective: Protect the airway, give oxygen, and support blood pressure before you package the spine. Use a board or a vacuum splint only for the move, then take the patient off it. Use a collar only if your protocol says so.

Why this matters

Full spinal immobilization on a longboard for every possible trauma patient was tradition. NAEMSP 2025 teaching is direct. There is no outcome evidence that immobilization, or spinal motion restriction as usually practiced, prevents a delayed spinal cord injury. There is known harm. Boards cause pain, make breathing harder, and cause pressure injury.

First, open the airway, give oxygen, and support blood pressure. Then decide on packaging. Check movement and sensation after the move. Do not leave the patient on a board for transport. A better explanation for delayed deficits is low blood flow to the cord, not a careful turn onto the stretcher. Your protocol still decides the collar. Use a board or a vacuum device for extrication. Then take it off.

Key points
  • Airway, oxygen, and blood pressure come first. The cord needs blood flow more than it needs a board.
  • A longboard or a full-body vacuum splint is for the extrication. Then take it off.
  • Use a collar only if your protocol still uses one for this patient. Pad a kyphotic neck in an older adult so you do not force the head back. Kyphosis is the forward curve of the upper back.
Verbalize
  • I will protect the airway and the blood pressure first. The cord needs blood flow.
  • The board is for the move. Then I will take it off.
  • I will use a collar only if the protocol says so for this patient.
  • I will repeat the neurologic check after we move the patient.

Clinical sequence

  1. Protect the airway, give oxygen, and support blood pressure first. Low blood flow hurts the cord more than a careful move.
  2. Do not put every patient on a board. Use a longboard or a vacuum splint for the extrication. Then take the patient off it.
  3. Apply a collar only if your protocol still uses one for this patient. Do not collar everyone by reflex. Pad a kyphotic older neck so you do not force the head back.
  4. After the move, repeat a neurologic exam and check the airway under the collar or padding on the neck. Transport on the stretcher. Do not leave the patient on the board.

Who Still Gets More Caution

  • A high-risk mechanism plus an exam you cannot trust still gets more caution in most protocols. Examples include an axial load, a high-speed crash, and a fall from height.
  • Midline spinal pain, a neurologic deficit, altered mental status, intoxication, and a distracting injury are reasons many protocols still want a collar. They are not a reason to leave someone on a board for a 40-minute ride.
  • Older adults often fit rigid packaging poorly. Judgment, padding, and blood flow matter more than a textbook board.

What SMR Often Looks Like Now

  • Use the stretcher, handle the patient carefully, and let a patient who is protecting their own neck keep doing that.
  • Limit longboards and full-body vacuum splints to the minutes of extrication. Then take them off.
  • Use a collar if your protocol still names one. Efforts to reduce reflex collar use match the direction of the evidence. They are not permission to ignore your medical director.
  • Remove a helmet when it blocks the airway. See the helmet lesson.

Key points

  • This is not a decision to do nothing. Protect the airway, breathing, and blood pressure first. Then package the patient in the way your protocol describes.
  • Boards cause pain, restrict breathing, and cause pressure injury when they stay on. That harm is documented.
  • Unstable multi-system trauma may need a packaging compromise. Document why.
  • Always reassess neurologic status after extrication.

Common errors

  • Strapping a walking, low-risk patient to a board because of mechanism alone.
  • Leaving the board on for the whole transport after the patient is already on the stretcher.
  • Chasing a collar while the patient has low oxygen or low blood pressure.

Practice

One-minute check

Give one sentence for each patient. Use a walking patient after a low-risk crash, an axial-load fall with midline tenderness, and an intoxicated patient who was ejected. For each, say whether you use a board for the move, whether your protocol wants a collar, and whether the board stays for transport.

Related: Traumatic brain injury, Helmet removal.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Walking patient after a low-speed fender-bender, reliable exam, no midline tenderness. Selective SMR means:
2. Partner wants a 40-minute boarded ride “for mechanism.” Many systems limit longboard transport because:
3. Ejected, intoxicated patient who cannot give a reliable exam. Per many protocols this:
4. After extrication onto the stretcher, current teaching is:
← Tension Pneumothorax Recognition Traumatic Brain Injury →