Spinal Motion Restriction (SMR) Standard

What are the criteria one considerations for a patient with a spine injury?

• any trauma where the patient is complaining of neck and/or back pain

• sports accidents (impaction, falls, etc.)

• diving/submersion accidents/injuries

• explosions

• falls

• pedestrians struck by vehicles

• electrocution and/or lightning strikes

• penetrating trauma to the head, neck, or torso

If the patient meets the considerations listed in criteria one, what needs to be determined?

• neck and/or back pain

• spine tenderness

• neurologic signs/symptoms

• altered LOC

• suspected/confirmed drug and/or alcohol intoxication

• a distracting painful injury

• anatomical deformities of the spine

• high-energy mechanism of injury

How does the ALS PCS define a distracting painful injury?

any injury that may distract the patient from the pain of a spinal injury

How does the ALS PCS define a high-energy mechanism of injury?

• fall from elevation greater than 3 feet (or 5 stairs)

• axial load to the head (e.g., diving accidents)

• high speed (>100 km/hr) MVCs

  • rollover

  • ejection

• hit by a bus or large truck

• motorized/ATV recreatioinal vehicles collisions

• bicyclist struck/collided with a vehicle

What is the special consideration surrounding falls in patients who are 65 or older?

SMR precautions apply to them even if the fall is from standing height

What should be done in situations where SMR precautions are indicated but the patient is agitated/combatative?

apply SMR to the best of the paramedic’s ability and secure the patient to the stretcher with stretcher straps and then document clearly the circumstances that prevented the paramedic from being able to apply SMR to the patient

True or false: patients with suspected pelvic fractures should not be secured on a spinal board or adjustable break away stretcher?

false

True or false: when possible, the paramedic should document on the ACR the patient’s neurologic status before and after SMR precautions are administered?

true

What determinations would contraindicate the use of SMR precautions?

• no spine tenderness

• no neurologic signs/symptoms

• no altered LOC

• no evidence of drug and/or alcohol intoxication

• no distracting painful injury

• no anatomical deformity of the spine