Clearing a Cervical Spinal Injury in the Pre-hospital Care Environment

Clearing a person’s possible cervical spinal injury in the pre-hospital care environment when mechanism alone indicates the potential for a spinal injury is not generally recommended for paramedics. Acknowledging this fact, there are certain Ambulance Services around the world that have protocols in place for their paramedics to clear a patient from a suspected cervical spinal injury while still within the pre-hospital care environment.

The Ambulance Service I work for does not advocate clearing a suspected cervical spinal injury in the pre-hospital care environment by a paramedic and I believe it would take a very competent (if not overly confident) paramedic to do so in any Ambulance Service.

While acknowledging this, it is still beneficial to consider how a doctor may clear a suspected spinal injury without the aid of x-ray or computer tomography. This is because it will provide you more knowledge and diagnostic techniques to identify or provide you with warning bells when treating a patient with a suspected cervical spinal injury.

If any of the following assessments are found to be possitive in the presense of a suspected cervical spinal injury based on mechanism, a patient can not be cleared of a suspected cervical spinal injury without the assistance of an x-ray or computer tomography:

1.Posterior, midline cervical tenderness
2.Focal neurological deficit
3.Normal levels of alertness/level of consciousness
4.Intoxication or other CNS depressants
5.Any painful distracting injury

As paramedcis, these should all be considered as warning bells to ensure you provide full spinal immobilisation and anti-emetic therapy (as per your Ambulance Service’s protocol or guidelines).