Skip spine stabilization and get to the hospital

In a study that runs counter to emergency-care protocols in some regions of the United States, researchers have found that gunshot patients who undergo spine stabilization before being transported to the hospital are twice as likely to die as those who are taken directly.

The problem appears to be delay, researchers report in the January Journal of Trauma. To stabilize the spine, paramedics wrap a cervical collar around a patient’s neck and strap the individual to a long board to keep the vertebrae from shifting during transport. Although these measures immobilize the spine, the patient loses precious minutes.

“Some injuries are very time sensitive,” says study coauthor Elliott Haut, a trauma surgeon at the Johns Hopkins Hospital in Baltimore, which averages one gunshot patient per day. “Sometimes, if you get here in 10 minutes we can save your life, but in 20 minutes we can’t,” he says. Spine immobilization delays a trip to the hospital by two or three minutes on average, but can take more than five minutes, previous research has shown.

Although spine stabilization has proved its worth for car-crash patients, no studies had established whether it helps patients with neck or torso wounds from gunshots or knifings, where wounds might include spine damage. So Haut and his colleagues scanned a nationwide database of roughly 45,000 patients treated for such wounds. About 15 percent of patients who received spine immobilization died in the hospital, compared with 7 percent of those not immobilized. When the researchers accounted for differences in wound severity, gender, race and age, the difference remained twofold.

Undergoing spine immobilization didn’t affect death rates from knife wounds. The gunshot wound patients most affected by the immobilization procedure were those with low blood pressure.

Patients with partial spine damage from trauma harbor the greatest risk of vertebrae movement during transport and are most likely to benefit from spine stabilization.

But those cases are rare among gunshot victims, says neurosurgeon Craig H. Rabb of the University of Oklahoma Health Sciences Center in Oklahoma City. The greater death rate among people in this study who got spine immobilization underscores that delay is the enemy, he says. “This provides powerful evidence that [paramedics and EMTs] should feel reassured that they’re unlikely to cause problems” by forgoing immobilization for gunshot patients, Rabb says.

The protocols that govern ambulance crews’ emergency medical care vary by state and locality. Haut says the new findings should be factored into these guidelines.