September 8, 2025
The National Association of EMS Physicians (NAEMSP)’s comprehensive review of spinal motion restriction in prehospital management of trauma concluded that cervical collars and backboards are likely more likely to harm patients than to prevent delayed neurological injury (DNI).
Step on a crack, break EMS dogma’s back
C-collars and backboard use to prevent DNI in suspected spinal trauma has been prehospital dogma for decades. But does the literature actually support this? NAEMSP’s team of prehospital trauma experts extensively reviewed the literature, studying 4,000 manuscripts and eventually including 115. Though limited by the largely retrospective nature of the available evidence, the following findings were provided:
- No strong evidence implicates post-injury movement of the spinal column as a primary pathophysiological cause of DNI. Correlational evidence suggests hypoperfusion of the spinal cord as the primary cause.
- C-collars, backboards, and even vacuum splints have serious potential patient harms:
- Increases in pain, decubitus ulcers, intracranial pressure in TBI patients, and increased radiology utilization.
- Respiratory compromise from obstruction or restricted pulmonary function.
- Missed injuries and delayed care from directly obscuring injured areas or complicating the physical exam.
- Geriatric patients are more likely to spend extended periods in c-collars, exposing them to increased risk of potential harms.
- C-collars may distort the anatomy of pediatric patients, contrary to their purpose.
- Ultimately, the authors concluded the available evidence does not support routine spinal immobilization via c-collars and backboards and recommended limiting their use altogether.
How will this change my practice?
In the ED, I will feel justified in liberating patients from c-collars and backboards as early as clinically feasible and voicing concern over their application within the department. Beyond the active extrication phase, use of these implements will be deemphasized in my practice as an EMS physician in favor of mitigating hypoperfusion in patients with suspected spinal injuries.
Source
Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries – A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13. doi: 10.1080/10903127.2025.2541258. Epub ahead of print. PMID: 40736221.
