Assessment of a young girl who was hit by a car while riding her bike reveals her to be responsive to painful stimuli with flexion of the extremities; she is also in respiratory distress. There is marked deformity to her thoracic spine and bruising noted to her anterior chest and abdomen. She does not move her legs when a noxious stimulus is applied to the lower extremities. Manual cervical spine motion restriction is being maintained and a cervical collar has been applied by fire department EMRs. Given the critical nature of this patient, which action is most appropriate for her care?

Emergency medical services (EMS) first aid for spinal trauma includes: Keeping the head in line with the neck Preventing twisting the head Maintaining an open airway Applying a cervical collar Securing the stretcher Minimizing movement Spinal motion restriction (SMR) is a technique used by Emergency Medical Services (EMS) to limit the movement of a patient's spine, especially when the patient may have sustained a spine injury. SMR involves stabilizing the head, neck, torso, and pelvis to protect the spinal cord from movement of potentially fractured or unstable bone elements. This... Show more

Emergency medical services (EMS) first aid for spinal trauma includes:
Keeping the head in line with the neck
Preventing twisting the head
Maintaining an open airway
Applying a cervical collar
Securing the stretcher
Minimizing movement

Spinal motion restriction (SMR) is a technique used by Emergency Medical Services (EMS) to limit the movement of a patient's spine, especially when the patient may have sustained a spine injury. SMR involves stabilizing the head, neck, torso, and pelvis to protect the spinal cord from movement of potentially fractured or unstable bone elements. This technique includes using cervical collars, gurneys, and other commercial devices to limit the movement of patients with potential spine injuries. 

SMR is used in cases of trauma when certain criteria are met, such as when the patient's GCS is less than 15. EMTs should apply or direct application of SMR when the extent of injury is in question or the patient's history is unreliable. 
The goal of SMR is to limit the spine's lateral movement, rotation, and flexion. The procedure includes:
Limiting flexion, extension, rotation, and distraction of spine
Providing manual stabilization restricting gross motion
Reducing gross movement of patient 
When using SMR, you should avoid methods that provoke increased spinal movement and/or combativeness. 
Improper movement and handling of patients in such situations can lead to permanent disability or even death. 

Other devices currently in use for spinal immobilization include: hard collar with blocks and tape, backboard, scoop stretcher, and vacuum splint.

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