When can a patient, intubated and ventilated by the ambulance team (Emergency Medical Services) after being extracted from a motor vehicle accident (RTA) by cutting the car roof, be safely lifted from the stretcher?

From the Guidelines

The patient should be lifted from the stretcher after the primary evaluation (option 1). In trauma cases involving high-energy mechanisms like motor vehicle accidents requiring extrication, the primary survey (ABCDE assessment) should be completed first to identify and address immediate life-threatening conditions [ 1 ]. Since this patient has already been intubated and ventilated by the ambulance team, airway and breathing have been temporarily secured. However, before moving the patient, it's essential to complete the primary assessment to check circulation, disability (neurological status), and exposure while maintaining cervical spine immobilization.

Key Considerations

• The patient should be transferred onto the transport trolley/stretcher, properly secured and padded with due regard to any possible spinal injury [ 1 ].
• The patient should be positioned with a 20–30° head-up tilt, and the use of ambulance trolleys that allow this degree of tilt, while maintaining spinal immobilisation, is encouraged [ 1 ]. Moving the patient prematurely could worsen potential spinal injuries. Once the primary survey is complete and any immediate threats to life are addressed, the patient can be carefully transferred using a log-roll technique with spinal precautions to maintain in-line stabilization.

Next Steps

• While imaging studies like whole spine X-rays are important for definitive diagnosis, they should not delay the initial assessment and stabilization.
• The secondary survey, which involves a more detailed head-to-toe examination, can be performed after the patient has been safely transferred to a hospital bed with proper immobilization in place.

From the Research

Spinal Injury Evaluation and Management

• The evaluation and management of spinal injuries in trauma patients is crucial to prevent further neurologic deterioration 2.
• The use of imaging modalities such as CT, MRI, and X-ray is essential in diagnosing spinal injuries 3.
• The Canadian C-Spine rule and NEXUS criteria guide clinical decision-making in evaluating cervical spine injuries 3.

Lifting the Patient from the Stretcher

• The patient can be lifted from the stretcher after the primary evaluation, which includes assessing the patient's airway, breathing, and circulation, as well as evaluating the patient's spinal injury using imaging modalities 4, 5.
• However, it is essential to ensure that the patient's spine is stabilized and that any necessary precautions are taken to prevent further injury 6.
• The decision to lift the patient from the stretcher should be made by a qualified healthcare professional, taking into account the patient's individual needs and the results of the primary evaluation.

Imaging Modalities and Spinal Clearance

• CT scans are highly sensitive in detecting unstable cervical spine injuries, but may not detect all injuries, particularly those that are not unstable 5.
• MRI may be useful in detecting injuries that are not visible on CT scans, particularly in patients with focal neurological deficits unexplained by associated intracranial injury 5.
• The use of X-ray and LODOX scans is not recommended for ruling out cervical spine injury due to their low sensitivity and specificity 3.

Spinal Motion Restriction

• Spinal motion restriction (SMR) is an essential aspect of prehospital care for trauma patients with potential spinal injuries 4, 6.
• The use of backboards and cervical collars may be necessary to stabilize the patient's spine and prevent further injury 4, 6.
• However, the use of backboards should be minimized, and alternative methods of maintaining spine precautions should be used whenever possible 4.