For gunshot and stab victims, on-scene spine immobilization may do more harm than good

Jan 11, 2010

Immobilizing the spines of shooting and stabbing victims before they are taken to the hospital -- standard procedure in Maryland and some other parts of the country -- appears to double the risk of death compared to transporting patients to a trauma center without this time-consuming, on-scene medical intervention, according to a new study by Johns Hopkins researchers.

The findings, published in January issue of the Journal of Trauma, suggest that prehospital spine for these kinds of patients provides little benefit and may lethally delay proven treatments for what are often life-threatening injuries. Wounds from guns and knives are often far from the spine, yet patients are routinely put in a cervical collar and secured to a board, the investigators say.

"If you're twice as likely to die, that seems like a bad thing to do," says Elliott R. Haut, M.D., an assistant professor of surgery at the Johns Hopkins University School of Medicine and the study leader. "We like to use interventions that preserve life."

Haut says he hopes that as a result of his study, Maryland will consider changing its protocol, which encourages spine immobilization for nearly all shooting and stabbing victims.

The researchers caution that spine immobilization has been shown to be well worth the time and quite effective in saving lives and reducing disability from injuries sustained in car crashes and similar events.

One finding that Haut says startled his team: Some of the least injured gunshot or stab wound victims appear to be at greater risk of death if time is spent on prehospital immobilization.

"The patients who are very, very severely injured from their penetrating trauma are going to die no matter what you do," says Haut, a trauma surgeon at The Johns Hopkins Hospital. "But if someone is stabbed in the lung or shot in the liver, what we do for them and how fast we do it make a huge difference. That time difference in getting them to the hospital for treatment may make the difference between life and death."

EMTs and others who immobilize gunshot and stab wound patients don't intend to do harm, Haut emphasizes, but a cervical collar may, for example, conceal an injury to the trachea or make inserting a needed breathing tube more difficult.

The merits of other prehospital protocols, such as the need for universal intravenous fluid administration, have also been called into question in recent studies.

Haut and his colleagues looked at records from more than 45,000 patients with penetrating trauma included in the National Trauma Data Bank from 2001 to 2004. They calculated that the chance of benefiting from spine immobilization in those cases was 1 in 1,000, while 15 additional people potentially died for every 1,000 shooting or stabbing victims immobilized before being taken to the hospital.

"The idea of putting a board and collar on everybody is probably not the way to go," Haut says.

While standard protocol in Maryland requires spine immobilization for nearly all patients with bullet and knife wounds, there is more flexibility in other jurisdictions, Haut says. In the national data used by his group, only 4.3 percent of shooting and stabbing victims were immobilized before being taken to the emergency department.

Explore further: Continued reliance on Windows XP in physician practices may threaten data security

Provided by Johns Hopkins Medical Institutions

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Race and insurance status associated with death from trauma

Oct 20, 2008

African American and Hispanic patients are more likely to die following trauma than white patients, and uninsured patients have a higher death risk when compared with those who have health insurance, according to a report ...

Traumatic aortic injury -- New Review

Oct 15, 2008

A blunt traumatic injury to the aorta, the body's main artery, is one of the leading causes of death following a vehicle crash. If it is not treated rapidly, the patient is at serious risk for artery rupture, which is nearly ...

Recommended for you

What are the chances that your dad isn't your dad?

12 hours ago

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments : 0

More news stories

Down's chromosome cause genome-wide disruption

The extra copy of Chromosome 21 that causes Down's syndrome throws a spanner into the workings of all the other chromosomes as well, said a study published Wednesday that surprised its authors.

How kids' brain structures grow as memory develops

Our ability to store memories improves during childhood, associated with structural changes in the hippocampus and its connections with prefrontal and parietal cortices. New research from UC Davis is exploring ...

Ebola virus in Africa outbreak is a new strain

The Ebola virus that has killed scores of people in Guinea this year is a new strain—evidence that the disease did not spread there from outbreaks in some other African nations, scientists report.