An Assessment of the Use of Spine Immobilization by EMS Professionals in South Carolina

Introduction—The National Association of EMS Physicians and American College of Surgeons Committee on Trauma state that use of backboards for prehospital spinal immobilization (SI) should be considered only when potential benefits outweigh risks.

Objective—To identify factors related to prehospital SI for trauma patients in South Carolina.

Methods—This retrospective observational study examined all 2016 9-1-1 EMS trauma calls in South Carolina. Study data were obtained from the South Carolina EMS data system. Independent variables included whether the patient met the 2011 Centers for Disease Control and Prevention (CDC) criteria for transport to a trauma center, community size, and patient age, gender, and race. Patient age in years was categorized as 1 or below, greater than 1–7, 8–17, 18—54, and 55 or more. Race was categorized as white (referent group), black, or other. Univariate and multivariable logistic regression modeling was performed.

Results—In 2016 there were 135,902 trauma calls in South Carolina. SI was performed on 24,699 (18.2%). There were 3,341 (2.5%) trauma patients who met CDC criteria; all had SI performed. Among patients who did not meet CDC criteria, 21,358 (16.1%) had SI performed. CDC criteria predicted SI perfectly; therefore, it was omitted from logistic regression analysis. Univariate analyses revealed significant (p<0.05) relationships between SI and all independent variables. These relationships remained significant after multivariable modeling. Urban patients had decreased odds of SI (OR 0.79; 95% CI, 0.77–0.82, p<0.001). African-Americans had decreased odds of SI (OR 0.97; 95% CI, 0.94–0.99, p=0.03). No difference was noted among other races (OR 1.05; 95% CI, 0.96–1.13, p=0.28). Males had increased odds of SI (OR 1.28; 95% CI, 1.24–1.31, p<0.001). All age groups had decreased odds of SI when compared to those 18–54 and 1 and below (OR 0.25; 95% CI, 0.19–0.33, p<0.001), 1–7 (OR 0.35; 95% CI, 0.31–0.40, p<0.001), 8–17 (OR 0.89; 95% CI, 0.84–0.95, p<0.001), and 55 or more (OR 0.54; 95% CI, 0.52–0.55, p<0.001) The multivariate logistic model demonstrated good fit (p=0.43).

Conclusion—EMS professionals in South Carolina appear to be considering risks and benefits of SI. All those who met the CDC criteria for transport to a trauma center had SI. Younger and senior patients were much less likely to have SI.