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Spinal Immobilization Technique Stirs Discussion

An October JEMS training article by Keith Widmeier, NREMT-P, CCEMT-P, EMSI, AAS, (“Hold Still: Teaching pediatric immobilization techniques”) spurred a discussion on proper spinal immobilization techniques for children. Also, a reader comments on a November clinical education article on the different types of diabetes by Donald A. Locasto, MD, FACEP; Dustin J. Calhoun, MD; Robbie J. Meek, CCEMT-P, CICP, PNCCT-P, NREMT-P, EMS-I & Thomas W. Trimarco, MD, (“Distinguishing Diabetes: Differentiate between Type 1 & Type II DM).

Car Seat Safety
As a child passenger safety technician and an advanced EMT, I question the use of a child’s car seat as a spinal immobilization device and transport option. What is ‘comforting’ about padding and taping a child into their own car seat? Child passenger safety seats are not pediatric spinal immobilization devices.

Also, using a potentially compromised child’s car seat to immobilize and transport puts everyone at additional risk. Once a child is “immobilized,” how is the seat secured for transport in the back of the ambulance?

The use of child passenger safety seats on ambulance cots is based on findings of research conducted and policies developed by the automotive safety program at Riley Hospital for Children in Indianapolis, in collaboration with the University of Michigan Transportation Research Institute (UMTRI). Recommendations based on crash testing were published in 2001 by Al Buller, “Crash Protection for Children in Ambulances.”

I believe all EMS providers/educators/training officers need to review the available research and recommendations when making decisions and providing training for pediatric patient packaging and transport.
Theresa Remsberg, AEMT
Twisp, Washington

If a patient deserves and warrants transport to a hospital via ambulance, I believe that patient deserves our unique attention to detail and a full head-to-toe assessment. This cannot be accomplished if the pediatric patient is left in a car seat. Also, if something happens, such as a seizure, then the car seats out there today don’t keep the patient in a good airway position. In fact, in addition to little or no shoulder blade support, there is slight cervical flexion and therefore, it’s difficult to neutralize the patient’s airway.
User J
Via JEMS.com

Author Keith Widmeier, NREMT-P, CCEMT-P, EMSI, AAS, responds: Would being padded and taped be the most comfortable position for a child? Probably not. However, they are used to their car seat, and they are used to padding around their head. As a CPS Tech, you are aware that many rear-facing infant seats come with padding around the head to assist infants because of the lack of sternocleidomastoid muscle tone.

Furthermore, the clinician must weigh the risks vs. benefits of immobilizing the child. Would a child be more likely to cause or further exacerbate a spinal injury because they were restrained? It’s not a simple yes or no procedure because the situations may vary. 


I’m a huge proponent of evidence-based medicine. I mention the debate regarding the effectiveness and necessity of spinal immobilization in the article because of the recent research that has proven it to be a controversial topic. I can only hope that EMS instructors incorporate the most recent and methodologically sound research into their educational teachings and practice.

Diabetes Discussion
This is an excellent article that achieved its purpose. I did notice that in the discussion of treatments for hypoglycemia, the authors went as far as mentioning rectal glucose but left out an important one: intranasal glucagon.

This has been my go-to route since my department began using the Mucosal Atomization Device (MAD) in the event of difficult or unfeasible IV access. It’s safer and easier than wielding a needle around a combative patient to attempt IV access or administer IM/SC glucagon. I have had great success thus far with IN glucagon.
Max Drucker
Washington, D.C.

Correction
The December JEMS Research Review column (“Debating Detox: Providers’ predictions about transporting inebriated patients”) contains an error. In the “Watch Box” section, a study from the Emerg Med J by Schmidbauer W, Ahlers O, Spies C, et al., was mistakenly included in this section. This particular study was not actually reviewed in the column. We regret the error. JEMS

This article originally appeared in January 2012 JEMS as “Letters.”



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