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

January 11, 2010, Johns Hopkins Medical Institutions

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.

Related Stories

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.