Question: Penetrating without neurological deficits. Delay on scene to spinal immobilize?

 Great question and very topical. At the last Ontario Base Hospital Medical Advisory Committee meeting, the regional medical directors along with senior MOH and Ontario Association of Paramedic Chiefs (OAPC) representatives reviewed the literature related to this very topic with a view to edit the future Basic Life Support Patient Care Standards (BLS PCS).

One of the papers reviewed can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21909006

To answer your question, for now, paramedics are to immobilize the cervical spine as per the current BLS PCS. In section 3 page 33 it states that paramedics are to assume neck and spinal cord injury until assessment indicates otherwise in all patients involved in and/or suffering from€¦ (and it lists multiple categories but specific to penetrating trauma it stipulates penetrating neck/back injuries).

Then, if the patient has any trauma associated with neck OR back pain OR neurologic symptoms then paramedics are to immobilize.

If a patient meets these indications as outlined above, then with penetrating trauma we would suggest you immobilize the patient following the series of steps as outlined in the BLS PCS in the trauma section related to "Load and Go" in section 3 page 7 beginning at point 10.

BLS,Miscellaneous

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