Page 263 - 2023 SMOG Digital

SPINAL EVALUATION &

IMMOBILIZATION/CANADIAN C-
SPINE RULE (CCR)

Rule does not apply if:
Continued from: Non-Trauma Case
Tactical Evacuation Guideline GCS <15
Unstable Vital Signs
Age <16
Universal Patient Care Guideline Acute Paralysis
Known Veterbrale Disease
Any high mechanism of Previous C-Spine Injury
injury? Age >65 or
* Dangerous Mechanism or YES *Definition of Dangerous Mechanism
Paresthesia in extremities Fall from >1 Meter
Axial Load to Head
NO High Speed RTC, Rollover, Ejection
Motorized Recreational Vehicle
Any low risk factor that allows safe Bicycle Collision
range of motion?
Simple rear-end traffic collision (RTC)
Ambulatory at any time
Delayed onset of neck pain NO Immobilize and Transport
Absence of midline C-spine tenderness
YES
Able to actively rotate neck? NO
45 ⁰ left and right?
YES
NO IMMOBILIZATION
CONTRAINDICATIONS:
• Patients with isolated penetrating cervical injury who are conscious and have no neurologic signs should not
have a cervical collar placed in the pre-hospital environment.
PROCEDURE:
• Evaluation should take place after the primary survey and all emergent procedures completed. However,
during the primary survey, the spine should be protected by manual inline stabilization/limited movement
prior to completion of spinal examination. This does not apply to situations in which imminent danger exists
and immediate movement is necessary.
Document procedure, results, and vital signs.

• On the battlefield, safety of patient and medical personnel are paramount. In hostile situations,
evacuation to a more secure area takes precedence over spine immobilization.

263