SMRF Study: To Collar or Not to Collar? That is the Question


Within the United Kingdom, Cervical Spinal Cord Injury (SCI) is a rare event yet Emergency Medical Services (EMS) routinely immobilise a significant number of patients. For over 50 years traditional three-point immobilisation for spinal stabilisation has been, and continues to be, the standard clinical practice for trauma patients with suspected cervical injury. Current practice is based on 1960’s opinion and limited case studies with no real evidence to support practice

Contemporary literature and consensus reports are now challenging traditional practices in favour of a pragmatic second generation of supportive techniques that follow patient centred spinal motion restriction principles. Spinal Motion Restriction principles include moving away from the routine application of rigid collars and back boards, encouraging self-extrication when appropriate, manual in line stabilisation and alternative approaches to spinal motion restriction while improving patient comfort. These principles empower clinicians to tailor their approach to spinal motion restriction and ensure effective and safe patient centred care.

Purpose and aim

The purpose of this body of work is to highlight the lack of evidence behind current immobilisation practices while concurrently gathering data regarding the consequences of ‘traditional’ immobilisation in the pre-hospital environment. The Northern Trauma Network and North East Ambulance Service has produced a spinal motion restriction protocol which provides a more pragmatic, patient centred approach. The Spinal Motion Restriction Feasibility (SMRF) study will prospectively compare a new spinal motion restriction protocol with existing immobilisation practices. 


Relevance to the Paramedic Profession/Healthcare

The SMRF study will be a randomised prospective two centred study. An intervention group will apply pragmatic and patient centred spinal motion restriction principles and also omit the use of traditional rigid collars (control group = current care). EMS will be at the forefront of this unique study. As such, this paramedic led trial may introduce a paradigm shift in the way UK EMS manage potential cervical injury. The SMRF Study will challenge the way Paramedics, and all EMS, have traditionally extricated and immobilised those patients who have experienced trauma and have been assessed as having a potential cervical injury.

Click here to see a diagram of the SMRF study intervention.

Importance/Implications for practice

The potential risks of using the traditional three-point immobilisation techniques include: airway compromise; impaired ventilation; aspiration risk; patient discomfort; increased agitation; worsening delirium; raised intra-cranial pressure (ICP); worsening of injury – spinal deformity; pressure injuries; transport delays.

This trial has evolved from the work of the Older Persons Trauma Working Group. Although initially targeted at addressing the emerging understanding that the older trauma patient is the largest cohort for major trauma, the protocol for the SMRF study is appropriate for all patients with potential SCI. The study will empower clinicians to provide a bespoke, patient centred approach to spinal motion restriction.

It will be UK Paramedics and EMS who will be at the forefront of change and developing evidence based practice that has hitherto been lacking and shape the way we manage patients with potential cervical SCI in the future.

Click here to see the SMRF study poster.

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Copyright 2011 North East Ambulance Service Trust

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