Cervical Spine Stabilization Techniques in the Wilderness

Introduction: Traumatic spinal injury in the wilderness poses many unique challenges. One of these challenges is the lack of resources that would otherwise allow for straightforward stabilization and transport of patients to further care. This challenge is often emphasized by a lack of preparedness. Our objective is to discuss optimal utilization of standard hiking equipment to stabilize a suspected cervical spine injury throughout transport to further care.

Methods: To simulate cervical spine injury, a model designed to mimic natural neck movement was used. An accelerometer was attached to the head, and the force transmitted across the neck was measured when this model was carried 20 paces. Measurements were made without any cervical spine stabilization, with a SAM splint oriented horizontally across the neck, and with a SAM splint oriented obliquely. A standard hiking backpack was also used for cervical stabilization.

Results: The use of any straight or oblique overlapping SAM splint, or a backpack cervical collar significantly reduces the force transmitted across the neck (p < 0.00001) when compared to nothing. An overlapping SAM splint collar noticeably decreased the force transmitted across the neck in comparison to the straight collar, but this did not meet the threshold for statistical significance (p=0.062). Supplementing the overlapping SAM splint collar with a backpack collar did not statistically decrease force across the neck, but supplementing the straight SAM splint collar with a backpack did statistically decrease the force across the neck by about half (p < 0.05).

Conclusion : Treating a suspected traumatic cervical injury in the wilderness, miles from the nearest hospital is challenging even for the experienced healthcare providers. In this study, we showed that applying any form of collar statistically decreases the force felt across the cervical spine with transport when compared to no collar. There is no significant difference between a straight SAM splint collar, an overlapping SAM splint cervical collar, or a backpack collar and these should be applied based on the availability of resources and the patient’s specific situation.