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Spinal Immobilization in Disasters: A Systematic Review

Published online by Cambridge University Press:  29 May 2020

Joseph L. Cuthbertson*
Monash University, Disaster Resilience Initiative, Clayton, Melbourne, Victoria, Australia
Eric S. Weinstein
CRIMEDIM, Università del Piemonte Orientale, Novara, Italy
Correspondence: Joseph Cuthbertson, MPH, MSC, MEH, Monash University, Monash University Disaster Resilience Initiative, Clayton, Melbourne, Victoria3800Australia, E-mail:


In response to the International Liaison Committee on Resuscitation (ILCOR; Niel, Belgium) release of an updated recommendation related to out-of-hospital spinal immobilization (SI) practice in 2015, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of English-language studies published from January 2000 through July 2019 on the use of SI in resource-scarce environments (RSEs). Studies meeting the following criteria were included in the analysis: peer-reviewed statistical studies or reports detailing management of potential traumatic spinal injury in RSE, civilian, and military environments; as well as consensus clinical guidelines, academic center, or professional association protocols or policy statements detailing management of potential traumatic spinal injury in RSE, civilian, and military environments; statistical analysis; and subsequent management of spinal injuries after mass-casualty incidents, in complex humanitarian events or conflict zones, low-to middle-income countries, or prolonged transport times published by government and non-government organizations. Studies excluded from consideration were those not related to a patient with a potential traumatic spinal injury after a mass-casualty incident, in complex humanitarian event or conflict zones, in low-to middle-income countries, or with prolonged transport times.

There were one thousand twenty-nine (1029) studies initially identified. After removal of duplicates, nine hundred-nineteen (919) were screened with eight hundred sixty-three (863) excluded. The remaining fifty-six (56) received further review with fourteen (14) selected studies achieving inclusion. The reviewed articles comprised six (6) types of studies and represented research from institutions in seven (7) different countries (Israel, United States, Haiti, Wales, Pakistan, China, and Iran). Thirteen (13) references were case reports/narrative reviews, policy statements, retrospective observational studies, narrative literature reviews, scoping reviews, and one systematic review. The majority of literature describing spinal cord injury was predominantly associated with earthquakes and blast-related disasters. There were no SI evidence-based clinical guidelines (EBG) in RSE. Information was obtained that could be used to formulate statements in a modified Delphi study to present to experts to obtain consensus SI EBG in RSE.

Systematic Review
© World Association for Disaster and Emergency Medicine 2020

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Singletary, EM, Zideman, DA, De Buck, ED, et al.Part 9: first aid: 2015 international consensus on first aid science with treatment recommendations. Circulation. 2015;132(16 Suppl 1):S269S311.CrossRefGoogle ScholarPubMed
Smith, E, Wasiak, J, Sen, A, Archer, F, Burkle, FM Jr. Three decades of disasters: a review of disaster-specific literature from 1977-2009. Prehosp Disaster Med. 2009;24(4):306311.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264269.CrossRefGoogle ScholarPubMed
Guyatt, G, Oxman, AD, Akl, EA, et al.GRADE Guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383394.CrossRefGoogle ScholarPubMed
World Health Organization. Coping with Natural Disasters: The Role of Local Health Personnel and the Community. Geneva, Switzerland: WHO; 1989.Google Scholar
Quinn, RH, Williams, J, Bennett, BL, et al.Wilderness Medical Society practice guidelines for spine immobilization in the austere environment: 2014 update. Wilderness Environ Med. 2014;25(4):S105S117.CrossRefGoogle ScholarPubMed
Hunt, J, Dykes, L, Walford, T. Unstable spinal fractures in Snowdonia Mountain casualties. Emerg Med J. 2016;33(12):925.CrossRefGoogle Scholar
Klein, Y, Arieli, I, Sagiv, S, Peleg, K, Ben-Galim, P. Cervical spine injuries in civilian victims of explosions: should cervical collars be used? J Trauma Acute Care Surg. 2016;80(6):985988.CrossRefGoogle ScholarPubMed
Arsh, A, Darain, H, Ul-Haq, Z, et al.Epidemiology of spinal cord injuries due to bomb blast attacks, managed at paraplegic center Peshawar, Pakistan: a nine years retrospective study. KMUJ. 2017;9(2).Google Scholar
Callaway, DW, Smith, ER, Cain, J, et al.Tactical Emergency Casualty Care (TECC): guidelines for the provision of prehospital trauma care in high threat environments. J Spec Oper Med. 2011;11(3):104122.Google ScholarPubMed
Gautschi, OP, Cadosch, D, Rajan, G, Zellweger, R. Earthquakes and trauma: review of triage and injury-specific, immediate care. Prehosp Disaster Med. 2008;23(2):195201.CrossRefGoogle ScholarPubMed
Lodhi, A, Khan, SA, Ahmed, E, et al.Prehospital management of spinal injuries in a natural disaster. J Ayub Med Coll Abbottabad. 2011;23(4):1012.Google Scholar
Priebe, MM. Spinal cord injuries as a result of earthquakes: lessons from Iran and Pakistan. J Spinal Cord Med. 2007;30(4):367.CrossRefGoogle ScholarPubMed
Haojun, F, Jianqi, S, Shike, H. Retrospective, analytical study of field first aid following the Wenchuan Earthquake in China. Prehosp Disaster Med. 2011;26(2):130134.CrossRefGoogle ScholarPubMed
Cartwright, C, Hall, M, Lee, A. The changing health priorities of earthquake response and implications for preparedness: a scoping review. Public Health. 2017;150:6070.CrossRefGoogle ScholarPubMed
Rathore, FA, Farooq, F, Muzammil, S, New, PW, Ahmad, N, Haig, AJ. Spinal cord injury management and rehabilitation: highlights and shortcomings from the 2005 earthquake in Pakistan. Arch Phys Med Rehabil. 2008;89(3):579585.CrossRefGoogle ScholarPubMed
Jones, L, Bagnall, AM. Spinal injuries centers (SICs) for acute traumatic spinal cord injury. Cochrane Database of Syst Rev. 2004;(4):CD004442.Google Scholar
Gosney, JE, Reinhardt, JD, von Groote, PM, Rathore, FA, Melvin, JL. Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce environments: implications for disaster research. Spinal Cord. 2013;51(8):603609.CrossRefGoogle ScholarPubMed