Cervical Spine Immobilization of Penetrating Neck Wounds in a Hostile Environment

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Abstract
Current guidelines concerning trauma suggest that cervical spine immobilization be performed on all patients with penetrating wounds of the neck. This study was undertaken to examine the risks and benefits likely to be found when such care is provided in a hazardous environment, such as the battlefield, or the scene of a terrorist attack or domestic criminal action. Data for casualties from the Vietnam conflict were reviewed to determine the potential benefit of cervical spine immbolization on the battlefield. In this population, penetrating cervical cord injury was always fatal and usually immediately so. Only 1.4% of all casualties who were candidates for immbolization might have benefitted from the care. However, the risk of performing immobilization in a hazardous environment is subsantial since about 10% of casualties are incurred while helping other casualties. Mandatory immobilization of all casualties with penetrating neck wounds sustained in an environment hazardous to first aid providers has an unfavorable risk/benefit ratio.