title: Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.
abstract: BACKGROUND
  Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings.
  
  
  METHODS
  In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'.
  
  
  RESULTS
  There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation.
  
  
  CONCLUSIONS
  There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.
authors.affiliation: Emergency Department, Monash Medical Centre, Monash Health Surf Life Saving Australia Representative, Australian Resuscitation Council, Clayton Road, Clayton, Victoria 3125, Australia. Electronic address: natalie.hood@monashhealth.org.
authors.forename: Natalie
authors.initials: N
authors.lastname: Hood
authors.affiliation: Eastern Health - Deakin University Nursing Research Centre, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University College of Emergency Nursing Australasia Representative, Australian Resuscitation Council, 221 Burwood Highway, Burwood, Victoria 3125, Australia. Electronic address: julie.considine@deakin.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
mesh_terms: D000328:Adult; D002648:Child; D004632:Emergency Medical Services / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods*; D055416:Evidence-Based Emergency Medicine; D006801:Humans; D007103:Immobilization / Q000379:methods*; D013124:Spinal Injuries / Q000628:therapy*; D016896:Treatment Outcome
keywords: Emergency nursing; Evidence-based practice; Spinal immobilisation; Spinal injury; Systematic review; Trauma