Table 4 Criteria PRO and CONTRA spinal immobilization taken from literature search and integration into the E.M.S. IMMO Protocol

PRO criteria

References

E.M.S. IMMO protocol

Age > 65 years

[4, 21, 43]

included in MARSHAL criteria

Rigid vertebral disease

[52]

not included as PRO criteria

State of acute anxiety

[53]

included in MARSHAL criteria (serious distraction)

Language barrier

[53]

included in assessment of impairment

Acute stress reaction

[54]

included in MARSHAL criteria (serious distraction)

Distracting injury

[42, 44, 54]

included in MARSHAL criteria (serious distraction)

Intoxication

[52, 54–56]

included in assessment of impairment

Fall from > 6 m

[57]

included in MARSHAL criteria (fall from ≥ 2 m)

Fall from 3 to 6 m

[57]

included in MARSHAL criteria (fall from ≥ 2 m)

Fall from > 3 m

[52, 58]

included in MARSHAL criteria (fall from ≥ 2 m)

Fall from > 2 m

[59]

included in MARSHAL criteria (fall from ≥ 2 m)

Fall from > 1 m

[38, 44]

not included as PRO criteria

Fall from large animal

[57]

included in MARSHAL criteria (fall from ≥ 2 m)

High speed accident > 100 km/h

[38, 44, 52]

included in MARSHAL criteria

Speed > 56 km/h

[58]

not included as PRO criteria

MVA or pedestrian vs. train

[57]

included in MARSHAL criteria (locomotive or bike collision)

MVA ejection

[38, 44, 57]

included in MARSHAL criteria

Vehicle rollover

[38, 44]

included in MARSHAL criteria

Bicycle collision

[38, 44]

included in MARSHAL criteria

Road traffic collision

[59]

not included as PRO criteria

Significant intrusion of vehicle

[44]

not included as PRO criteria

Axial load to head

[38, 44]

included in MARSHAL criteria

Diving accident

[52]

included in MARSHAL criteria (axial load to head)

Sport injuries

[59]

not included as PRO criteria

Shooting

[59]

not included as PRO criteria

Death at scene

[58, 60]

not included as PRO criteria

Altered/loss of consciousness

[52–56, 61, 62]

included in ABCDE criteria (unstable patient)

Spine pain/tenderness

[4, 11, 20, 21, 24, 41, 49]

included in MARSHAL criteria and in indication of spine injury

Abnormal sensory/motor exam

[44, 45, 52, 55, 56, 62]

included in MARSHAL criteria

Significant head or facial injury

[52, 58, 61]

included in MARSHAL criteria (supraclavicular injuries)

Other spine fractures

[52]

not included as PRO criteria

Supraclavicular lesions

[45]

included in MARSHAL criteria

Severe injuries to other body systems

[52, 55, 56, 58, 61]

not included as PRO criteria

CONTRA criteria

References

E.M.S. IMMO protocol

No neurological abnormalities

[39, 50]

included in MARSHAL criteria

No evidence of intoxication

[39, 50, 63]

included in assessment of impairment

No midline C-spine tenderness

[39, 50]

included in MARSHAL criteria

No distracting injury

[39, 50, 63]

included in assessment of impairment

Able to actively rotate neck

[38, 44]

included in indication of spine injury

Penetrating trauma

[33]

not included as CONTRA criteria

Functional range-of-motion

[64]

included in indication of spine injury