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Spinal motion restriction

Spinal motion restriction (SMR) is external stabilization of the head, neck, torso, to protect a potentially injured spinal cord by minimizing movement.




  • Newly reported numbness, tingling, weakness, or paralysis to any extremity.

  • Neck or spinal pain (voluntary stated by patient or upon questioning)

  • Spinal tenderness over the bony spine upon palpation

  • Injury with altered mental status (including intoxication) such that physical assessment is unreliable

  • Painful injury of the head, chest, abdomen-pelvis, arms or legs such that physical assessment for potential spinal injury may not be reliable due to victim focusing on pain or injury.




  • Accidents in which the head strikes an obstacle and the cervical spine is stressed by motion or mechanical force (such as occurs with diving, surfing, football, fall, and automobile accidents).

  • Hyperextension neck injuries (forceful bowing of the next from the head being pushed or thrown back).

  • Victims of electric shock with reported or suspected muscle convulsive activity or loss of consciousness.



  • SMR should be placed if an EMT or Paramedic suspects spinal injury based on history, physical exam, mechanism (maintain high suspicion for spinal injury in victims 65 years and older).



In the following situations, patients should be moved (while limiting motion of the spine as much as possible) to an appropriate perimeter or location before placing SMR:

► Unsafe scene that poses an imminent danger to the patient or rescuers.

► Patient with a life-threatening condition that requires immediate intervention.

► Patient must be moved so that rescuers can access other patients(s) with potential serious conditions.



  • Facial/oral bleeding or uncontrolled vomiting such that airway cannot be controlled.

  • Uncontrolled bleeding that cannot be controlled with spinal immobilization in place.



  1. Manually restrict motion, maintain in-line neutral position and avoid unnecessary pt. movement.

  2. Assess and monitor airway continuously.

  3. Assess motor, sensory, and circulation and document Pre and Post SMR.

  4. Use manual stabilization of head and neck until motion restricted by C-Collar.

  5. If ambulatory - Escort and assist onto gurney, position on gurney in supine or POC if supine not tolerated.

  6. If Non-ambulatory / Extrication / High risk injury - Use C-Collar and Backboard /  KED.

  • Blunt trauma to head, neck, or spinal area and ALOC.
  • Spinal pain or tenderness.

  • Acute neurological complaint (numbness, tingling, weakness, or paralysis of extremities).

  • Visible of palpable deformity of the spine

  • High-energy mechanism of injury (ETOH, inability to communicate, distracting injury)

7.   Long board or extrication device may be removed for long transports if C-Collar and gurney straps are in place.

8.   For transports less than 10 minutes, long board or extrication device may be left in place during transport if tolerated by pt.

9.   If wearing helmet:

  • Helmeted athletes lying supine and wearing shoulder pads should be motion restricted and transported with helmet and pads left in place, face guard or shield should be removed.
  • If not wearing shoulder pads, remove helmet with second responder maintaining manual stabilization of the head and neck

10.  If obvious pregnant, secure in left lateral position and maintain SMR with pillows of blankets.

11.  Remove C-Collar if device impairs airway or breathing or cannot tolerate, document reasons.

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