Kevin Collopy, Sean Kivlehan and Scott Snyder are featured speakers at EMS World Expo 2013, September 8–12 in Las Vegas, NV, and will present on several topics including Pediatric Spinal Immobilization, Hot Topics in EMS and Case Studies in Medical Emergencies.
This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. There are two ways to take the CE test that accompanies this article and receive 1.5 hours of CE credit accredited by CECBEMS: 1. Click here to download a PDF of the test. The PDF has instructions for completing the test. 2. Or go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com.
To download this article in pdf format click here.
• Review pediatric spinal anatomy
• Describe mechanisms of injury
• Review assessment techniques
• Discuss injury types in the pediatric patient
• Review pediatric immobilization techniques
On a warm, pleasant August morning, Waushara County (WI) EMS was dispatched to a diving accident. A 12-year-old female dove from the pier at her family’s remote country cabin and came up from the water screaming that she’d felt a snap in her neck. The girl and her family waited anxiously for the 20-plus minutes the closest ambulance took to arrive, knowing it was at least 45 minutes to the closest hospital.
When the EMS crew arrived, the patient complained of feeling neck pain since the snap but showed no neurological deficit. Knowing they had an extended drive to the hospital plus a 30-foot hill from the lake to the driveway to traverse, the crew spent several minutes carefully immobilizing their wet and shivering patient with blankets. After carefully padding a backboard and securing her tightly, they slowly carried her up the steep hill and to the ambulance for the 45-minute drive to the local ED.
I watched this entire call unfold, and when my cousin was diagnosed with a C2 body fracture and then driven, fully immobilized, three hours to the children’s trauma center for neurosurgical repair, the importance of careful and complete spinal immobilization took on a new meaning for me.
Scope of the Problem
According to the CDC, as many as 20,000 new spinal cord injuries occur annually.1 Depending on the year, up to 10% of spine injuries occur in pediatric patients.2 Spinal cord-injured patients face lifetimes of increased medical costs that can be as high as $30,000 a year. When these injuries occur in children who have many years to live, the lifetime costs for a single patient can exceed $3 million.1
Fortunately, in the scope of pediatric patients seen, fewer than 1% who present for trauma evaluation have cervical spine injury.3 Even so, almost all pediatric patients presenting to emergency departments with traumatic injuries are immobilized for transport. This practice is not without a downside: immobilization increases the risk for pain, pressure ulcers, respiratory distress, and radiation from x-rays and CT scans.3 No provider wishes to fail to immobilize a child when a spine injury is present, particularly when 80% of pediatric spine injuries occur in the cervical spine.2 Fortunately these risks can be minimized with proper screening and careful immobilization. This article explores the anatomy of the pediatric spine and the management of pediatric spinal cord injury.
Spinal column development begins early during embryonic growth. By the sixth week of fetal growth, a cartilaginous vertebral column forms. Throughout the remainder of fetal growth, ossification (bone growth) occurs. By birth there are definable vertebral bodies as well as cartilaginous vertebral arches that form the posterior aspect of the spinal canal. These cartilaginous arches strengthen into bone and become the lamina and pedicles during the first 5 years of life. By age 6 the pedicles have generally ossified to the point where they are called bone. Bones then continue to grow and strengthen until a child is fully grown. A spine doesn’t completely take on adult characteristics until at least age 9.2 Even after this age the column continues to add cartilage at the growth plates as it builds size and strength. Injury at the growth plates can result in long-term impairment of vertebral growth.