May the Canadian C-Spine Rule be applied in patient assessment

The purposes of both the Canadian C-Spine Rule (CCSR) and the Basic Life Support (BLS) Spinal Motion Restriction Standard (SMR) are very similar:

• The CCSR is designed to be a highly sensitive decision aid for detecting acute C-spine injury and allow emergency department physicians to be more selective in use of spinal x-rays in trauma patients. A modified version has been found to be effective in guiding paramedics in the decision to provide spinal immobilisation to trauma patients.
• The SMR guides paramedics when to apply spinal immobilisation or to not consider a spinal injury, based on the mechanism of injury and the presence or absence of risk criteria. It does not allow the paramedic to clear the spine.

Apart from terminology, there are a few subtle differences in the criteria for these two decision tools:

• The CCSR does not make exceptions for penetrating trauma, while the SMR does
• The SMR is broadly applied in any mechanism of injury potentially leading to spinal injury, while the CCSR also specifies patient presentation and medical history that must be considered.
• The SMR considers that "distracting injuries" (non-specified) prevent accurate assessment, while the CCSR does not consider this as relevant.
• The SMR considers patients over 65 years to be high risk of spinal injury based only on mechanism of injury; while the CCSR excludes the assessment of patients under 16 and over 65 years.

The major difference is that the CCSR is presented in an algorithmic format, while the SMR is in the numbered, all-text process typical of the Patient Care Standards (PCS), however, the immobilisation decision is usually the same. Some paramedics may find they prefer one style easier to use than the other.

It does not appear that there will be significant differences in which patients are immobilised regardless of which these tools is applied.

In a future version of the BLS PCS Spinal Motion Restriction Standard, the CCSR will be be incorporated into the standards based on the latest evidence from the paramedic study.

As the SMR resides within the BLS PCS you are advised to consult with your Paramedic Service if you prefer the use of the CCSR over the SMR.