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SMORE (Spinal Motion Restriction Evaluation)
I. Purpose Select patients can be treated and safely transported without Spinal Motion Restriction (SMR) if they meet certain criteria. By following a specific process validated by research on cervical spine injury, these patients can be spared the uncomfortable process of SMR without risk of harm. Moreover, valuable resources, such as in an MCI event, can be better prioritized to those patients who require SMR. Opposed to “clearance”, this process is more accurately termed risk stratification, where the chance of cervical spine injury in greatly minimized, not totally eliminated. Occult spine injury could exist, although research demonstrates it would be clinically stable and the patient should suffer no harm. This is not a protocol of “convenience” for the provider. This is an ALS protocol, coupled with a Check Sheet, and a well defined Quality Assurance/Quality Improvement Process. Remember, “Above all, do no harm”. II. Spinal Motion Restriction(SMR) General Principles While maintaining manual stabilization of the C-spine during the evaluation process, you will assess the mechanism of injury. You will interview and examine the patient, then use this information to determine which patients require SMR. At any point of the decision tree you find a positive factor, you must provide SMR. You do not balance or weight the merits of each component to make your decision. A SMORE Worksheet will be completed on any patient determined to NOT require SMR. This will be returned to Public Safety for review by the Operational Medical Director (OMD). A QA/CQI process will monitor, evaluate and provide modification/intervention to the provider or protocol as necessary. It is considered to be a credentialed skill which can be revoked or modified, just as any other advanced skill. Certification levels of EMT-I and above is required to execute the SMORE program. A. SMR is indicated in pre-hospital trauma patients who sustain an injury with a mechanism having the potential for causing spinal injury and who have at least one of the following clinical criteria:
Franklin County Public Safety Protocol: SMORE (Spinal Motion Restriction Evaluation) B. High risk mechanisms of injury include
C. Reliable patient characteristics
D. Unreliable patient characteristics
III. Implementation Provider will review the protocol and supporting materials. Completion of written test with 100% correct will allow provider to execute protocol. A yearly update will be required. Resources BTLS for Paramedics and Other Advanced Providers, Fifth Edition. John E. Cambell, editor. Alabama Chapter American College of Emergency Physicians. Pearson Prentice Hall, 2004. Chapter 11, pp 155-159. Domier, R.M. The National Association Emergency Medical Services Physicians Standards and Clinical Practice Committee. Prehospital Emergency Care, Vol. 13(1999), pp 251-253. Franklin County Public Safety SMORE(Spinal Motion Restriction Evaluation) Worksheet Patient Initials:________ Age:___/___/___ Date Event:___/___/___ PPCR#:___________ Unit #:_________ Provider Name:________________________ Number:______________
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