Spinal Motion Restriction: Indications, Devices, Helmets, and Children Practice Questions

25 multiple-choice questions on Spinal motion restriction: indications, devices, helmets, and children for paramedic and EMT students, from Chapter 35 (Head and Spine Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Current EMS guidance favors the term spinal motion restriction over spinal immobilization mainly because:

   1. A. Spinal injuries no longer need any special handling in the field
   2. B. Immobilization is now reserved for patients who are fully alert
   3. C. The term applies to patients secured to a long backboard
   4. D. True immobilization cannot be achieved with current devices
   Show answer

   Answer: D. True immobilization cannot be achieved with current devices

   No device fully immobilizes the spine, so the realistic, goal-oriented aim is to limit unwanted motion while avoiding harm from the devices themselves. Spinal precautions still matter; the change is in how the goal is defined.

2. According to the 2018 joint position statement of ACS-COT, ACEP, and NAEMSP, the long backboard is best used to:

   1. A. Transport every patient with a mechanism
   2. B. Replace the cervical collar in alert adults
   3. C. Help extricate or move a patient
   4. D. Restrict motion during long transports
   Show answer

   Answer: C. Help extricate or move a patient

   The statement limits the long board mainly to extrication and movement, after which the patient can be placed on the stretcher mattress, a scoop, or a vacuum mattress. Prolonged board time causes pain, pressure injury, and breathing restriction.

3. Under the 2018 joint statement, which adult with blunt trauma needs spinal motion restriction?

   1. A. One with a minor laceration of the scalp
   2. B. One with midline cervical tenderness
   3. C. One with pain in the shoulder muscles only
   4. D. One whose car was struck at low speed
   Show answer

   Answer: B. One with midline cervical tenderness

   Indications include altered mental status or intoxication, midline spinal pain or tenderness, focal neurologic signs or symptoms, spinal deformity, and distracting injury or an inability to communicate. Mechanism alone, without these findings, is not an indication.

4. A 30-year-old was the restrained driver in a low-speed rear-end crash. He is alert, sober, and calm, with no midline neck pain or tenderness, no neurologic deficits, and no other injuries. Regarding spinal motion restriction, you should:

   1. A. Apply a collar and backboard because of the crash
   2. B. Apply a collar only if he asks to have one
   3. C. Not apply it, because no criteria are present
   4. D. Apply it until x-rays rule out a fracture
   Show answer

   Answer: C. Not apply it, because no criteria are present

   A reliable patient without midline tenderness, neurologic findings, deformity, intoxication, or a distracting injury can be cleared clinically in the field per protocol. Applying SMR because of the crash alone exposes him to discomfort and harm without benefit.

5. A 45-year-old who smells of alcohol fell down a flight of stairs. He denies neck pain and moves all extremities. You should:

   1. A. Apply spinal motion restriction
   2. B. Clear the spine because he denies pain
   3. C. Clear the spine after a normal motor exam
   4. D. Apply SMR if a deficit develops
   Show answer

   Answer: A. Apply spinal motion restriction

   Intoxication makes the patient's denial of pain unreliable, so he meets criteria for SMR. Clearing him based on his own report is the classic error. A normal motor exam does not clear the spine in an unreliable patient, and waiting for a deficit to appear before restricting motion defeats the purpose of SMR.

6. A 24-year-old has a gunshot wound to the neck. He is alert with normal motor and sensory function and has noisy breathing. Regarding the spine, you should:

   1. A. Apply a collar and secure him to a long backboard
   2. B. Apply a collar but leave the board off
   3. C. Hold the head and delay airway care
   4. D. Focus on the airway and not apply a collar
   Show answer

   Answer: D. Focus on the airway and not apply a collar

   Penetrating trauma without neurologic deficit rarely causes an unstable spine, and SMR in these patients is linked to higher mortality from delayed care and hidden airway or vascular injury. A collar would hide an expanding hematoma and hamper airway management.

7. Spinal motion restriction is generally not indicated for penetrating trauma to the head, neck, or torso unless:

   1. A. The wound was caused by a high-velocity hunting rifle
   2. B. The patient has a neurologic deficit or deformity
   3. C. The patient is older than 65 years of age
   4. D. The transport time is longer than 30 minutes
   Show answer

   Answer: B. The patient has a neurologic deficit or deformity

   Without a deficit or obvious spinal deformity, SMR after penetrating injury offers little benefit and costs time. When a deficit is present, motion restriction may be considered while lifesaving care proceeds.

8. An alert adult who meets criteria for SMR is found walking around the crash scene. The preferred approach is to:

   1. A. Perform a standing takedown onto a long backboard
   2. B. Let him walk without a collar to the ambulance
   3. C. Lay him on the ground, then log roll him onto a long board
   4. D. Apply a collar and have him sit, then lie on the stretcher
   Show answer

   Answer: D. Apply a collar and have him sit, then lie on the stretcher

   A patient who is already ambulatory can have a collar placed and then sit on and lie back on the stretcher with minimal assistance, which causes less spinal movement than a standing takedown. Movement is limited, not eliminated.

9. Which complication is associated with prolonged time on a long backboard?

   1. A. Pressure injury to the skin
   2. B. Improved lung function
   3. C. Hypertension from pain
   4. D. Reduced risk of aspiration
   Show answer

   Answer: A. Pressure injury to the skin

   Rigid boards cause pain, pressure ulcers within hours, reduced respiratory capacity, and increased aspiration risk. These harms are why the joint statement restricts board use.

10. A distracting injury, for the purpose of spinal assessment, is best described as one that:

    1. A. Is located anywhere below the waistline
    2. B. Causes the patient to be anxious
    3. C. Could mask the patient's spinal pain
    4. D. Requires a tourniquet to control
    Show answer

    Answer: C. Could mask the patient's spinal pain

    A painful injury such as a long-bone fracture, large burn, or degloving wound can mask spinal pain, making the exam unreliable. The defining feature is the potential to distract, not its location.

11. A 72-year-old with a severely kyphotic spine needs spinal motion restriction. To maintain alignment you should:

    1. A. Press the head down until it touches the board
    2. B. Place her flat with no padding at all
    3. C. Pad behind the head and shoulders as needed
    4. D. Use a collar sized for a smaller neck
    Show answer

    Answer: C. Pad behind the head and shoulders as needed

    Forcing the head back to the board can hyperextend a rigid, curved spine and cause injury. Pad the voids to support the patient in her normal position.

12. Children younger than about 8 years often need padding beneath the shoulders and torso during SMR because:

    1. A. Their spine is stiffer than an adult spine
    2. B. Their large occiput flexes the neck when supine
    3. C. Their necks are longer than an adult neck
    4. D. Padding hyperextends the neck to open the airway
    Show answer

    Answer: B. Their large occiput flexes the neck when supine

    A young child's proportionally large occiput pushes the chin toward the chest on a flat surface; raising the shoulders and torso about 1 inch brings the head back to neutral, which protects the spine and keeps the airway open. A child's spine is more flexible than an adult's, not stiffer. Children have short necks, not long ones. The goal of the padding is neutral alignment, not hyperextension; extending the neck of a child with a suspected spinal injury is exactly what SMR tries to avoid.

13. Which child meets criteria for spinal motion restriction after a car crash?

    1. A. A 6-year-old with a stiff, tilted neck
    2. B. An alert 5-year-old with a forehead bump
    3. C. A 9-year-old who is shaken and tearful but calm
    4. D. An alert 3-year-old with a scalp cut
    Show answer

    Answer: A. A 6-year-old with a stiff, tilted neck

    Pediatric criteria include neck pain, torticollis, neurologic deficit, altered mental status, a high-risk mechanism, and substantial torso injury. A minor head bump or scalp cut in an alert child, or being upset after a crash, does not by itself require SMR.

14. A 2-year-old is found in an intact car seat after a moderate-speed crash. He is alert, and you can assess him fully in the seat. An acceptable option is to:

    1. A. Remove him and hold him on a parent's lap
    2. B. Place him prone on the stretcher for safety
    3. C. Transport him in the seat without securing it
    4. D. Restrict motion in the car seat with padding
    Show answer

    Answer: D. Restrict motion in the car seat with padding

    An undamaged car seat that fits the child and allows assessment can serve as the motion-restriction device when it is padded and secured to the stretcher. A damaged seat, or one that hides the child's injuries, is a reason to remove him.

15. A motorcyclist wearing a full-face helmet is vomiting, and you cannot reach his airway. You should:

    1. A. Leave the helmet on and suction through the visor
    2. B. Cut the chin strap and leave the helmet in place
    3. C. Remove the helmet alone while he holds his head
    4. D. Remove the helmet using a two-person technique
    Show answer

    Answer: D. Remove the helmet using a two-person technique

    A helmet that prevents airway management must come off, with one rescuer stabilizing the neck from below while the other spreads and removes the helmet. A helmet that fits snugly and allows airway access can be left on.

16. A helmet should generally be left in place when it:

    1. A. Fits snugly and the airway is accessible
    2. B. Lets the head move freely from side to side inside
    3. C. Prevents you from seeing the airway
    4. D. Is a full-face motorcycle style helmet
    Show answer

    Answer: A. Fits snugly and the airway is accessible

    A well-fitting helmet that does not interfere with airway care or assessment holds the head in line with the shoulders. A loose helmet allows movement and should be removed.

17. During two-person helmet removal, the role of the rescuer at the patient's side is to:

    1. A. Pull the helmet straight off the head
    2. B. Hold the neck and occiput from below
    3. C. Tilt the head back to clear the chin
    4. D. Hold the shoulders against the stretcher
    Show answer

    Answer: B. Hold the neck and occiput from below

    The second rescuer takes over stabilization by supporting the occiput and the mandible from below while the first rescuer spreads and tilts the helmet to clear the nose and slides it off. Tilting the head itself would move the spine.

18. A high school football player is down on the field with neck pain. The athletic trainer and two other rescuers trained in equipment removal are present. Current guidance on his equipment is that:

    1. A. The helmet comes off but the pads stay on
    2. B. The shoulder pads come off but the helmet stays
    3. C. Helmet and shoulder pads come off together
    4. D. The face mask must stay on for transport
    Show answer

    Answer: C. Helmet and shoulder pads come off together

    Equipment is all-or-none: the helmet and shoulder pads keep the head and torso level, so with at least three trained rescuers both are removed (sequentially, as a unit) before or during transport, and the face mask is removed early for airway access regardless of breathing status. Removing only the helmet lets the head fall back into extension because the pads lift the shoulders. Removing only the pads lets the helmeted head fall into flexion relative to the torso. Leaving the face mask on blocks the airway; it should come off as soon as possible. If trained rescuers are not available, both helmet and pads stay on until they are.

19. While you move a patient's head to a neutral position, he reports a sudden increase in neck pain. You should:

    1. A. Continue gently until alignment is complete
    2. B. Have him move his head into position
    3. C. Apply traction to lengthen the neck
    4. D. Stop and stabilize the head where it is
    Show answer

    Answer: D. Stop and stabilize the head where it is

    Pain, resistance, muscle spasm, new neurologic symptoms, or airway compromise during movement are reasons to stop and stabilize in the position found. Traction can stretch and further injure the cord.

20. After a cervical collar is applied, manual stabilization of the head should:

    1. A. Continue until the patient is fully secured
    2. B. Stop once the collar is fastened firmly
    3. C. Stop once the patient says he is comfortable
    4. D. Stop once the head rests on the board
    Show answer

    Answer: A. Continue until the patient is fully secured

    A collar limits motion but does not prevent it, so hands-on stabilization continues until the head and body are secured to the stretcher or device. Releasing it early lets the head rotate and flex.

21. Compared with a log roll, a scoop stretcher placed under the patient:

    1. A. Requires a log roll first
    2. B. Requires removing the collar to place it
    3. C. Generally produces less spinal motion
    4. D. Increases motion of the thoracic spine
    Show answer

    Answer: C. Generally produces less spinal motion

    Studies suggest that log rolling moves the spine more than a scoop or lift-and-slide technique. The scoop splits and closes beneath the supine patient and can carry him to the stretcher. Each half slides in from the side, so no log roll is needed, and the cervical collar stays on while the scoop is placed.

22. A driver in a crash has a suspected spinal injury and is now hypotensive with rapidly declining mental status. To get him out of the car you should:

    1. A. Apply a vest-type device before moving him
    2. B. Use rapid extrication with manual stabilization
    3. C. Wait for the patient to stabilize in the seat
    4. D. Pull him out by the arms without holding his head
    Show answer

    Answer: B. Use rapid extrication with manual stabilization

    Rapid extrication accepts slightly more spinal motion to avoid the minutes a short board or vest device takes, because this patient's life is threatened now; manual stabilization and moving him as a unit still limit motion. A vest-type device is appropriate for a stable seated patient, not one who is deteriorating. A hypotensive patient with falling mental status will not stabilize while trapped in the seat; he needs resuscitation and transport. Pulling him out by the arms with no head support abandons motion restriction altogether when a controlled rapid technique is available.

23. When securing a patient to a long backboard or vacuum mattress, you should secure the:

    1. A. Head first and the torso last
    2. B. Legs first and the arms last
    3. C. Torso first and the head last
    4. D. Head and legs first together
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    Answer: C. Torso first and the head last

    Securing the torso first prevents the body from shifting relative to a fixed head, which would flex or angulate the neck. The head is secured last while manual stabilization is maintained.

24. A swimmer with a suspected neck injury is face down in shallow, calm water. The first step is to:

    1. A. Turn him supine as a unit while holding the head
    2. B. Slide a board under him while he is face down
    3. C. Check for a pulse before turning him over
    4. D. Wait for a backboard before touching the patient
    Show answer

    Answer: A. Turn him supine as a unit while holding the head

    Turn the patient face up while splinting the head between the arms to restore breathing, then float him onto a board or device to remove him. A board is placed after he is supine, breathing and pulse cannot be assessed or supported while he is face down, and waiting for equipment delays rescue breathing.

25. Before and after applying spinal motion restriction, you should:

    1. A. Check pupil size and reactivity each time
    2. B. Check motor and sensory function in all limbs
    3. C. Have the patient turn his head to test
    4. D. Measure the blood pressure in both of his arms
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    Answer: B. Check motor and sensory function in all limbs

    Documenting motor and sensory function in all four limbs before and after SMR shows whether moving the patient, or the injury itself, has caused a new deficit. Pupil checks assess the brain rather than the spinal cord, and comparing arm blood pressures screens for vascular injury, not cord function. Asking a patient with suspected spinal injury to turn his head defeats the purpose of motion restriction.