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Spinal immobilization is probably one of the most controversial things EMS does–there really isn’t a lick of strong evidence showing it actually does anything other than add to scene time.  I’ve always felt it might have the most value in unresponsive patients, because most of the body’s self-defense mechanisms (such as pain, muscle spasm, etc.) have basically been overridden.

Every so often, though, I see a bit of data suggesting that immobilization doesn’t do as much as we think it does, even in the unresponsive patient.  The latest example is a study in which the authors surgically separated C4 from C5 in several cadavers, then intubated them with 2 types of laryngoscope using either manual in-line stabilization or no stabilization; measurements of C-spine movement were made by fluoroscopy.  While the authors were able to show slight statistical differences between the Macintosh blade and the Bullard laryngoscope (which caused very slightly less movement), they were able to show no such difference between manual stabilization and leaving the head to flop.