Assessing the spine. Doing a thorough job is the key to an appropriate immobilization decision.

The decision to apply spinal motion restriction should be based upon assessment findings. Mechanism of injury is a consideration, but ultimately the decision should be made on objective physical exam findings. The patient in the scenario has a significant mechanism of injury and a potentially distracting forearm fracture. However, was the pain from the fracture enough to distract him from participating in the exam and giving reliable answers? Did he need to be collared and boarded? When in doubt, or when local protocols are ambiguous, err on the side of caution.