1. Normal Exam C-Collar CT Abnormal Neck CT C-Spine Fx Normal Patient
MRI
C-Spine
Normal Exam
Pre-Hospital
C-Collar CT
Abnormal
Neck CT
C-Spine Fx
Normal
Patient
Examinable A
Yes C B No No
Yes D E F G
Prehospital indications for Spine Motion Restriction (SMR): blunt mechanism patients unless all the following are met (C-Collar not indicated for penetrating injuries)
Reliable history and exam - mental status normal, no intoxicants/language barrier. 
No neurologic deficits, midline spine pain/tenderness, spine deformity. 
Passive ROM normal. 
Examinable:
Mental status normal, no intoxicants/language barrier.
Absence of injury that prevents reliable history and physical exam 
Normal Physical Exam
No neurologic deficits, midline spine pain/tenderness, or spine deformity. 
High resolution (64Slice) CT scan with Multi-planar reconstructions. Screening CT as part of trauma Whole Body CT
Normal age appropriate findings
Radiology findings associated with ligamentous injuries i.e. soft tissue swelling, subluxation etc.
C-Spine fracture. Refer to BCVI algorithm for CTA
Option comfort collar for neck strain/sprain
Maintain SMR, Spine consultation. Option to provide comfort collar for isolated spinous process fractures without spine consult
NO Ligament
Injury
Ligament
Injury H I
Remove Collar
Spine Consultation