Our 22-year-old daughter came home from Iraq in a wheelchair with a spinal cord injury at C5. I guess we feel grateful she didn’t come home in a body bag. But we can’t help but wonder if there was some mismanagement at the time of injury. No one put a collar on her neck or put her on a rigid board. I thought everyone knew that was the first thing to stabilize possible neck fractures.

This is a hard question to answer because there are so many levels of consideration. We’ll try and cover as many as possible to help you sort through all that has happened. First (and maybe a shock to you) but there really isn’t sufficient evidence to support the current policy we all follow regarding the need to stabilize the head and neck after a traumatic injury.

In fact, there have even been studies that show better outcomes when patients were NOT immobilized in a neck collar and strapped to a rigid back board. In those cited studies, trauma patients who were treated in the manner we have come to expect (and as you described) had worse results.

All that aside, the battlefield has its own unique circumstances to consider. Once a soldier is down on the battlefield, the nearest service member or combat medic attempts to get him or her as far from the front line action as possible. If under enemy attack or fire, it may not be possible to protect the spinal cord from further injury. The hard cold fact is that the risk of death outweighs the risk of spinal cord injury. And keep in mind, not only are these folks often still under attack, there is often more than one comrade down and in need of care.

Resources are limited on the battlefield. There may not be enough backboards and protective neck guards to go around. Medics learn how to evaluate each injured soldier for risk of spinal cord injury. Red flags suggesting a need for immobilization include altered consciousness (e.g., amnesia), unconscious state, or paralysis (even if only temporary). Type of injury can also raise a warning flag. Soldiers involved in explosion or blast, fall from height, ejection from vehicle, or vehicle rollover are assessed carefully for the need to immobilize.

None of this information takes away the wonder and “what ifs” that many people (patients and their families) experience after a traumatic injury of this type. Your positive attitude is essential in going forward in this difficult situation.