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In some EMS systems, patients who have experienced seizures are often secured to backboards to facilitate spinal motion restriction. There appears to be very limited evidence to support this practice, although trauma from seizures has been reported in case reports, case series, and retrospective reviews.

Seizures uncommonly cause fractures and dislocations. Some uncommon orthopedic injuries, such as bilateral posterior dislocation of the shoulder, fracture‐dislocation of the shoulder, or fracture‐dislocation of the hip, suggest a generalized convulsion as the etiology. Bilateral hip fractures have been reported [47]. These cases are notable for their rarity.

Only very rare cases of cervical fractures from uncomplicated seizures are reported. There is one description of an odontoid fracture following an epileptic seizure [48]. One retrospective study of over 1,600 transports for uncomplicated seizures (i.e., age greater than 5 years, no associated major trauma, afebrile) found no spinal fractures. Transport charges and nursing charges were higher in the group with spinal immobilization. The authors raised the question of the need for full spinal precautions in patients sustaining uncomplicated seizures [49]. Compression fractures of the thoracic vertebrae were reported in a patient taking steroids [50]. There is one report of a higher risk of cervical spinal cord injuries in patients with refractory epilepsy attributed to seizure‐related falls. This residential facility for patients with refractory epilepsy reported four instances of spinal cord injuries in its patient population over 10 years, which they extrapolated to be a 30‐fold to 40‐fold risk increase [51].

Retrospective chart reviews of patients with seizures have also identified patients with intracranial hematomas resulting from falls associated with seizures. The authors advocate early investigation in patients with head injury due to seizures and caution that decreases in level of consciousness or focal neurologic deficits in seizure patients should only cautiously be interpreted as postictal until traumatic hematomas have been excluded [52]. This review undoubtedly incorporates significant ascertainment bias, as it was from a neurosurgical service.

Given the paucity of reports of significant trauma following uncomplicated seizures, routine use of backboards in attempts to achieve spinal immobilization is not warranted. However, EMS clinicians should be aware that unusual injuries can occur. They must also be alert to historical features or physical findings that indicate potential injuries.