Transport of Patients with Head, Neck and Spine Injuries
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EMS Care™ | Head Neck & Spine Injuries
Lesson 5 | Transport of Patients with Head, Neck and Spine Injuries | Part A
Slide 97 | 1 of 8 | Transport of Patients with Head, Neck and Spine Injuries
I am so glad to see you again. Now let’s apply what you have learned in the first four lessons, to the Transport of Patients with Head, Neck, and Spine Injuries.
As you know from personal experience, these patients are often difficult to assess and may exhibit unstable or evolving symptoms. And the time to transport is usually of the essence.
So, as there is a lot to cover, we have broken the lesson into three parts.
- Part A is an overview of some of the devices you may use for spinal motion restriction.
- Part B discusses how to prep supine, sitting, and standing patients for transport.
- And Part C examines the helmet removal process.
After lesson B is a video on Spinal Immobilization of the Seated Patient.
And if appropriate for your role, you may want to consider additional courses on vehicle extrication, to further hone your skills.
Slide 98 | 2 of 8 | Preparation for Transport | Spinal Motion Restriction
The American Association for Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) provides recent guidelines for cervical spine immobilization. In the prehospital setting, the committee recommends spinal immobilization of all trauma patients with a known or suspected cervical spine or spinal column injury. However, experienced personnel should evaluate the need for immobilization during transport.
Fully awake and communicable patients that are not intoxicated, without neck pain or tenderness, neurologically intact, and without distracting injuries should not be immobilized. The preferred method of immobilization is the combination of a rigid collar and supportive blocks on a spine board with straps.
Spinal immobilization in patients with penetrating trauma is not recommended.
Therefore, because any manipulation of the unstable cervical spine may cause permanent damage to the spinal cord, you must assume the presence of spinal injury in all patients who have sustained head injuries.
Remember, during an assessment, pain in the spine may be missed because of shock, or because the patient’s attention is directed to more painful injuries.
So, when indicated, use manual in-line immobilization stabilization or a cervical collar and long backboard.
Note that according to the NIH, approximately 5% of patients with spinal injuries experience some degree of neurological worsening, even with good immobilization of the spine. This may be the result of hematomas, edema, hypotension, hypoxemia, or inflammation.
Slide 99 | 3 of 8 | Spinal Motion Restriction | The Cervical Spine
When proceeding with the application of a cervical collar:
- First, manually restrict head movement by placing your hands on either side of the patient’s head.
- Next, be sure to properly size the collar.
- And then use in conjunction with another immobilization device.
Cervical collars come in a variety of shapes, sizes, and constructions. They are designed to prevent the patient’s chin from dipping down toward the chest. They work by placing stiff foam or plastic between the shoulders, clavicles, and chin.
Sizing varies by the manufacturer as well. Most important, know the collars you have available on your truck, and how to size them.
Slide 100 | 4 of 8 | Spinal Motion Restriction | Applying a Cervical Collar
Remember that Cervical spine immobilization devices are designed to limit flexion, extension, and lateral movement.
And, continuing to stress the importance of sizing the collar correctly, note that the height of an individual has no relationship to the length of their neck. Therefore, a very tall male may have a short squat neck, while a petite female’s neck may be slender and long.
Placing the cervical collar on the patient should be accurate and precise. Often, the chin section of the collar is placed in the correct position first, with the rest of the collar carefully wrapped around the neck and affixed with hook-and-loop fasteners. Once secured, the collar should be snug enough to keep your patient from nodding their head downward, but not so tight as to keep from opening their mouth.
Adjust the collar as necessary until it fits correctly; if it is the wrong size, replace it immediately.
Slide 101 | 5 of 8 | Spinal Motion Restriction | Immobilization Devices
According to the NREMT, spinal motion restriction may be considered specifically for patients who meet conditions such as the NEXUS criteria or the Canadian C-spine Rule.
NREMT now defines spinal immobilization as the use of adjuncts such as a cervical collar or longboard, being applied to “minimize movement” of the spinal column. This contrasts with the prior practice of “preventing movement” of the spine.
Note that although backboards remain useful, the ambulance stretcher often provides sufficient spinal protection.
Bottom line is to know the spinal restriction tools you have available. And then do your best to apply the ones most appropriate for the situation, and the patient assessment.
And again, be aware of your local protocol, as many EMS providers are updating S O Ps as to when to use a spine board or vacuum mattress.
Slide 102 | 6 of 8 | Spinal Motion Restriction | Long backboards
Long backboards have been commonly used to attempt to provide rigid spinal immobilization among EMS trauma patients. However, the benefit of long backboards remains under study.
Reasons, why protocols are changing, is because the long backboard can induce pain, patient agitation, and respiratory compromise. Further, the backboard can decrease tissue perfusion at pressure points, leading to the development of pressure ulcers. Hence, the Utilization of backboards for spinal immobilization during transport should be judicious.
Whether or not a backboard is used, attention to spinal precautions among at-risk patients is vital. These include the application of a cervical collar, adequate security to a stretcher, minimal movement or transfers, and maintenance of in-line stabilization.
Finally, know the spinal motion restriction devices available on your truck. and their methodology for securing the patient.
Slide 103 | 7 of 8 | Spinal Motion Restriction | Vacuum mattress
An alternative to the use of a long backboard is a vacuum mattress. Some advantages include:
- The mattress molds to the specific contours of the patient’s body, reducing pressure-point tenderness, and therefore providing better comfort.
- Also, they can be used on a supine, sitting, or standing patient.
- It also provides thermal insulation.
- And they are excellent for the elderly or a patient with an abnormal curvature of the spine.
However, a drawback to the device is its thickness as it cannot be used for patients who weigh more than 350 pounds.
Finally, note that a Patient can be moved onto the vacuum mattress with a scoop stretcher or a log roll.
Slide 104 | 8 of 8 | Spinal Motion Restriction | Short backboards
Short backboards are used to immobilize noncritical patients who are found in a sitting position and have possible spinal injuries. The most common short backboards are the vest-type device and the rigid shortboard. These devices are designed to immobilize and restrict the movement of the head, neck, and torso.
Again, become familiar with the device on your truck and how to administer it to a patient.
That’s it for part A of this lesson. I will be right back with part B to discuss preparation for the transport of supine, sitting, and standing patients.