9.3 Spinal immobilization techniques

Spinal immobilization techniques are crucial for preventing further injury in patients with suspected head, neck, or spinal trauma. These methods focus on maintaining proper alignment and minimizing movement to protect the delicate structures of the nervous system.

From cervical collars to backboards and vacuum mattresses, various tools and techniques are employed to stabilize patients. Proper assessment, careful handling, and clear communication among rescuers are essential for effective immobilization and safe transport of injured individuals.

Cervical Immobilization

Stabilizing the Cervical Spine

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• Cervical collar used to restrict movement of the cervical spine and prevent further injury
• Inline stabilization maintains the head and neck in a neutral position, minimizing movement and reducing risk of additional damage
• Neutral alignment ensures the head, neck, and spine are kept in a straight line, preventing any twisting or bending that could exacerbate the injury
• MILS (Manual In-Line Stabilization) technique involves manually holding the patient's head and neck in a neutral position until a cervical collar can be applied

Assessing and Maintaining Airway

• Assess the patient's airway while maintaining cervical spine stabilization to ensure it remains open and unobstructed
• If the patient is unconscious or has a compromised airway, use jaw-thrust maneuver instead of head-tilt/chin-lift to open the airway without moving the cervical spine
• Monitor the patient's breathing and be prepared to provide ventilatory support if necessary, taking care not to move the head or neck during the process

Spinal Immobilization Equipment

Rigid Immobilization Devices

• Backboard is a rigid, flat board used to immobilize the entire spine and prevent movement during transport
• Head blocks are placed on either side of the patient's head to prevent lateral movement and maintain neutral alignment when secured to the backboard
• Strapping techniques involve securing the patient to the backboard using straps across the chest, pelvis, and legs to prevent any movement or sliding during transport

Conforming Immobilization Devices

• Vacuum mattress is a flexible device filled with small beads that conform to the patient's body shape when air is removed, providing full-body immobilization
• Vacuum mattress is particularly useful for patients with suspected spinal injuries who are found in awkward positions or have other complicating factors (pregnancy, obesity)
• Once the patient is positioned on the vacuum mattress, air is removed using a pump, causing the mattress to harden and maintain the patient's position for safe transport

Spinal Immobilization Techniques

Moving Patients with Suspected Spinal Injuries

• Log roll technique is used to move a patient with a suspected spinal injury onto a backboard or vacuum mattress while maintaining spinal alignment
• Log roll involves multiple rescuers working together to roll the patient onto their side as a single unit, allowing the backboard to be placed behind them before rolling them back onto it
• Proper log roll technique requires clear communication and coordination among the rescuers to ensure the patient's spine remains in a neutral position throughout the process

Clearing the Cervical Spine

• Spinal clearance protocols are used to assess whether a patient requires full spinal immobilization based on specific criteria and physical examination
• Protocols typically involve assessing the patient's level of consciousness, mechanism of injury, presence of pain or tenderness in the spine, and any neurological deficits
• If the patient meets all criteria for spinal clearance, the cervical collar may be removed and full immobilization may not be necessary, allowing for more efficient patient assessment and transport