Spinal Immobilization Techniques

[SA_Medic]

It seems we all pretty much follow the same procedures when it comes to spinal immobilization. I will however concur with everyone above thus far, it's a complete waste to go through the motions and do a spinal immobilization and not follow the same precautions on the C-Spine.

In my service we have the good old Scoop (can't remember what you guys call it across the waters) and the LSB (sadly it's still wood, apparently it's illegal there???) I personally prefer using the scoop with the spider harness. We also have access to vacuum mattresses, I have used them on more than one occasion on flights in and around Namibia brilliant piece of equipment if used properly. the part I like about it would be the fact that it forms to the patients body when suctioned.

[croaker260]

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

We are strongly recommnded to use the "back Raft" inflatable /disposable pads whenever possible, and we probably do on all bu tthe most critical patients. I cant reccomend them enough. In addition, we commonly add padding under the knees, or where ever needed.

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

Medics choice, tpically wither towell rolls or "sta Blocks" disposable CID.

Do you use backboards always? Or do you have the hard foam boards?

We only have back boards, though we have a vac matress for back country work.

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

Spider straps or long straps in X patterns. Medics Choice.

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

If Im doing full immobilization, though we do practice Selective spinal immobilization here.

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

Medics choice, typically a combination of tape and vwelcro (see reference to "sta-blocs"). Angled.

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

Depends...

[CBEMT]

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

Depending on the patient, and if I have time to do so enroute, I will put a blanket under the knees. If they start complaining of more lumbar pain post-board, I will slide a towel under there, then (every time) yell at myself for not doing it sooner.

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

We use these, and carry the adult/pedi/infant sizes. They're not my favorite, but they do ok. My main concern is the lack of padding under the head to maintain neutral alignment- I often end up putting a towel under their head, on top of the thin Styrofoam connecting the two blocks.

Do you use backboards always? Or do you have the hard foam boards?

Nothing but backboards.

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

My preferred method is X over the chest, one over the hips, and a figure-8 at the feet that also crosses above their knees, all using 9-footers- I've noticed that trying the X method with quick clips doesn't work as well. That said, convincing people who've never seen my method that its worth the extra time (because I end up having to do it myself since they aren't trained on it) is often not worth the effort. So more commonly, its 3 across with quick clips.

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

Last time the situation came up, I ommited cervical. MOI was a trip over a raised grass edge onto more grass, and I felt badly about making an older woman so uncomfortable for so long for so little reason.

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

Our head blocks come with head and chin tape. Head tape usually goes straight down, chin tape at an angle to meet it.

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

Patient's conscious, we coach them to hold on to themselves. Unconscious, I will either tuck their hands into the void at the hip strap, if any, or sometimes I'll put their hands together in a "praying" position, then wrap tape around their wrists. Not ideal, but quick and effective.

[AnthonyM83]

Thanks for the continuing replies.

Addenum Question:

Do you guys put the HEAD padding on the board before rolling patient onto it or after?

I know some like to stick the disposable head padding (Head Wedges, Sta Blocks, etc) onto the board first, so you don't have to lift the head later.

The downside you don't always know where the patient's going to land when you roll.

Also, if you need to go down, then back up, the head sliding off the pad (bigger deal for thicker Sta Block pad than for thin Head Wedge pad).

What's the correct way of doing it? Or what ways do people do it in?

[rock_shoes]

In my service we have the good old Scoop (can't remember what you guys call it across the waters) and the LSB (sadly it's still wood, apparently it's illegal there???) I personally prefer using the scoop with the spider harness. We also have access to vacuum mattresses, I have used them on more than one occasion on flights in and around Namibia brilliant piece of equipment if used properly. the part I like about it would be the fact that it forms to the patients body when suctioned.

In BC we call it a clamshell, but I suspect that is also local vernacular. From what you're saying it sounds as though the vacuum mattress is probably a little fiddly for short transports but worth its weight in gold for longer trips.

[croaker260]

Thanks for the continuing replies.

Addenum Question:

Do you guys put the HEAD padding on the board before rolling patient onto it or after?

I know some like to stick the disposable head padding (Head Wedges, Sta Blocks, etc) onto the board first, so you don't have to lift the head later.

The downside you don't always know where the patient's going to land when you roll.

Also, if you need to go down, then back up, the head sliding off the pad (bigger deal for thicker Sta Block pad than for thin Head Wedge pad).

What's the correct way of doing it? Or what ways do people do it in?

With the back raft that is not an issue.

http://www.thomasems.com/Back_Raft.html

Really, this is one of the best things my department ever invested in. We have been using them for several years and I love them!

Edited November 5, 2009 by croaker260

[tniuqs]

Croaker260:

Thanks for the link, looks like a good piece of Kit.

cheers

[CBEMT]

Addenum Question:

Do you guys put the HEAD padding on the board before rolling patient onto it or after?

With our blocks, it has to be after. If I'm holding c-spine during the roll, I keep the patient's head elevated slightly during "landing" so the head will only go down instead of down/up/down.

[Brandon Oto]

I used quick clips (X across the chest, straight across hips, straight across legs) at my last agency, and while it's fast and good for BS C-spining, ghetto-splinting, and "just to making carrying easy" jobs, I don't really trust it for serious immobilization. If you're going to be cartwheeling people through hallways or the like I think you need much better superior-inferior immobilization. I vaguely remember something about looping around the feet from back in school, but we use 9-foot straps here and that works for me -- you can still go straight across if you want (just have lots of slack), but you can also do a Grady strapping which IMO is very secure due to the hips being "harnessed" in. Pad voids if possible and you're golden. Just make sure to tighten down reasonably well, too many people just kinda tug on the straps like they would on the stretcher, which I don't think is good enough...

I do prefer the stick-on plastic headbeds to the ginormous blocks though. I suppose security is debatable either way but I'd rather not carry around the damned things.

[RavEMTGun]

Full body vaccuum splint is the bees knees.