Spinal Immobilization Techniques

[rock_shoes]

Full body vaccuum splint is the bees knees.

I think I'm going to have to call "useless without pictures".

[RavEMTGun]

I think I'm going to have to call "useless without pictures".

[SA_Medic]

Now that's exactly what we call a vacuum mattress. It works excellent for the long haul (+2hr) road transports and obviously the flights we do around here.

[rock_shoes]

Now that looks like an exceptional piece of kit! I can't help drooling when thinking about how incredible something like that would be for SAR evacs in particular.

[frogman]

Hi there just on the issue of C spine immobiliseation for lower back pain.

At a recent 999call we had a pt who tripped when walking in the front door of her house.

The Pt. was complaining of pain to the L4, L5 area no c spine pain but we decieded to immobilise. Later on in the ED the Doc showed me the pt. xray they had an L4 compression fracture.

A lot of our calls involving spinal precautions are short transport times sometimes you forget the padding and blankets not on purpose hust out of habit, that is until the pt. tells you that they cannot straighten out their legs.

we have recently purchased vacum mattress for every vehicle in my region but what the TDO didnt think about was storage in the vehicles (theres no room).

In my opinion spinal board is only an extracation device and the gold standard is the vacum mattress.

[RavEMTGun]

Now that looks like an exceptional piece of kit! I can't help drooling when thinking about how incredible something like that would be for SAR evacs in particular.

Wondrous. Infinitely more comfortable for the patient during long and bumpy lower/carry/wheelout. Also, it insulates!!! Any SAR team that isn't using these is living in the dark ages.

Edited November 13, 2009 by RavEMTGun

[AnthonyM83]

Good replies, everyone.

I've often heard of people using a towel around a person's neck when a collar won't fit (or perhaps not tolerated).

How is the towel actually applied? Wrap it like a scarf? Does it stay? Does it have to be a certain length or do those smaller hospital towels work?

Or is it just put laterally under the patient's neck and then rolled up on each end (in addition to the lateral head immobilization device, still, right?)?

[emsgirl911]

Everyone at my service boards a pt. a little differently, but all methods accomplish the same task.

We all use plastic boards with pins, quick-clips, and coated foam head blocks.

The way that I like to board someone assuming they have no additional injury (hip fx, shoulder dislocation, etc.) is to cross two straps over the chest (like an "X" as someone mentioned earlier), put one across the hips, and one across the lower legs. However, I have recently learned a new strapping technique specifically for carrying down the stairs/inclines and what not. Not many people I talk with seem to know about it, so I figured I'd share.

This method uses five sets of quick-clips along with the C- spine/head stuff

-As far as C - spine/head blocks and what not goes, its the same as usual.

-Cross two straps over the chest (X)

-Put one set of quick-clips on a single pin, on each side of the hip line. make sure the "button" part of the buckle is on the outermost side of the pin. Take the "clip" part and pass it through the void behind the knee. Snug it up to your pt.'s crotch, buckle, tighten, all that stuff. Same for the other side.

-Last clip goes across pt.'s lower legs. Ta Da!

The whole purpose of this particular technique is to keep your pt. situated on the board the way you put them there. We put another student on the board the "regular" way, and carried him down the stairs. By the time we got to the last step, he'd moved down about 4 or 5 inches. He also said he "felt" it in his head when we asked him - obviously because thats going to be the only part that isnt going anywhere using the "regular" method. When you use the "going down stairs" (or the parachute method, as we call it at my service) the pt. wont move. If they do, it will be minimal. VERY minimal (we did the same test for this method.) We came up with this by applying the same concept of a rock climbing harness. Sounds dumb, but it works, and in the end, its more comfortable for the pt.

Now that Im done ranting like an idiot, Im going to call it good and leave it at that.

Take care and stay safe -emsgirl911

[Bieber]

Just wondering specifics of how other agencies do their spinal immobilization.

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

Padding under the knees or elsewhere prn. I would put a blanket over the board if necessary (which, the way the weather is going, might be more frequently in the upcoming future.)

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 the headbed, the efficacy of which I've heard is questionable, but there's not really anything that we do right now that could keep the patient from compromising their own spine if they wanted. For pediatrics, we use the LSP pediatric immobilization board--which I really like. I wish they made an adult size version.

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

We have soft cots, haven't ever used one, though.

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

X over the chest.

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

I would immobilize the entire spine if I thought any one part of it needed to be immobilized.

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

Nope. And I helped out as a patient for an EMT class today and they used both a strap and tape over my neck and I absolutely hated it. Felt like it was choking me, and I'm not ever going to be doing it on any of my patients.

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?

I strap the arms while I'm loading them, and get them out in the truck--one for an IV and one for BP.

Oh, and on another note, I absolutely refuse to be boarded ever again. =) That's how bad my experience with the EMT students today was.

[medicgirl05]

The vacum splint is a great way to immobilize in certain conditions. I use it alot in the nursing home for fall victims. It makes them much more comfortable than riding the 30 minute transport time on a backboard. It is great because you can mold it to them. It also is a great way of stabilizing hips without using too much pressure. Some patients request them. Only downside is they take a little longer to apply than a traditional backboard.