Spinal Immobilization Adult

Manual Stabilization of C-Spine  Standing or Sitting Patient  While behind the patient, hands should be placed on the side of the face/neck  Thumbs should be extended to provide support to the back of the head  Fingers should be spread out to cover a greater surface area. Avoid placing pressure on the soft tissues of the neck. Fingers should be placed over the bony areas (jaw or skull)  When applying a c-collar, fingers are lifted up while maintaining stabilization  Once a c-collar is in place, the EMT’s hands should be returned to the original position over the c-collar  Supine Patient  While kneeling or lying behind the patient, hands should be placed on the side of the face/neck  Thumbs should be extended to provide support to the side of the head  Fingers should be spread out to cover a greater surface area. Avoid placing pressure on the soft tissues of the neck. Fingers should be placed over the bony areas (jaw or skull)  Once a c-collar is in place, the EMT’s hands should be returned to the original position over the c-collar PATIENT ASSESSMENT 19 C-Collar Sizing  While looking at the patient, an imaginary line should be drawn across the top of the shoulders and another across the bottom of the chin  Measure the space/distance between the two imaginary lines using your fingers. Note how many fingers wide this space is.  Select a collar. The distance between the sizing post (black fastener) and the lower edge of the rigid plastic should match the distance of the finger widths previously measured. If not, select another size of collar until a size matches. Be aware that different manufacturers may use different measuring points.  Note that some patients anatomically will not fit into a c-collar. In this situation towels or a blanket roll may be used. C-Collar Application  After selecting the appropriate sized collar, slide the c-collar up the chest wall into place. The chin should rest on the chin piece. The chin must not be able to retract into the chin piece (this may cause airway issues if not fixed).  Pull the remainder of the collar around the neck and secure the Velcro. Once the Velcro has been fastened, the collar should be snug around the neck. If properly applied, the patient will not be able to move head forward and backward and/or left and right. 20  Recheck the position of the head. Head should still be in the neutral position and aligned straight. If not, adjust or select a different size ccollar. Backboarding  One student maintains manual c-spine control  Manual c-spine control CANNOT be released until the patient is fully immobilized  A minimum of two, preferably three, providers will kneel down at the side of the patient in a row to perform a ‘logroll’.  The providers on the side will reach across and take hold of the patient (providers arms on the inside will cross over to allow greater stabilization of the patient)  The patient is rolled onto their side, toward the providers. Provider at the head must keep control of the head and roll it in time with the body. The timing of the log roll should be controlled by the person holding the head.  The backboard is placed against the patient and the patient then rolled back into their original position, now supine on top of the backboard.  The patient should be positioned centrally on the backboard with neither their head nor feet hanging over the ends of the board. 21  If the patient needs to be repositioned this can be done in a zig-zag motion  When adjusting a patient, one provider will take hold of the patient at the shoulders. The other provider will take hold of the pelvis. Working together, the two providers will adjust the patient up or down as needed. Providers need to hold the patient by their body parts, not grab the patient by their clothes.  The patient should NEVER be pushed from the side, as this compromises c-spine control.  The patient is then fully immobilized to the backboard using an appropriate method of strapping down the patient (i.e. spider straps). o CARE SHOULD BE TAKEN TO PAD ALL VOID SPACES AND PRESSURE POINTS BETWEEN THE PATIENT AND THE BACKBOARD. AS NECESSAY, PADDING CAN BE PLACED UNDER HEAD AND/OR SHOULDERS TO MAINTAIN NEUTRAL POSITION!! Padding under head may be necessary to maintain in-line positioning. Spider-Strap Application  Spider-straps are the most commonly used backboard straps in Loudoun County. Alternatives may be used such as seatbelt straps, cravats, etc. 22 Spider straps are detailed here due to their popularity and ease of application.  The shoulder straps are secured first. Straps should be flush with the shoulder to allow proper placement of head blocks. Caution should be used that the straps are not impinging on the patient’s neck area.  The feet straps are secured next  Should be placed so that the center strap extending from the head to feet is snug against the body and midline.  There is no specific order for applying the three remaining straps, however they need to be in the proper place.  One strap will need to be over the pelvis (the bony part)  One strap will need to be over the chest (ribs), as close to the armpits as is comfortable for the patient.  One strap will need to be over the lower thigh  Straps cannot be placed over the kneecap or over the abdominal region. Straps need to be placed over hard bony surface areas on the body. Head Immobilization  C-spine should already be manually maintained and c-collar already applied to the patient.  Head blocks are placed on the left and right side of the head. As a head block is being placed on each side of the head, the provider manually maintaining c-spine will place their hand over the head block continuing to manually maintain c-spine with head blocks in place  Tape is used to secure head blocks. Tape should be placed across the forehead and across the chin. Each piece will extend from one side of the backboard to the opposite side  Provider can release manual c-spine once the head blocks and tape have been secured 23 The Proper Way to REMOVE TAPE is to tear the

Spinal Immobilization is included in this California-based EMT program as it is required for skills verification for California Registration. It is no longer required for National NREMT registration.