Spinal Immobilization

A normal healthy spinal column can be severely stressed and maintain its integrity without damage to the spinal cord. However, certain mechanism of trauma can overcome the protective defenses, injuring the spinal column and cord. 

The most common mechanisms are hypertension, hyperflexion, compression, and rotation. A lack of neurologic deficit does not rule out bone or ligament injury to the spine or conditions that have stressed the spinal cord to the limits of its tolerance.

Based on the mechanism of injury, it is appropriate to place the head and neck in a neutral position as the rescuer first approaches the patient. The neck is then maintained in stabilization until the patient is securely strapped to the long backboard.

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Equipment:

• (3) Rescuers

• Long Backboard

• (3-6) Straps

• Cervical Immobilization Device or substitute  

Indications:

1. Any trauma patient

• with obvious neurological deficit

• who complains of pain in the neck, head or back

• who is unconscious

• who may have injury to the spine but whom evaluation is difficult due to altered mental status

• with facial or head injuries

• subject to deceleration forces

2. Any unconscious patient who may have incurred trauma.

Goal of Spinal Immobilization: IMMOBILIZE THE SPINE AND PREVENT FURTHER HARM

Procedures: 

Lying Down Patient

1. Evaluate and managed any life threatening conditions.

2. Rescuer 1 maintains the cervical spine (neck) immobilized in a neutral position

3. Rescuer 2 assess distal pulse, motor and sensory

4. Apply appropriate size semi-rigid cervical collar to patient

5. Position the patient in supine position (his/her back with legs and arms extended in a normal manner)

6. Position the long backboard next to the body (bottom of the board at knee level)

7. Rescuer 2 and 3 kneel at patient’s side opposite to the board

   1. Rescuer 2 is positioned at midchest area

   2. Rescuer 3 is positioned at the upper legs

   3. Rescuer 2 grasps the shoulder and the hips (holding the patient’s far arm in place)

   4. Rescuer 3 grasps the hips and holds feet together

8. When everyone is ready, Rescuer 1 gives the command to roll the patient on his/her side as a unit (towards the rescuers’ side and maintaining spinal alignment)

9. When the patient is upon his/her side, Rescuer 2 examines the back for injuries and move the board toward the patient (keep the board flat on the ground)

10. When everyone is ready, Rescuer 1 gives the order to roll the patient onto the backboard

11. Rescuer 2 grasps the patient’s armpits and Rescuer 3 grasps the hips

12. When everyone is ready, Rescuer 1 gives the order to slide the patient straight up on the backboard.

13. Strap the patient’s torso and legs

14. Pad and strap patient’s  head

15. Re-assess distal pulse, motor and sensory.

Special Situations: 

STANDING PATIENT

1. Rescuer 1 (tallest member) gets positioned behind patient and hold cervical stabilization

2. Rescuer 2 assess for distal pulse, motor and sensory

3. Apply appropriate size cervical collar to patient

4. Rescuer 3 position a long spine board behind the patient

5. Rescuer 2 and 3 reach under the patient’s armpits and grasps the spine board (must grasps a handhold on the spine board at the patient’s armpit level or higher

6. When everyone is ready, Rescuer 1 will give the order to begin to tilt the board and the patient slowly to the ground

7. Slide the patient up on the backboard if necessary

8. Strap the patient’s torso and legs

9. Pad and strap patient’s  head

10. Re-assess distal pulse, motor and sensory.

Contributed by LT Manuel Santiago, NC, USN, Naval Medical Center, Portsmouth

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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