Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXXIII: Wounds and Injuries of the Spinal Column and Cord

Initial Management

United States Department of Defense

Initial management of the individual with suspected injury of the cervical spine entails preservation of the airway, maintenance of ventilation, control of hemorrhage, and the preservation of residual neurological function. Movement of the head and neck must be minimized. When the injured individual presents in the prone position, he should be log-rolled into the supine position with the most experienced person present maintaining the neck in the neutral position. Once the victim is in the supine position, the airway should be maintained with the chin lift maneuver. The neck should never be hyperextended in these situations. If a surgical airway is required, cricothyroidotomy is the method of choice. Stabilization of the neck during transport is provided by a stiff cervical collar or sand bags. Then the head should be taped to whichever extraction device is utilized (Figures 41, 42).

When injury to the spine is suspected, spinal alignment must be maintained when the victim is moved. Table 17 summarizes extrication techniques for suspected spine injuries. This can be accomplished by log-rolling onto a stretcher or, where two-man assistance is available, the two-man arm carry is an appropriate method of initial transport to a rigid surface (Figure 43). This technique does not protect the cervical spine; therefore, if cervical spine injury is also suspected, the victim should not be moved until a semirigid collar and spine board are available. In the absence of back boards and stretchers, makeshift litters can be fashioned from doors, lumber, or poles and clothing. (Figure 44).

Figure 41

Figure 42

Figure 43

Figure 44

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Operational Medicine 2001

Health Care in Military Settings

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