Sequence of Spinal Immobilization

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Prehospital personnel are taught to have a high index of suspicion for spine trauma. If the patient is sitting in a car after an accident and is stable from respiratory and circulatory standpoints, the short spine board and rigid cervical collar or KED are first used to safely get the patient onto a long spine board and out of the vehicle in a orderly manner. If time is critical because of the patient's condition or the threat of hazards such as chemicals, fire, or water, the patient can be extricated more rapidly without the short board or KED. The risk of rapid extrication must be weighed carefully but quickly against the benefit of getting out of the vehicle promptly.

At a noncritical scene, when the patient is still sitting in the vehicle upon EMS arrival, one EMT secures the neck with his or her hands and applies the necessary airway maneuvers while the second EMT secures the rigid cervical collar. The short board is then slid in behind the patient and the patient is strapped to the board while still seated (short boards are not used if the patient is not seated in a vehicle). The first EMT maintains manual stabilization of the neck until the patient is secured to the short board. The patient can then be rotated around and slid directly onto the long board positioned on the car seat or directly onto the ambulance stretcher. The MAST garment, if needed, is often already placed on the long board underneath the patient. The patient is then strapped to the long board. A properly secured patient can be turned on the board or even stood on end if necessary to move the patient to the ambulance. If the patient vomits, for instance, the board can be partly turned ("logrolled") to prevent aspiration.

Because of the difference in relative size and positions of head and body, adults and children need slightly different positioning on a backboard. An adult needs more padding under the head, while a child needs more padding under the body, to maintain neutral neck position.

In more dangerous situations where rapid extrication is required, the short board is omitted, but the rigid cervical collar should still be used. The patient is carefully rotated out and slid onto the waiting long board.

If a patient is walking at the scene when EMS personnel arrive but complains of neck pain, the patient should be boarded from a standing position. If the patient is lying on the ground when the EMTs arrive, the patient should be carefully logrolled by several attendants onto a long backboard.

Radiographs can be obtained without difficulty through short and long boards. In general, patients should not be removed from these devices until the spine has been "cleared" clinically or radiographically. If removal off the spine board is necessary before clearing, the patient should be logrolled or lifted off carefully.

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