Immobilisation and extrication:
Immobilisation of the patient is an important aspect when dealing with potential SCI. The aim of immobilisation is to protect the spine from any further secondary injury that may occur through movement and during extrication and transport. Multiple aspects need to be taken into account when deciding if a patient does or doesn’t need immobilisation such as:
- Does the traumatic incident pose a high risk of SCI or is there significant MOI to cause SCI, such as axial load to the head or direct trauma to the spinal area?
- Is the patient fully alert and aware, able to give you accurate answers on the history of events. If they are, do they have any pain or neurological deficits?
- Does the patient have any risk factors that makes them more susceptible to SCI, such as previous spinal fractures, severe osteoarthritis, elderly patient?
- On assessing the patient, is there any abnormal neurology reported (lack of sensation, tingling, numbness, etc), is there any bony pain along the spine, is there any deformity or injury obvious to the spine, does the patient have any injuries that may distract them from any spinal pain?
- Is there evidence the incident is of low MOI and the patient is unlikely to have suffered any harm?
- Has the patient been mobilizing independently without any deficits or pain?
A great number of considerations need to be considered when deciding whether to fully immobilise a patient or not. Fortunately, many Ambulance Services have their own guidelines or policies and procedures that clinicians can use to help them in making their decision to immobilise or not.
When looking at immobilising a patient, there are several options that can be considered depending on the situation:
- Manual immobilisation of the patient can be taken initially to protect the spine from any unnecessary movement. This is usually a temporary measure while spinal assessment of the patient is undertaken, or the patient is being immobilised to further devices
- A cervical collar is applied in many cases. The aim of the collar is to immobilise the neck and reduce any movement or rotation of the neck where there may be a C1 to C7 injury. As discussed in the head injury section, where there is a TBI suspected, a decision needs to be made whether to use a collar or not due to the risk of increasing ICP
- Head blocks and tape are used to keep the head in a secure position. The occiput should be raised by around 2 cm’s to help keep it in neutral alignment. Many head blocks come with their own pad to allow for this, or you may have to place a folded sheet under the patients’ head
- A Scoop Stretcher can be used for immobilising the patients’ body and for transporting. The patient can be strapped to the Scoop, limiting the amount of movement their body can do. This aims to help protect the full spinal column. Time on Scoop needs to be considered due to the hardness of the device. A prolonged lay on the scoop can cause discomfort and pressure sore development. Consider transporting the patient in a scoop if you expect a short to moderate immobilisation period.
- If there is a prolonged immobilisation period expected, a Vacuum Mattress can be used instead. This device wraps around the patient and air can be sucked from the mattress. As air is removed, the device moulds around the patient and becomes rigid. This immobilises the body, protecting the spine from further movement. As this device isn’t as hard or rigid as the Scoop, the patient can remain on it for a longer period.