Important information for the novice caregiver C-SPINE MANAGMENT Important information for the novice caregiver Jen Manganaro RN, HAZMAT CAPTAIN Emergency Department Beth Israel Deaconess Medical Center

What are we trying to prevent????

Cervical Injuries Non-urgent Urgent Ligament Sprain Muscle Strain Neuropraxia Urgent Vertebral Fracture Vertebral Dislocation Spinal Cord Shock Unconsciousness (suspected)

Cervical Injuries Urgent Vertebral Fracture Vertebral Dislocation Spinal Cord Shock Unconsciousness (suspected)

Mechanism of Injury (Banerjee, 2001)

Spinal Cord Shock MOI Signs/Symptoms Severe twisting or snapping of the neck Direct blow to spinal column Signs/Symptoms Unable to move certain parts of body Numbness/tingling in arms Symptoms are transient and athlete is usually able to move freely Result is nothing more than a sore neck (Prentice, 2003)

Management Urgent injury All urgent injuries handled as suspected spinal injuries Immediate stabilization Ensure ABC’s are controlled Examine for other injuries Immobilize and transport

Management “DO NO HARM” Improper handling of the cervical spine can lead to, or even cause, spinal cord injury Cervical spine stabilization is primary objective in urgent situations Prepare for transition into emergency medical system “DO NO HARM”

Now, how do I do it? At least four staff members will be required to assist in the log roll procedure as outlined below: 1 staff member to hold the patient's head 2 staff members to support the chest, abdomen and lower limbs. An additional staff member may be also required when log rolling trauma patients who are obese, tall, or have lower limb injuries.  1 staff member to perform the required procedure (ie. assessment of the patient's back)

Three Person Log Roll

Pre-Hospital Equipment What you can expect to see and use

Emergency Equipment Spine board Cervical collar OPA/NPA Reflex hammer Triangular bandages Tape Pruning shears/power screwdriver (football) Air inflation needle (football) (Sanchez, 2005)

Immobilization Procedure Apply rigid cervical collar

Immobilization Procedure Log roll and place spine board underneath athlete

Immobilization Procedure Reposition on spine board

Immobilization Procedure Attach and secure straps

Immobilization Procedure Secure arms

Conclusions Err on the side of caution. Immediate management of a cervical spine injury plays important role in outcome following injury Err on the side of caution. Ultimately, the priority is to prevent any secondary injury following initial trauma

References Anderson MK, Parr GP & Hall SJ. (2009). Foundations of athletic training: Prevention, assessment, and management. Baltimore: Lippincott. Alberta Health and Safety Training Institute. (2005, August). EMR Trauma Survey [Handout]. Emergency Medical Responder course, Calgary, AB. Boulay J. (2008, February). Football: 2008 Spinal Immobilization Guidelines. Sports First Responder, Montreal, QC. Carlyle, K. (2007). PHED 3352 Course Notes. Mount Royal College, Calgary, AB. Kleiner DM, Almquist JL, Bailes J. et al. (2001). Prehospital Care of the Spine-Injured Athlete: A Document From the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Dallas, TX: National Athletic Trainers’ Association. Prentice WE. (2003). Arnheim’s principles of athletic training: A competency-based approach (11th ed.). New York: McGraw-Hill. Sanchez AR, Sugalski MT & LaPrade RF (2005). Field-side and prehospital management of the spine-injured athlete. Current Sports Medicine Reports, 4, 50-55. Waninger K. (2004). Management of the helmeted athlete with suspected cervical spine injury. American Journal of Sports Medicine, 32(5), 1331-1350.