1. 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

2. What are we trying to prevent????

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

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

5. Mechanism of Injury
(Banerjee, 2001)

6. 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)

7. 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

8. 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”

9. 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)

10. Three Person Log Roll

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

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

13. Immobilization Procedure
Apply rigid cervical collar

14. Immobilization Procedure
Log roll and place spine board underneath athlete

15. Immobilization Procedure
Reposition on spine board

16. Immobilization Procedure
Attach and secure straps

17. Immobilization Procedure
Secure arms

18. 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

19. 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, Waninger K. (2004). Management of the helmeted athlete with suspected cervical spine injury. American Journal of Sports Medicine, 32(5),