Emergency Transport for Spinal Injuries: Key Steps

When someone has a spinal injury, every movement matters. Improper handling can lead to paralysis or worse. Here’s what you need to know:

  • Stabilize the spine: Use tools like rigid cervical collars and backboards.
  • Identify injuries: Look for paralysis, numbness, difficulty breathing, or unusual spine/head positions.
  • Call for help: Provide clear details to emergency services – location, injury cause, symptoms, and hazards.
  • Safe transport: Use techniques like the log roll or scoop stretcher to minimize movement.

Proper training and teamwork are essential to ensure safety. Follow these steps to protect the spine and improve outcomes during transport.

Logrolling a patient

Identifying Spinal Injuries

Quickly spotting potential spinal injuries is key to avoiding further harm during transport. Over 37% of spinal cord injuries are caused by motor vehicle accidents, while falls account for about 31% [5].

Common Signs of Spinal Injury

Be alert for these symptoms:

  • Loss or reduction of muscle movement
  • Numbness or tingling in the arms or legs
  • Difficulty breathing, especially with upper cervical injuries
  • Odd positioning of the head or spine [6]
  • Loss of bladder or bowel control

Also, watch for critical changes in motor and sensory function:

  • Weakness or full paralysis
  • Muscle stiffness or spasms
  • Pain or pressure in the neck, head, or back
  • Loss of sensation in hands, feet, or limbs [4]

Scene Safety Check

If you suspect a spinal injury, ensure the area is safe before acting:

  1. Initial Assessment
    Look for risks like unstable structures, hazardous materials, or live wires.
  2. Protection Measures
    Use proper PPE before approaching the injured person. Follow the ABCDE assessment:
    • Check for catastrophic bleeding
    • Assess the airway while keeping the spine immobilized
    • Evaluate breathing
    • Check circulation
    • Conduct a neurological (disability) assessment
    • Consider environmental factors [7]

Emergency Services Contact

When calling 911, provide clear and detailed information:

  • Exact location, including nearby landmarks
  • How the injury occurred
  • Number of people injured
  • Symptoms and level of responsiveness
  • Any hazards at the scene

If the person is conscious, encourage them to remain still unless there’s immediate danger. While waiting for emergency responders, perform chest-compressions-only CPR if necessary, ensuring the spine stays aligned [8].

Once help is on the way, focus on stabilizing the injured person.

Patient Stabilization

Keep the spine stable to avoid further injury by maintaining a neutral alignment and minimizing movement.

Head and Neck Support

Follow these steps to stabilize the head and neck:

  • Firmly hold the mastoid processes.
  • Cup the occiput to support the head.
  • Keep the spine in a neutral position.
  • Provide steady support without pulling or traction.

If you’re working alone, use your knees to brace the head, freeing your hands for managing the airway.

Neck Collar Application

1. Size Assessment

Determine the correct collar size by measuring the space between the shoulder and chin using your fingers.

2. Application Technique

While one person maintains manual stabilization, another should:

  • Slide the back portion of the collar under the neck.
  • Position the front piece under the chin and secure it with Velcro, ensuring it’s snug but not overly tight.
  • Confirm the collar limits movement without affecting the patient’s ability to breathe.

3. Final Check

Make sure the collar supports the chin, reaches the shoulders, and does not interfere with breathing.

Spine Alignment

Preserve spinal alignment to avoid worsening the injury. Stop any attempts at realignment immediately if the patient experiences increased pain, new neurological issues, muscle spasms that affect breathing, or resistance to movement.

If alignment is necessary, proceed slowly while monitoring neurological responses. Even after applying a cervical collar, continue manual stabilization to ensure extra protection during transport.

Soft cervical collars are unsuitable for trauma cases – only use rigid collars designed for spinal immobilization [9].

Once stabilized, prepare for transport by selecting the right equipment and organizing your team.

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Transport Preparation

Equipment Selection

Choosing the right equipment is critical for safe transport. A properly fitted hard collar, paired with blocks and tape, is key for cervical spine protection [10]. For full-body support, consider these options:

  • Backboard: Offers rigid support and makes it easier to transfer patients between surfaces, ensuring the spine stays protected during transport [10].
  • Scoop Stretcher: Splits lengthwise to minimize movement during loading, making it ideal for situations where patient access is limited [10].
  • Vacuum Mattress: Molds to the patient’s body, providing better comfort and pressure distribution compared to rigid boards, which helps reduce pressure points [1].

For seated patients who need to be removed quickly, the Kendrick Extrication Device (KED) is a specialized tool for spinal protection [10]. Once you’ve selected the equipment, focus on team positioning to maintain spinal stability during movement.

Team Positioning

The positioning technique depends on the situation and the number of available team members. Here are the two main methods:

  1. 6+ Lift Technique
    This method requires seven team members:
    • One leader at the head to stabilize the cervical spine.
    • Three rescuers on each side, positioned at the chest, pelvis, and legs, to evenly distribute the lifting force.
    • Best suited for heavier patients [12].
  2. Lift-and-Slide Method
    Designed to minimize spinal motion, this approach needs four team members:
    • One person stabilizes the head and neck.
    • Three rescuers straddle the patient to lift the upper torso, hips, pelvis, and legs [12].

Team Communication

Clear and precise communication is essential to avoid unnecessary spinal movement and ensure everyone stays coordinated. The team leader, typically positioned at the patient’s head, should:

  • Clearly announce each step.
  • Use simple, straightforward commands.
  • Confirm team readiness before any movement.
  • Signal both the start and end of each maneuver.

“When implementing spinal motion restriction, all members of the interprofessional health care professional team must be familiar with their preferred technique and exercise good communication to execute the technique properly and reduce excessive spinal motion.” – Kristopher Milland [11]

Blunt traumatic injuries result in about 54 spinal cord injury cases per million people annually in the United States [11]. Proper preparation and coordination are crucial to prevent further injury during transport. With the equipment chosen and the team aligned, the next step is focusing on transfer methods.

Transfer Methods

After stabilizing the patient and preparing the team, the next step is safely transferring the patient without causing further harm. Moving a patient with a spinal injury requires careful techniques, tailored to the patient’s position and the environment.

Log Roll Technique

The log roll method ensures the body moves as a single unit to protect the spine. This approach requires 5–6 trained individuals working in sync.

  • Setup: Assign roles. A leader at the head manages cervical spine control, while three team members support the shoulders, hips, and legs. One additional team member handles the backboard.
  • Execution: Under the leader’s guidance, roll the patient as a single unit, maintaining neck alignment. The patient’s arms should either rest at their sides or cross over their chest to avoid interference. Alternative techniques are available for seated or water scenarios.

Seated Patient Transfer

When a patient is seated, such as in a car or chair, maintaining spinal alignment is key. Use specialized equipment for a smooth transfer:

  • Position a transfer surface at a 45° angle.
  • Secure a transfer belt around the hips or buttocks.
  • Employ slide boards to minimize friction.
  • Maintain constant cervical spine stabilization throughout.

Studies confirm that using proper transfer devices can help reduce the risk of additional injuries.

Water Rescue Transfer

Water rescues come with unique challenges, requiring specific tools and methods.

  • Initial Stabilization: Secure a personal flotation device (PFD), protect the airway from water, and keep the spine aligned despite water movement.
  • Equipment: Use tools like a Sked stretcher with inflatable sides or a floating Stokes basket, ensuring all gear is rated for water rescue.

Water rescue zones are divided into three areas:

  • Cold Zone: Staging and preparation.
  • Warm Zone: Support operations.
  • Hot Zone: Direct interaction with the patient in the water.

When moving the patient from water, focus on controlled, efficient actions while maintaining spinal protection. Proper tools and trained personnel play a crucial role in improving outcomes in these scenarios [13][14].

Transport Security

During transport, it’s crucial to keep the patient immobilized to prevent further injuries. This involves maintaining spinal alignment, protecting pressure points, and managing body temperature.

Straps and Blocks

Use restraints to limit spinal movement and maintain proper alignment. Spinal immobilization helps reduce unnecessary motion of the spinal column [15].

Here’s how to ensure proper security:

  • Use a correctly sized semi-rigid collar.
  • Place the patient on a scoop stretcher with a slight 10° tilt.
  • Secure the head using head blocks and tape.
  • Consider using a vacuum mattress for added stability.

Vacuum mattresses are especially effective as they provide excellent stability and limit movement, even around the head [10].

Pressure Point Protection

Prolonged time on rigid surfaces can lead to pressure sores [2]. To avoid tissue damage:

  • Pad key contact areas like the occiput, shoulder blades, sacral region, and heels.
  • Use a vacuum mattress to distribute pressure evenly [10].
  • When transferring, place a protective pad or towel on boards to reduce friction [16].

Temperature Control

Patients with spinal cord injuries often struggle with temperature regulation [17]. Adjust temperature management based on weather conditions:

In Hot Weather:

  • Apply cold compresses to the face every 15–20 minutes [19].
  • Ensure there’s proper ventilation.
  • Keep the patient out of direct sunlight.
  • Use cooling vests if available [18].

In Cold Weather:

  • Limit exposure to cold conditions [18].
  • Add insulating layers.
  • Use warming blankets.
  • Ensure the patient stays dry.

“The most important thing is to avoid extreme temperatures.” – Shirley Ryan AbilityLab – Spinal Cord Injury Team [17]

Conclusion

The steps outlined above ensure a well-coordinated and safe transfer for patients with spinal injuries. Precision and proper training are crucial to safeguard the patient and avoid further harm.

Training Requirements

ProTrainings Europe (https://protrainings.uk) offers courses focused on spinal injury management techniques. Their training highlights practical experience with tools like spine boards, cervical collars, and vacuum mattresses.

“When an athlete is suspected to have a spine injury, every moment and every movement counts”, says Tory Lindley, MA, ATC, NATA President [20].

To stay prepared, teams should:

  • Regularly refresh their skills
  • Practice emergency scenarios
  • Keep certifications up to date
  • Document all training activities

These practices support the essential steps outlined next.

Step Review

Key actions for safe spinal injury transport include:

Initial Response

  • Ensure the scene is safe
  • Maintain spinal and airway alignment
  • Apply a cervical collar

Immobilization

  • Use the right equipment
  • Protect pressure points
  • Secure the head
  • Monitor breathing regularly

Transport Considerations

  • Choose the transport method based on the situation
  • Control the patient’s temperature
  • Allow for side-to-side rotation if needed
  • Keep monitoring devices within reach

Careful handling and proper positioning help minimize discomfort and avoid complications. Prompt transport to a medical facility, while maintaining immobilization, is critical for the best outcomes [3]. By following these steps, teams uphold their commitment to patient safety throughout the process.

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