SPINAL MANAGEMENT

SCI = spinal cord injuries

CSF = Cerebrospinal fluid

Spinal cord injuries are classified as:

Traumatic resulting from external causes like motor vehicle accidents, violence, falls and water
or sport related injury.
Non-traumatic caused by medical conditions. Eg: cancer, disc disease and spinal infections.
OR
Complete injuries Total loss of motor function (paralysis) and sensory perception
Incomplete injuries Partial preservation of sensory and/or motor functions
Unless an accident has been witnessed, the motionless and unconscious casualty should be
treated as having a spinal injury.
A first aider must balance the aim of minimal movement of the spinal column and the requirement to
maintain an open airway.

Central Nervous System (CNS) comprises the brain and spinal cord.
Peripheral Nervous System (PNS) comprises all nerves that lie outside the brain and spinal cord.
The central nervous system cannot regenerate itself.
Only around 50% of casualties show recognised symptoms or signs of spinal damage.

The spine is made up of 33 separate vertebrae.

The spine can be divided into five sections;
o the first three sections (Cervical, Thoracic and Lumbar) are flexible and allow movement,
twisting and bending of the spine.
o the two lower sections (Sacrum and Coccyx) are fused and provide attachment points for
muscles (such as the gluteus maximus).

12

5
4
Flexion = chin to chest

Damage to the spinal cord can be caused by:

Concussion a sudden violent jolt injures the tissues around the cord. ie surfing or diving injury
Contusion bleeding occurs in the spinal column exerting pressure around or onto the cord.
Compression an object exerts pressure on the spinal cord. ie object falls on the spinal column depressing a vertebra
Tearing or Cutting the spinal cord is partially or completely severed due to a force.

Mechanisms of Injury (MOI)

The mechanism of injury is the exchange of forces that result in an injury.

There are five main mechanisms in spinal cord injury:
Hyperextension: spine is arched backwards beyond its normal limits
Hyperflexion: spine is arched forward beyond its normal limit
Compression: spinal cord is compressed following impact
Distraction: overstretching of the spinal cord
Rotation: head and body rotate in opposite directions

Types of Injury
Quadriplegia or Tetraplegia
Paralysis of four limbs, usually the result of spinal cord damage between C1 and C7.
Paraplegia or Biplegia
Paralysis of both lower extremities (legs) as a result of damage to the cord at T1 and below.

SCI signs and symptoms

The signs and symptoms of a spinal cord injury depend on two factors:
the location of the injury
the extent of the injury complete or partial injury.
Signs

Loss of consciousness or fading in and out

Loss of function in hands, fingers, feet or toes
Fluid leaking from the ears
Neck or head in abnormal position
Breathing difficulties
Loss of bladder or bowel control
Dilated pupils
Abnormal blood pressure
Profuse bleeding from the head
Abrasions or bruising to the head or forehead
Shock
Prioprism (erection in males)

Symptoms

Back or neck pain (often intense)

Tingling, numbness or lack of feeling in lower or upper limbs
Headache or dizziness
Nausea
2

Increased muscle tone

Special considerations -- Infants and children compared to adults

When treating a casualty younger than 8 years the anatomical differences between the child and adult
SCI casualty must be considered.
The younger child or infant has a relatively large head in proportion to their body. In the supine
position the enlarged head can be pushed forward into a hyperflexed position narrowing the airway and
elongating the cervical section of the spine.
In cases of suspected SCI in children, the placement of padding under the child or infants torso
(shoulder to hip) will assist in aligning the casualtys head to the neutral position. Once the head is
in the neutral position a paediatric cervical collar should be applied before moving the infant or child.

An infant without padding under torso with head in hyperflexed position (left) and with padding under torso with head in
neutral position (right)

Managing a Suspected Spinal Injury

Unless an accident has been witnessed, or if a neck and/or back injury is highly improbable,
motionless and unconscious casualties should always be treated for a suspected spinal injury.
Management:
Conduct Primary Survey, Vital signs and Secondary Surveys accordingly
Call 000 urgently
Keep the patient still and reassure them
Maintain normal body temperature
Minimise any movement of the head and spinal column
o Manual stabilisation, cervical collar, spine board, strapping
Manage any other injuries
Provide oxygen
Continually monitor vital signs
A clear airway, breathing and circulation take precedence over a spinal injury. However, where a
casualty must be moved, minimising movement of the head and spinal column should occur.
It is recommended that a casualty with a suspected head, neck or spinal injury should not be moved.
However, if danger exists to the casualty and they must be moved, then spinal immobilisation
techniques should be applied.

Step 1 - Manual stabilisation

Even when spinal immobilisation equipment is utilised (ie cervical collar), manual stabilisation should
always be maintained.

Log roll
The log roll is an accepted method to position a casualty on their side, allowing for the placement of a
blanket, board or litter against the spine. The casualty can then be rolled back onto the blanket or
board.
A log roll is best performed using four to six first aiders, however modified versions drawing on two
and three people can still be successfully used.
At present the safest techniques, based on current research, is for the patients arms to be fully
extended and placed by the patients side with the palms facing inwards. While some sagging will
occur, it is minimal and less that other methods currently use. Techniques which elevate the arms
above the head or place the arms across the chest result in thoracic / lumbar spine sagging, and should
therefore be avoided whenever possible.

LOG ROLL - 4 PERSON SUPINE

Step 1
Step 2

Officer 1 maintains manual In-Line Stabilisation of casualtys head with both hands (by
placing one hand on either side of the casualtys head), positioned behind.
Officer 2 applies a Cervical Collar and places the spine board alongside Officer 1.
The Manual In-Line Stabilisation is maintained until full spine immobilisation is achieved as a Cervical Collar
will at best provide only 50% immobilisation.

Step 3

Officer 2 kneels at the patients mid-torso, straightens the patients arms with the
patients palms facing in next to the torso.

Step 4

Officer 2 positions themselves on the same side of the injured person and reaches across
the injured person, securely grasping the upper arm and hip.
Officer 3 kneels next to Officer 2, reaches across the injured person and grasps the hip.
Officer 3s lower hand grasps both trouser cuffs at the ankles.
Officer 4 kneels on the opposite side of the patient at the patients pelvic level. Officer
4s upper hand is placed on the patients upper arm and Officer 4s lower hand is placed
on the patients upper leg.
A coordinated roll (patient towards the first aiders) is performed, ensuring head and
spine stability is maintained.
Officer 1 at the head watches the patients torso turn and maintains manual support of
the head, rotating it exactly with the torso.
The first aider at the head is in charge of coordinating the movement.
Officer 4 slides the board in against the patients back and elevates the side of the board
furthest from the patient at a 45 angle towards the patients back.

Palm-out may result in elbow joint damage during the roll.

Step 5
Step 6

Step 7

Step 8

Step 9

Step 10
Step 11

Align the patients shoulders level with the shoulder markings on the board.

Lower the casualty and elevated side of the spinal board down onto the ground, the
board maintains body alignment with the casualty.
Check first aiders body position supports casualtys body from sliding off or away from
spinal board
Keeping the patient in the neutral in-line position, gently adjust the patients position
sideways so that the patient is centred on the board.
Apply appropriate padding under the patients head and lumbar spine to maintain proper
alignment of the spinal column and for comfort.
5

Step 12

Immobilise the patient onto the board for transport.

The first aider on the head is in charge of the operation and the casualty should be rolled on their word.
Note:
Blanket or Litter Board can be used in place of spine board.
The log roll can be performed if a casualty presents in a face down position.

LOG ROLL - 5 PERSON PRONE 180

When the patient presents in a semi-prone position (as shown), the Officers may wish to carry out the
following manoeuvre which rolls the patient onto their back. It incorporates the same initial alignment
of the patients limbs as other log rolls - arms by the patients side
Points To Remember:
1. The patient is log rolled away from the direction in which the patients face initially points.
2. A Cervical Collar is not applied until the patient is in the supine position on the Spine Board.
3. Remaining in the prone position will limit the patients ability to breath due to pressure on the rib
cage.
4. Arching of the spine will occur with each of the patients breath whilst in the prone position.
Officer 1 positioned at the patients head, positions their arms in anticipation of the
full rotation that will occur. Officer 1 positions at a 45 angle to the patient, with arms
placed so that the elbow to the side the patient will be rolled onto is in line with the
patients inner shoulder to roll. Manual In-Line Stabilisation is achieved Officer 1
placing their distal hand under the patients head and their proximal hand on top of the
patients head.

Officer 2 kneels at the patients mid-torso, on the other side to which the patient is to
be rolled, and extends the patients arms down the patients torso. Officer 2 places their
upper hand under the patients shoulder and the lower hand under the patients
abdominal region level with lower ribs.

Officer 3 kneels on the same side as Officer 2 at the patients thigh, slides their upper
hand under the patients pelvic region, and lower hand under patients upper leg.
Officer 4 kneels at the patients mid torso grasping the patients opposite side
shoulders and opposite lower chest. Officer 5 kneels at the patients thigh grasping
the patients opposite pelvis and opposite mid femur.
A LSB is rested on the knees of Officer 4 & 5. The LSBs shoulder marking is
aligned with the patients shoulders.
The patient is carefully log rolled until the patients back is placed on the LSB.
Officer 1 at the patients head watches the patients torso turn and maintains the
current position of the head, rotating it exactly with the patients torso. Whilst
rotating the patient, Officers 4 & 5 steadily shuffle backwards until the LSB and
patient are flat on the ground.

Keeping the patient in the neutral in-line position, gently adjust the patients
position sideways until centred on the LSB.
A Cervical Collar is now applied, and the patient immobilised to the LSB for
transport