Professional Documents
Culture Documents
Medical Evacuation On Trauma
Medical Evacuation On Trauma
Trauma
Prepared by
Ribut Agung Nugroho
Medical Evacuation on Trauma
Manual Immobilization
Remove Helmet
Rigid Cervical Collar Application
Logrolls
Spinal board
Spider strap
Scoop stretcher
Splint
Traction splint
Kendrick Extrication Device
Lifting and Moving Patients
Manual Immobilization
SPINAL INJURY
Resistance to movement
Neck muscle spasm
Increased pain
The presence or increase in neurological
deficit during movement.
Compromise of the airway or ventilation.
Immobilization from the sitting or
standing patient’s side.
Stand along the side of the patient, holding the
back of the head with one hand. Place thumb
and first finger of the other hand on each cheek,
just below the zygomatic arch.
Tighten the position of both hands without
moving the head or neck.
Move the head to an in-line position if needed.
Immobilization from the front of
the sitting or standing patient.
• Stand in front of the patient and place the thumb
of each hand on the patient cheeks, just below
the zygomatic arch.
• Place the little fingers of each hand on the
posterior aspect of the patient’s skull.
• Spread the remaining fingers of each hand on
the lateral planes of the head and increase the
strenght of the grip.
• Move the head to an in-line position if needed.
.
Immobilization with a supine
patient
• Kneel or lie at the patient’s head and place
the thumbs of each hand just below the
zygomatic arch of each cheek.
• Place the little fingers of each hand on the
posterior aspect of the patient’s skull.
• Spread the remaining fingers of each hand
on the lateral planes of the head and
increase the strength of the grip.
• Move the head to an in-line position if
needed.
Helmet Removal
Indications to Leave Helmet
in Place
Good fit, little movement
No current or expected airway
problems
Removal would cause further
injury
Continued…
Indications to Leave Helmet
in Place
Proper immobilization is able to be
performed
No airway or breathing concerns
Continued…
Indications for Removing
Helmet
Inability to assess or treat airway
and breathing
Improper fit/movement within
helmet
Continued…
Indications for Removing
Helmet
Inability to immobilize spine
Cardiac arrest
Stabilize head and helmet. Fingers
should be on patient’s mandible.
Second EMT–B loosens strap.
Transfer stabilization to second EMT–B.
Carefully remove the helmet.
Prevent head from falling once helmet
is removed.
Begin routine stabilization and
immobilization.
RIGID CERVICAL COLLAR
APPLICATION
RIGID CERVICAL COLLAR
• RCC are designed to protect the cervical
spine from compression and reduce range
of motion (ROM) of head
• They are not provide adequate neck and
head immobilization
• Must be used in conjunction with manual
in-line immobilization or others mechanical
immobilization head rolls, long spinal
board, short spinal board, spider strap
GUIDELINES OF RCC
APPLICATION
• RCC must not inhibit patient’s ability to
open the mouth or to clear airway in case
vomiting occur.
• RCC must not obstruct airway passages
or ventilations.
• RCC should be applied only after the head
has been brought into neutral in-line
position.
STEPS TO APPLY RCC
• Rescuer 1
applies manual
in-line
immobilization
from behind the
patient and
maintains
throughout the
procedure
• Rescuer 2
measure the
patient’s neck
using fingers and
choose the right
RCC and adjust
the size of RCC
and lock it (for
adjustable RCC)
• Rescuer 2 slide
the bottom of
RCC under
patient’s neck,
set it around
neck and secure
it with velcro
straps
• Rescuer 1
spread fingers
and maintains
the support until
patient is
secured to spinal
board with spider
strap and head-
rolls in place
Logroll
Log – roll of the supine patient
• Rescuer 1 is positioned at the patient’s head,
providing in-line manual stabilization.
• Rescuer 2 grasps the far of the patient at the shoulder
and wrist.
• Rescuer 3 grasps the hips and both lower extremities at
the ankles.
• While maintaining immobilization, the rescuers slowly
log-roll the patient onto his or her side perpendicular to
the ground in one organized move.
• Rescuer 4 positions the long spine board by placing the
device flat on the ground or at a 30-to40 degree angle
against the patient’s back.
• In one organized move , the rescuers slowly log-roll and
center the patient on the long spine board
Log – roll of the prone patient.
• Rescuer 1 places his or her in a position that
provides in-line stabilization and that
accommodates rotation of the patient with the
torso.
• The long spine board is places on a flat surface
or positioned between the patient’s back and the
rescuers 2&3 at the patient’s side.
• In one organized move, the patient is rotated
away from the direction of the initial prone
position
• In one organized move, the rescuers slowly log-
roll and center the patient on the long spine
board.
• A rigid cervical collar is applied.
SPINE BOARD AND SPIDER
STRAP
INDICATIONS
• The use of a spine board is indicated when a spinal injury is
suspected.
• This occurs either when a casualty complains of pain in the
neck and/or back following a traumatic
• event or when the mechanism or pattern of injury indicates
possible spinal injury i.e.: a fall from greater than 2 meter
AIM
• The aim of the spine board is to
immobilize the thoracic and lumbar spine,
providing full spinal immobilization when
used in conjunction with a cervical collar,
head blocks and strapping
Step 1
• Inform and reassure the casualty. Fit the
cervical collar. Place arms against the side
of the body, palms facing in, or fold the
arms across the chest. A figure-of-eight
bandage can be tied around the ankles for
ease when rolling.
STEP 2
Position the spine board alongside the casualty, on the
opposite side to the rescuer, the top of the board being
about 50cm above the casualty’s head.
STEP 3
• Prepare to log roll the casualty. Rescuer A knees at the
head, rescuer B knees at the mid-thorax and rescuer C
knees at the casualty’s knees.
• When log rolling the casualty, rescuer A maintains support
of the head
and neck, keeping an anatomical alignment. Rescuer B
grasps the far side of the casualty at the shoulder and
waist. Rescuer C grasps the far side of the casualty at the
hip and lower leg or ankles
Support the head and body and roll the casualty
STEP 4
• Rescuer A is then in control of the roll, and the casualty is rolled
towards the patrollers, at the time and pace called by rescuer A,
ensuring minimal spinal movement. Slide the spine board along and
against the casualty’s back, either flat or slightly angled
STEP 5
• Lower the casualty and the board to the ground together. Maintaining
an anatomically neutral position, gently slide the casualty up the
spine board to the correct position on the board (in as straight an
axial movement as possible). Without moving the head, apply
padding under the occiput (base of the skull) and lumbar spine to
maintain correct positioning
Slide the spine board along and against the casualty’s back
STEP 6
• Secure the casualty to the spine board using the straps. Apply strap 1
from the shoulder, across the chest, to the opposite pelvic region,
strap 2 across the other shoulder, as per strap 1. strap 3 across the
pelvis and strap 4 across the upper legs above the knees.
(Alternatively, strap 3 & 4 can be crossed from pelvis to opposite knee
area).
STEP 7
• Strap 5 secures the ankles. Further strapping is used across the
chest to secure the arms. Head supports (head blocks, towel rolls,
etc) are positioned against the side of the head, from the shoulders,
covering the ears.
Attach straps
STEP 8
• Secure the casualty’s head and the head support to the
spine board by placing tape, in the following positions.
(a) across the casualty’s eyebrows and
(b) across the cervical collar, ensuring that both pieces of tape are
brought completely around the back of the spine board.
Step 3
• Bend the splint into a U-shape. This cradles the arm, giving greater protection and
making the splint more comfortable. It also give the splint greater structural strength.
Sam Splint cont.
• Wrap the splint and the limb with a roller bandage so that the splint
and the limb are firmly bonded together. Don't make the wrapping so
tight that blood flow through the limb is obstructed. Commonly-used
wrapping materials include Coban, Ace Bandages, Roll gauze, and
Adhesive tape.
• For upper extremity injuries, place a sling on the patient to keep the
arm elevated and immobile. A chest strap across the arm in a sling
will keep the arm tight against the chest.
FYI
• When securing the splint to the limb,
remember that you need to keep an open
area for monitoring pulse, motor, sensation
and circulation.
• For open fractures or other open wounds, the
application of the splint is the same.
However, you may need to apply sterile
bandages or dressings to the open wounds
before placing the splint in place.
• For lower extremity applications, you may
need to use two splints instead of one. Two
splints can be overlapped at one end and
taped in place with adhesive tape.
• To increase structural strength, after curving
the splint in a "U" shape, bend the edges
down slightly.
Rapid Form
Immobilizer
• Assess the pulse, motor, sensation
and circulation of the injured area.
• For splinting to be effective, the joints above and below
the fracture must be immobilized.
• If possible, remove any clothing that may impede the
splint's ability to work properly.
• If there are open wounds or exposed bone, bandage
appropriately.
• The injured area must be manually stabilized, which
prevents movement. This can be done by simply holding
the affected area, preventing movement above and
below it. For example, for a radius/ulna fracture, the arm
should be held at the wrist and elbow.
Rapid Form
Immobilizer
• When using vacuum splints,
place the injured extremity
inside the splint.
• Use the pump to draw air out of the splint, which
compresses it, making it rigid. It also conforms to
the patient and reduces pressure on the area.
• When using vacuum splints, make sure to keep
the patient's fingers and/or toes exposed to
assess motor function and capillary refill.
• The splint should be checked periodically during
transport to ensure there are no leaks. Leaks in
the splint diminish its rigidity and effectiveness.
Traction Splint Application
Traction Splint Application
NOTE: Is to be used only for a painful, swollen, deformed mid thigh injury with NO lower leg injury.
This information is designed to be used as a guide for an “Ischial” type traction splint. There
are several different types of commercially made traction splints available. This information
may differ for the device that you use.
Why a Traction Splint?
The theory behind the traction splint is that it reduces
potential blood loss by separating and aligning the
fracture segments through traction. This serves to keep
the thigh at its normal length and relatively normal
circumference - thus decreasing the potential space for
blood loss.
Contraindications for the use
of a Traction Splint
11. Reassess distal pulses, motor, and sensory function distal to the
injury site and compare to the opposite non injured extremity.