Emergency Medical Services (EMS) were established in the U.S. in 1966 under the National Highway Safety Act. Since then, pre-hospital care has evolved significantly.

In this explanation, we’ll cover basic immobilization techniques and equipment used before arriving at a hospital, such as spinal immobilization and pelvic stabilization.

Spinal Immobilization

The concept of spinal immobilization was first recommended by the American Academy of Orthopedic Surgeons in 1971. This guideline advocated immobilizing the spine in patients showing symptoms or physical signs of potential spinal cord injury (SCI). Since then, these recommendations have continued to evolve.

The most common cause of SCI is car accidents, accounting for more than 40% of cases. Other high-risk activities include sports like rugby, gymnastics, track and field (especially pole vaulting), and baseball. These injuries often require long-term care, leading to extended hospital stays and high medical costs, particularly for young individuals. Depending on the injury level, the lifetime medical and caregiving costs for SCI patients can range from ¥50 million to over ¥100 million.

Forces Acting on the Spine

The direction and intensity of the force during an injury can help predict the type of injury sustained. The basic forces that can affect the spine include:

• Flexion (bending forward)
• Extension (bending backward)
• Rotation
• Lateral bending (side bending)
• Compression (axial loading)

Car accidents can involve multiple forces. For example, in high-speed rollover accidents, all the forces mentioned above might occur simultaneously.

Anatomy of the Spinal Cord

The spinal cord is an extension of the brainstem and is part of the central nervous system. It is a cylindrical structure, about 1 cm thick and 40 cm long, housed within the vertebral canal. The spinal cord is divided into segments: cervical (neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal (tailbone).

Similarly, spinal nerves are divided into 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. These nerves extend throughout the body, except for the brain.

Spine Board (Backboard)

The spine board is a rigid board designed to firmly support the body. It is often used with head immobilizers and belts to secure the head, neck, and body, ensuring full-body immobilization during transport.

Spine boards were first introduced alongside cervical collars to prevent or reduce spinal injuries, which could worsen due to improper handling at the scene. Additional advantages of spine boards include easy storage, low cost, and versatility. They can be used to slide accident victims out of vehicles or provide protection during rescue operations.

Cervical Collar

A cervical collar is applied to a patient’s neck to stabilize it when spinal injury is suspected, such as in car accidents or falls. This device prevents movement of the neck to protect the spine and avoid further damage to the nerves inside.

The collar is designed with a rear section that supports the trapezius muscles and a front section that supports the jaw, chest, and collarbones.

Log Rolling Technique

Log rolling is a technique used to move a patient while limiting spinal movement. This technique usually requires three people: one at the head, one at the torso, and one at the lower body.

Steps:

1. Stabilize the head and neck: One rescuer stabilizes the head and neck in a neutral position without applying force. Another rescuer applies a cervical collar to the patient. Even with the collar on, the first rescuer must maintain head and neck stability until full-body immobilization is complete.
2. Extend the patient’s legs: The patient’s legs are straightened, and their arms (palms inward) are extended to the sides.
3. Position the spine board: The spine board is placed next to the patient. If one arm is injured, the board is placed on the injured side, and the patient is rolled toward the uninjured side.
4. Kneeling on the opposite side: Two rescuers kneel on the opposite side of the board. One places their hands on the chest, and the other positions their hands on the upper limbs.
5. Grip the patient: The second rescuer holds the patient’s near arm in place, while the third rescuer grips the pelvis and lower limbs.
6. Roll the patient: The rescuer at the head instructs the team to log roll the patient.
7. Maintain alignment: The rescuer at the head ensures the head and neck remain in a neutral position during the roll. The other rescuers maintain alignment of the head, shoulders, and pelvis throughout the movement.
8. Inspect for injuries: Once the patient is rolled to their side, the second rescuer quickly checks for injuries from the back of the head down to the heels.
9. Place the spine board: The spine board is placed under the patient’s back.
10. Roll onto the board: Once everyone is ready, the head rescuer instructs the team to roll the patient onto the spine board.

When Not to Use Log Rolling

Log rolling is generally not recommended for patients with penetrating objects or pelvic fractures. In cases of pelvic fractures or when space is too tight to log roll, the log lift technique is recommended instead.

Complications of Spine Board Use

In recent years, complications from spinal immobilization with a spine board have been a growing concern. One of the most common issues is pressure sores (bedsores), which can develop in patients immobilized for extended periods. Reports suggest that up to 30.6% of patients on spine boards develop bedsores.

Pressure sores occur when blood flow is restricted to areas under prolonged pressure, leading to red, irritated skin, sores, or even open wounds.

Another issue identified in studies is the impact on respiratory function caused by belts used to secure the patient to the board. For healthy young individuals, the chest belt has been shown to reduce lung function, decreasing lung capacity and the amount of air exhaled.

In studies involving children, lung capacity decreased by as much as 80%. Therefore, careful attention is required when immobilizing patients, especially those with pre-existing lung conditions, children, and the elderly.

Related posts:

Using Cranes in Rescue Operations Vehicle Stabilization: Ensuring Safety in Rescue Operations Vehicle Stabilization Overview Vehicle Stabilization in Normal Position Vehicle Stabilization After a Rollover Stabilization of Overturned Vehicles Vehicle Rescue Techniques: An Overview Essential Vehicle Rescue Techniques for Accident Sites Vehicle Rescue Techniques: Glass Removal and Cutting (Part 1) Vehicle Rescue Techniques – Creating Access Points for Rescue (Part 2) Vehicle Rescue Techniques: Creating Access Points – Part 3 Vehicle Rescue Techniques: Creating Rescue Points Part 4