Its your worst nightmare as a First Responder. You hear a loud crash, followed by a scream. You race over to the where the noise was, and you find your colleague on the floor, unconscious, with laboured breathing. He is lying flat on his back, his chest moving rapidly in and out. You can see a small amount of blood on the top of his head, and the large amount of debris that has fallen down upon him is lying in a pile next to him. You look up and see that more debris may fall down, and will cause more injury to him, or to you if approach to assist. Another colleague arrives, he is also First Aid trained, and is clearly distressed at seeing his mate in such a condition. You take some deep breaths, you need to engage your frontal cortex rather than your amygdala (emotional centre), and you get to it. You’re in charge now. What are your priorities?
Of course, safety is your number one priority. But how do you move him? You want to move your patient away from the falling debris, but do you need to be concerned about spinal precautions? You have one person to assist you, so can move him easily enough away from the imminent danger. And then what about Airway management? He is unconscious, but clearly breathing. You know that unconscious patients need to be on their side, or in the recovery position, but are concerned that this is a traumatic injury, and that there may be a spinal injury involved. Your assistant is getting more concerned, you think you want to pull him away from the danger, and roll him onto his side, but he feels you may cause a spinal injury.
“What if he ends up in a wheelchair?”
These are the sort of high pressure, high acuity situations we aim to prepare you for, so you can approach them with confidence, backed with years of research and scientific evidence.
Danger takes precedence over everything! There is no point treating a patient if there is a risk of you becoming injured, or your bystanders. You will only create more patients to treat, and may become useless to the situation. Not only that, if you don’t mitigate the danger, your patient may be at risk of becoming further injured, possibly even fatally. Spinal precautions do not take more importance than safety.
Let’s talk about Airway Vs Spinal. For too long, there has been a misperception in the pre-hospital setting about spinal injuries, spinal immobilization and the possible worsening of spinal injuries during treatment and movement.
AIRWAY TAKES PRECEDENCE OVER SPINAL
The evidence is clear. The management of this patient’s Airway by either rolling him onto his side, or by placing him into the recovery position is far more important than worrying about worsening a spinal injury. The following are direct extracts from the Spinal injury treatment guidelines, according to the Australian Resuscitation Council.
Airway management takes precedence over any suspected spinal injury. It is acceptable to gently move the head into a neutral position to obtain a clear airway. If the victim is breathing but remains unconscious, it is preferable that they be placed in the recovery position.
The clinical importance of pre-hospital immobilisation in spinal trauma remains unproven.
Pre-hospital spinal immobilisation has never been shown to affect outcome and the estimates in the literature regarding the incidence of neurological deterioration due to inadequate immobilisation may be exaggerated.
At RR+R, we teach you the correct method to perform a log roll, or spinal roll, so you can place this patient onto his side, maintain spinal alignment, and keep his airway open. So you can be assured that you can cover all bases in keeping this patient safe.
Ambulance Services across the world are recognizing that we need to think differently when it comes to the treatment of Spinal patients. In fact, it has been found that the young, fit and healthy patient rarely injures their spine, and it is far more likely to occur in elderly, frail casualties who fall from standing height.
Of course, this does not remove the need to take spinal precautions, or change good habits when it comes to treating your suspected spinal injury patients. Keep them still, use good technique when moving them, and maintain spinal alignment as best you can.
At RR+R, we teach you all these methods so you can be confident and sure of yourself. But we also want to remind you that you can feel safe that you won’t worsen or exaggerate an injury with simple movements, and airway management. We teach you to be an advocate for your patient, and prioritize treatment in the order in which would best suit them.
Following is a short video from SEC Ambulance in the UK who are radically changing how they do business when it comes to Spinal injuries: