Procedure 33 - Treatment: Spinal Precautions

What precautions should always be used during spinal assessment?

Universal precautions, including gloves.

What must be done first in all spinal precaution cases, before proceeding?

Immobilize the patient's cervical spine.

What is the first step of the conventional spinal immobilization technique?

Instruct the patient to restrict their movement.

How should a supine patient be moved during conventional spinal immobilization, without spinal manipulation?

Log roll the patient.

What should be inspected during conventional spinal immobilization for later reporting?

The patient's back, for later reporting and documentation.

Where is the long spine board positioned during conventional spinal immobilization?

Behind the patient's back.

How is the patient moved onto the long spine board in conventional technique?

Log roll the patient onto the long spine board.

What is secured first when securing a patient to a spine board?

The chest and pelvis.

What is secured second when securing a patient to a spine board?

The thighs and legs.

What is secured third when securing a patient to a spine board, and with what?

The patient's head, using towel rolls, blocks, or other commercially available devices.

When is the Rapid Extrication Technique used?

Only when patient condition warrants.

What should a conscious patient be instructed to do during rapid extrication?

Eliminate movement.

Where is the long spine board placed initially during rapid extrication?

Underneath the patient's buttocks.

How is the patient rotated onto the board during rapid extrication?

Torso first, without manipulating the spine.

What must be maintained throughout movement during rapid extrication?

Cervical spine control.

What is done once the patient is evaluated in the ambulance?

Log roll the patient onto the cot, secure the patient to the cot, and restrict spinal motion as appropriate.

What age must a patient be to potentially omit spinal motion restriction?

13 years old or older.

Why must children under 12 be placed in spinal motion restriction?

Because they cannot consistently verbalize neck pain.

What orientation status is required to omit spinal motion restriction?

Alert and oriented x4 (person, place, time, events) with good short-term memory or at baseline for the patient.

What neurological exam finding is required to omit spinal motion restriction?

Normal neurological exam, with motor and sensation intact in all 4 extremities.

What substance use finding is required to omit spinal motion restriction?

No evidence of drug or alcohol use.

What consciousness history is required to omit spinal motion restriction?

No evidence (or reliable history) of loss of consciousness.

What pain complaints must be absent to omit spinal motion restriction?

No complaints of neck pain or back pain.

What injury finding must be absent to omit spinal motion restriction?

No penetrating injury near the midline spine area.

What mechanism of injury finding must be absent to omit spinal motion restriction?

No strong evidence of potential spinal injury in mechanism of injury (e.g. high-speed, severe damage motor vehicle crash).

What communication factor must be absent to omit spinal motion restriction?

No language or communication barriers (i.e. language, hearing).

How strictly must the spinal motion restriction omission criteria be followed?

All conditions must exist and be documented clearly on the run sheet, with no exceptions.

What level of diligence is required when evaluating the cervical spine?

Extreme diligence, due to the potential for serious and/or life threatening injury.

What should be done if there is any question about patient safety regarding cervical spine clearance?

C-collar the patient.

Is a backboard required when a c-collar is used?

No, a backboard is not required with a c-collar.

What provider levels perform spinal precautions per CFD protocol?

EMT-A, EMT-B, and EMT-P.