Procedure 33 — Treatment: Spinal Precautions

Name three of the six questions asked when clearing the cervical spine in the field.

Is the patient alert? Are there neuro symptoms? Is there intoxication?

Name three more questions asked when clearing the cervical spine in the field.

Is there a distracting injury? Is there midline spinal tenderness? Is there a significant mechanism?

What outcome results if cervical spine clearing criteria are met, with no concerning findings?

Spinal precautions are not required.

What outcome results if cervical spine clearing criteria are not met, with concerning findings present?

Consider spinal motion restriction.

What does spinal motion restriction consist of per the field clearing flowchart?

A C-collar, 3 straps, and head of bed at 30 degrees.

What must always be used during spinal precautions, including gloves?

Universal precautions.

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

Immobilize the patient's cervical spine.

What must be selected after immobilizing the cervical spine?

The appropriate spinal immobilization technique.

What should a patient be instructed to do at the start of the conventional spinal immobilization technique?

Restrict their movement.

How is a supine patient log rolled during conventional spinal immobilization?

Without spinal manipulation.

What should be inspected during the log roll in conventional spinal immobilization?

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 during conventional immobilization?

Log rolled onto the board.

What is used to secure the patient to the board during conventional immobilization?

Tape or webbing.

What is secured to the board first during conventional spinal immobilization?

The chest and pelvis.

What is secured to the board second during conventional spinal immobilization?

The thighs and legs.

What is secured to the board third during conventional spinal immobilization, and with what?

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

When is the rapid extrication technique used instead of the conventional technique?

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 for 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 rapid extrication?

Cervical spine control.

What is done after rotating the patient onto the board during rapid extrication?

Slide the patient into normal position on the long spine board.

How is the patient secured to the board during rapid extrication?

As in the conventional technique.

What should be done once a spinally precautioned patient is evaluated in the ambulance?

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

Under what documentation condition may spinal motion restriction be omitted?

If ALL required conditions exist and are documented clearly on the run sheet, with no exceptions.

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

13 years old or older.

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

They cannot consistently verbalize neck pain.

What orientation level must a patient demonstrate 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?

A 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 location must be absent to omit spinal motion restriction?

No penetrating injury near the midline spine area.

How are distracting injuries defined for spinal motion restriction criteria?

Any significant painful injury.

Name three examples of distracting injuries given for spinal precautions.

Long-bone fractures (femur, humerus, and tibia), abdominal pain, and chest pain.

What additional example of a distracting injury is given for spinal precautions?

Pelvic fractures.

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

No strong evidence of potential spinal injury in the mechanism of injury, such as a high-speed, severe-damage motor vehicle crash.

What communication finding is required to omit spinal motion restriction?

No language or communication barriers, such as language or hearing.

What should be exercised when evaluating the cervical spine, given the potential for serious injury?

Extreme diligence.

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

C-collar the patient.

What equipment is not required when a patient is placed in a c-collar?

A backboard.

What provider levels can perform spinal precautions?

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