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When dealing with a patient who you suspect of having a spinal injury, such as someone who may have fallen out of a tree or fallen badly, we would always treat them as if this was the case until the emergency services arrive. If you think a patient could have a spinal injury, we treat them as if they have a spinal injury as moving them can cause significant damage to their spine. We generally immobilize them by supporting their head and ensuring that their neck does not move. You can move their head carefully into a neutral position to aid breathing. Holding their head with your hands whilst not covering their ears prevents them from moving and you can still talk to them directly. If the person vomits or you have to leave them to get help, you will need to carefully place them onto their side. If there is more than one person, you can use the log roll technique. If you are on your own, the solution is a variation of the recovery position. This carefully places them onto their side but keeps their spine straight, not allowing it to be twisted. If they vomit, the fluid will flow out of their mouth and not obstruct their breathing. You may assume that moving someone into the recovery position would twist their spine, but if it is done slowly it can be done. The whole time that you move them, think about what you are doing and make sure that you do not twist their spine, something which could make the injury worse. Talk to them the whole time, even if they are unconscious, as they may still be able to hear from you. To do this, we start with them on their back. We then move to their side, leaving the head if we were previously stabilizing it. Cross their legs by moving the leg farthest away towards you. The hand that is nearest to you, place it palm up under the head ensuring minimal movement of the head. We do this by placing one hand on theirs, which is above the head, and the other hand under the arch of the neck. Slowly and carefully lift the head slightly at the same time slide the hand under the head. This places the head into the ideal neutral position. It is vital the head is not lifted too much during this stage. Next move their other hand across their body and place it on the arm that is nearest to you. Place one hand on their far shoulder and the other on their far hip, slowly pull them evenly to avoid twisting the spine. Move the leg so it bends at right angles to the body to support them and check their airway is open. Once you have moved them, ensure that they are breathing and the airway is open, then go for help. If they vomit, they will not choke, and they should stay in that position. When you return, recheck their breathing, and cover them with a blanket to keep them warm. Keep reassuring them and checking their breathing until help arrives. Tell the EMS what has happened, what signs you may have seen. If they were conscious when you found them, explain what symptoms the patient complained of.
Dealing with Suspected Spinal Injuries:
The Importance of the Recovery Position
When faced with a patient you suspect has sustained a spinal injury, such as a fall from a tree, especially when you are alone, it's crucial to take immediate steps to ensure their safety while obtaining help.
The Dilemma
The challenge lies in the balance between seeking assistance and safeguarding the patient. Leaving them on their back could pose risks of choking if they vomit, yet moving them might exacerbate their injury.
Teamwork and the Log Roll
If there are multiple responders or bystanders, you can assign someone to fetch help or utilize additional hands to safely execute a log roll—a technique to turn the patient without spinal twisting.
The Recovery Position: A Solution
The recovery position is a viable solution. Contrary to common misconception, when executed slowly and carefully, it allows you to turn someone onto their side without risking spinal damage. It's advisable to practice this skill several times to ensure proficiency.
Post-Movement Assessment
Once repositioned, promptly check for signs of breathing and ensure their airway remains unobstructed. Maintain communication with the unconscious patient, as they may still hear you, providing a source of reassurance. Afterward, proceed to seek assistance.
Vomiting Prevention
The recovery position offers protection against choking in case of vomiting, as the patient's airway remains clear. During your absence, if they vomit, they will remain in this safe position.
Returning to the Patient
Upon your return, reevaluate their breathing status and ensure they stay warm by covering them with a blanket. Maintain a reassuring presence until professional help arrives. When reporting to emergency medical services (EMS), provide a comprehensive account of the situation, including observed signs and any symptoms the conscious patient communicated.