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SAFE HANDLING PROTOCOLS AND TECHNIQUES

REPOSITIONING

Repositioning a prone athlete to supine may be required in order to facilitate medical assessment and care, establish neutral cervical position, or provide access to the athlete’s airway and chest.  The logroll maneuver is the accepted technique used to reposition injured athletes.  The  medical team recognizes that there are variations of the log roll maneuver that may be employed to reposition an injured athlete.  The  will decide which variation is most appropriate based on the team’s expert opinion of how best utilize existing emergency response equipment and personnel to meet the team’s Primary Objectives™ established for each unique injury management scenario.

The various techniques that the medical team may elect to employ are outlined below:

5-Person Log Roll-Push

A-Man
⦁ Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
⦁ Directs the log roll maneuver;
⦁ Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
⦁ Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Step 1
⦁ B- and C-Man clear the area of any extraneous objects or medical equipment;
⦁ If the protective athletic equipment remains in place, B- and C-Man utilize pack-n-fill towels to maintain cervical neutral alignment;
⦁ If the protective athletic equipment has been removed, B- will apply a c-collar on the patient and provide pack-n-fill padding as required to support cervical neutral position;
⦁ B-Man kneels at the patient’s mid-torso, straightens the patient’s arms with the patient’s palms facing in next to the torso. Palm-out may result in elbow joint damage during the roll;
⦁ B-Man then grasps the far side of the patient at the shoulder and just above the elbow;
⦁ C-Man kneels next to B-Man and grasps the patient just above the elbow, crossing over the B-Mans arm;
⦁ C-Man’s lower hand grasps the patient at the mid-thigh;
⦁ C-Man places their lower foot up against the patient’s legs, just below the knees for the patient’s lower legs to roll onto during the log roll, to prevent the patient’s pelvis drooping;
⦁ D-Man kneels next to C-Man and grasps the patient’s mid-thigh with their upper hand by crossing over the C-Man’s arms;
⦁ D-Man grasps the patient with their lower hand at the ankles;
⦁ E-Man kneels on the opposite side of the patient at the patient’s pelvic level;
⦁ E-Man’s upper hand is placed on the patient’s upper arm and the lower hand is placed on the patient’s upper leg.

Step 2
⦁ Under the direction of the A-Man, the patient is carefully log rolled until at a right angle to the ground;
⦁ A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso:
⦁ C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping;
⦁ E-Man facilitates the efforts of the B-, C-, and D-Man by carefully pushing the patient into proper position.

Step 3
⦁ The A-Man directs the medical team to reposition to complete the log roll.  When in proper position, and under the direction of the A-Man, the log roll is completed by carefully rolling the athlete to a supine position;
⦁ A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso;
⦁ C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping.
⦁ E-Man facilitates the efforts of the B-, C-, and D-Man by carefully pushing the patient into proper position;
⦁ Upon completion of the log roll, the A-Man positions the patient into cervical neutral position, unless otherwise contraindicated.

4-Person Log Roll-Push

A-Man
⦁ Prepare to log roll the patient in the direction opposite the patient’s face by assuming a start position with the A-Man’s inside knee positioned at the patient’s lower shoulder;
⦁ Place hands on head/helmet with the palms together and thumbs down, and the arm corresponding to the direction of the log roll on top such that the A-Man’s arms are twisted at initiation of the log roll and untwist during the maneuver;
⦁ Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
⦁ Directs the log roll maneuver;
⦁ Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
⦁ Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Step 1
⦁ B- and C-Man clear the area of any extraneous objects or medical equipment;
⦁ If the protective athletic equipment remains in place, B- and C-Man utilize pack-n-fill towels to maintain cervical neutral alignment;
⦁ If the protective athletic equipment has been removed, B- will apply a c-collar on the patient and provide pack-n-fill padding as required to support cervical neutral position;
⦁ B-Man kneels at the patient’s mid-torso, straightens the patient’s arms with the patient’s palms facing in next to the torso. Palm-out may result in elbow joint damage during the roll;
⦁ B-Man then grasps the far side of the patient at the shoulder and just above the elbow;
⦁ C-Man kneels next to B-Man and grasps the patient’s pelvic bone;
⦁ C-Man’s lower hand grasps at the ankles.
⦁ C-Man places their lower foot up against the patient’s legs, just below the knees for the patient’s lower legs to roll onto during the log roll, to prevent the patient’s pelvis drooping;

Step 2
⦁ Under the direction of the A-Man, the patient is carefully log rolled until at a right angle to the ground;
⦁ A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso:
⦁ C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping.

Step 3
⦁ The A-Man directs the B- and C-Man to reposition to complete the log roll.  When in proper position, and under the direction of the A-Man, the log roll is completed by carefully rolling the athlete to a supine position;
⦁ A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso;
⦁ C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping.
⦁ D-Man facilitates the efforts of the B- and C-Man by carefully pushing the patient into proper position;
⦁ Upon completion of the log roll, the A-Man positions the patient into cervical neutral position, unless otherwise contraindicated.

2-Person Log Roll

A-Man
⦁ Inform and reassure the conscious and alert patient about the use of the scoop stretcher and what they can expect to experience during the process;
⦁ Maintain manual head stabilization until full immobilization is achieved;
⦁ Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso.

B-Man
⦁ Clear the area of any extraneous objects or medical equipment;
⦁ If the protective athletic equipment remains in place, utilize pack-n-fill towels to maintain cervical neutral alignment;
⦁ If the protective athletic equipment has been removed, a c-collar will be placed on the patient and padding will be placed under head of patient as needed;
⦁ Kneels at the patient’s mid-torso on the side to which the patient is to be log rolled. The patient’s legs are tied together and the knees bent up to a 90º angle;
⦁ The patient’s arms are extended beside their torso with their palms facing inwards;
⦁ Grasps the far side of the patient at the shoulder;
⦁ Grasp lower arm grasps the patient’s hip just distal of the wrist and runs their arm along the patients upper legs which will help assist with the log roll;
⦁ Position patient’s lower foot so that on log rolling the patient, the patients knees will rest of B-Man’s foot to reduce the patient’s pelvis drooping;
⦁ Carefully log roll patient until they are at right angles to the ground;
⦁ As the B-Man at the patient’s torso will bear most of the patient’s weight during the log roll the B-Man is in charge and sets the pace;
⦁ A folded blanket running the length of the patient’s posterior body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the spine board.  This will also assist in removing the patient from the spine board;
⦁ Slide the spine board in against the patient’s back and elevate the side of the spine board furthest from the patient at a 45º angle towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the spine board;
⦁ Lower the patient and elevated side of the spine board down onto the ground together, with the spine board assisting to maintain alignment of the patient, again with B-Man at the patient’s torso setting the pace. The spine board, therefore, acts a body splint for lowering the patient;
⦁ Straighten out the patient’s knees;
⦁ Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the patient’s spinal column and to improve comfort;
⦁ Immobilize the patient on the spine board.