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TRANSFER and IMMOBILIZATION TECHNIQUES

Spinal Immobilization vs. Spinal Motion Restriction
Spinal immobilization and spinal motion restriction both relate to preventing movement of the spine.  Spinal immobilization involves the use of cervical immobilization devices such as cervical collars and spine boards to minimize movement of the spine.  Conversely, spinal motion restriction refers to maintaining anatomical alignment of the spine and minimizing movement without the use of such cervical immobilization devices.

Though a long standing practice, the benefit of spinal immobilization in most trauma patients is unproven.  Recent literature indicates that spinal immobilization may actually harm some patients, resulting in agitation, pain, increased radiography, pressure sores, tissue ischemia, aspiration and respiratory compromise. Studies have also suggested that there is no significant difference in movement within the spinal column when comparing patients immobilized to a backboard versus those who were placed on a gurney. Thus, the criteria for the application of spinal precautions though unproven but generally accepted and prudent, should continue to be updated to follow validated, evidence-based indications.1  However, most experts participating in Sports Medicine Concepts’ In 2Min or Less!® sports emergency care curriculum prefer traditional spine immobilization using a cervical collar and spine board when transporting a potentially neurologically injured athlete.  Most experts express that the complications found to be associated with use of spinal immobilization using a spine board result from prolonged immobilization, and that spinal immobilization of patients presenting with mid-line cervical pain, neurological signs and symptoms, or apprehension secondary to an axial load mechanism of injury is warranted in management the neurologically unstable athlete.  Evidence Category C. 

Therefore, spinal immobilization will be considered for patients that have sustained blunt trauma through a high-energy or axial load injury mechanism and present with any of the following:

For these athlete, a cervical collar will be applied and the athlete immobilized to a spine board. 

Spinal motion restriction will be considered when athletes meet NEXUS exclusionary criteria.2

Transferring to a Spine Board
Transferring an athlete to a spine board may be required in order to immobilize an athlete to protect against secondary injury or to facilitate transport to an appropriate medical facility.  The medical team recognizes that there are various accepted techniques employed to transfer an injured athlete to rigid support.  When transfer to rigid support is indicated, The will decide which transfer technique is most appropriate based on the team’s expert opinion of how best to utilize existing emergency response equipment and personnel to meet the team’s Primary Objectives™ established for each unique injury management scenario.

In all transfer techniques the task is completed under the direction of the A-Man.  The A-Man’s primary responsibilities include:

Upon completion of any transfer technique, the medical team will likely need to utilize a V-Slide technique to properly position the athlete on the LSB.

A variation of the flat-log techniques described blow would involve log rolling the patient to 45º while the LSB is slid in against the ground with the back of the LSB resting on the thighs of B- and C-Man.  Once in position, A-Man directs the medical team to lower the athlete onto the LSB, then lower the LSB to the ground.

The various techniques that the medical team may elect to employ to transfer an injured athlete to rigid support are outlined below:

From Supine

5-Person Log Roll-Push

A-Man

Step 1

Step 2

Step 3:  If appropriate, 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 LSB.  This will also assist in the later removal of the patient off the LSB.

Step 4:  E-Man slides the LSB in against the ground with the edge of the LSB towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the LSB.

Step 5:  Lower the patient onto the LSB, again with A-Man setting the pace.

Step 6:  Keeping the patient in the neutral in-line position, use a v-slide to gently adjust the patient’s position sideways so that the patient is centered on the LSB.

Step 7:  Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column and for comfort;
Immobilize the patient onto the LSB for transport.

4-Person Log Roll-Push

A-Man

Step 1

Step 2

Step 3:  If appropriate, 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 LSB.  This will also assist in the later removal of the patient off the LSB.

Step 4:  D-Man slides the LSB in against the ground with the edge of the LSB towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the LSB.

Step 5:  Lower the patient onto the LSB, again with A-Man setting the pace.

Step 6:  Keeping the patient in the neutral in-line position, use a v-slide to gently adjust the patient’s position sideways so that the patient is centered on the LSB.

Step 7:  Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column and for comfort;
Immobilize the patient onto the LSB for transport.

2-Person Log Roll

A-Man

B-Man

6-Person Straddle Lift-Slide

Key Points

Step 1: Place the LSB at the patient’s feet and in-line with the patient’s body so that the LSB can be slid under from the patient’s feet.  A-Man positions at the patient’s head and squats down on their knees.  A-Man positions at the patient’s head and squats down on their knees. Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.  A cervical collar is applied in the absence of protective athletic equipment. The manual in-line stabilization is maintained until full spine immobilization is achieved.  B- and C-Man straddle the patient’s torso. B- and C-Man pull the patient’s clothes at the shoulders firmly to the sides with their lower hands to allow their upper hand to easily slide under patients shoulders. DO NOT lift patient’s shoulder upward during this procedure. B- and C-Man’s upper elbow should rest on their upper thigh to avoid strain on the responder’s back during the lift.  B- and C-Man’s lower hand should be placed under the patient’s lumbar spine.  D- and E-Man straddle the patient on either side of the patient’s mid thigh. C- and D-Man pull the patient’s clothes at the patient’s bottom firmly sideways with lower hand to allow their upper hand to slide easily under patient’s bottom. DO NOT lift patients bottom upward. D- and E-Man’s upper elbow should rest on their upper thigh to avoid strain on their back during the lift.  F-Man is positioned above the patient’s head to slide the LSB into place.  Before inserting the LSB, F-Man insert a forearm airsplint on top of the LSB where the patient’s lumbar spine will be positioned.

Step 2:  With A-Man at the patient’s head in-charge, A-E-Man lift the patient only enough for F-Man to slide the LSB under the patient.

Step 3:  F-Man then slides the LSB underneath the patient.   The patient is then immobilized to the Board for transport.

4-Person Straddle-Lift- Slide

Key Points

Step 1:  Place the LSB above the patient’s head and in-line with the patient’s body.   Alternatively, the LSB can be slid under from the patient’s foot end if access above the patient’s head is not possible. A-Man positions at the patient’s head and squats down on their knees with one leg on either side of the LSB so that the LSB can be slid through A-Man’s legs.  Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.   A Cervical Collar is also applied in the absence of protective athletic equipment. The Manual in-line stabilization is maintained until full spine immobilization is achieved.  B-Man 2 is positioned above the patient’s head to slide the LSB into place. Before inserting the LSB, E-Man should place a forearm airsplint on the LSB where the patient’s lumbar spine will be positioned.

Step 2:  C-Man straddles over the patient’s torso and faces side-on to the patient. C-Man then squats down and places their hands underneath the patient’s armpits. C-Man’s arms should rest on their inner legs with their back and arms kept straight. D-Man (at the same time as C-Man) straddles over the patient’s upper legs and faces the same way as C-Man. D-Man then squats down and places their hands underneath the patient’s bottom. D-Man’s arms should rest on their inner legs with their back and arms kept straight.

Step 3:  WithA-Man in charge, A-Man at the head lifts by slightly flexing both their elbows. C-Man at the patient’s chest and D-Man at the patient’s pelvis keep their arms and backs straight and lift the patient approximately 5″ of the ground by flexing their quadriceps only. B-Man then slides the LSB underneath the patient.

2-Person Straddle-Lift-Slide

Key Points

Step 1: A-Man places the LSB above the patient’s head in-line with the patients body and then positions beside the LSB.

Step 2: B-Man straddles the patient’s torso facing A-Man, squatting down and is positioned at the patient’s torso and places a pillow under the patient’s head (if non trauma) or towel (if trauma).  B-Man supports the patient’s head as A-Man slides the LSB under the patient’s head.

Step 3: B-Man now repositions their hands underneath the patient’s armpits. B-Man’s arms should rest on their inner legs, with their back and arms kept straight. B-Man lifts the patient’s torso by slightly flexing their quadriceps, but only enough to slide the LSB underneath the patient’s torso.  A-Man stops sliding the LSB when it touches the patient’s bottom. The curve of the LSB will allow the LSB to slide correctly aligned under the patient.

Step 4: B-Man now moves down to the patient’s pelvis and straddles the patient, squatting down and placing their hands underneath the patient’s bottom.  B-Man’s back and arms are kept straight. B-Man then lifts the patient’s pelvis by slightly flexing quadriceps. A-Man then slides the LSB underneath the patients bottom and legs until the patient’s shoulders are correctly aligned with the shoulder markings on the LSB. The patient is then secured to the LSB for safety during transport.

6-Person Lift-Slide

After careful evaluation of various transfer techniques the  medical team has adopted the following 6-person lift-slide technique as its preferred method of transferring an injured patient to a long spine board (LSB).  However, the medical team may elect to employ any of the other accepted transfer techniques, if deemed by the medical team to be more appropriate to the given situation.

Key Points

Step 1:  Place the LSB at the patient’s feet and in-line with the patient’s body so that the LSB can be slid under from the patient’s feet.  A-Man positions at the patient’s head and squats down on their knees. Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.  A cervical collar is applied in the absence of protective athletic equipment.  Manual in-line stabilization is maintained until full spine immobilization is achieved.  B- and C-Man kneel on either side of the patient’s torso. B- and C-Man pull the patient’s clothes at the shoulders firmly to the sides with their lower hands to allow their upper hand to easily slide under patients shoulders. DO NOT lift patient’s shoulder upward during this procedure. B- and C-Man’s upper elbow should rest on their upper thigh to avoid strain on the responder’s back during the lift.  B- and C-Man’s lower hand should be placed under the patient’s lumbar spine.  D- and E-Man kneel on either side of the patient’s mid thigh.  C- and D-Man pull the patient’s clothes at the patient’s bottom firmly sideways with lower hand to allow their upper hand to slide easily under patient’s bottom. DO NOT lift patients bottom upward. D- and E-Man’s upper elbow should rest on their upper thigh to avoid strain on their back during the lift.  F-Man is positioned above the patient’s head to slide the LSB into place.  Before inserting the LSB, F-Man insert a forearm airsplint on top of the LSB where the patient’s lumbar spine will be positioned.

Step 2:  With A-Man at the patient’s head in-charge, A-E-Man lift the patient by slightly flexing their arms upwards, lifting the patient only enough for F-Man to slide the LSB under the patient.

Step 3:  F-Man then slides the LSB underneath the patient.   The patient is then immobilized to the Board for transport.

Scoop Stretcher

 Scoop Stretcher Football Review  Scoop Stretcher Ice Hockey and Slide Board Review  
 

A-Man

B- and C-Man

Adjust length of Scoop Stretcher

Slide scoop stretcher into place

Immobilize or secure patient to scoop stretcher as required by patient’s condition

From Prone

In athletics, expert opinion suggests that it is generally agreed upon that an athlete should be repositioned from prone to supine before being transferred to rigid support.  This is so because most experts feel that most athlete’s will not ultimately require immobilization on rigid support, or that completion of critical care tasks would be unecessarily delayed by the transfer process.  However, there may be instances where the medical team elects to transfer a prone athlete directly to rigid support.  When transfer from prone to rigid support is required the medical team will employ one of the following accepted techniques:

5-Person 180º- Log Roll

A-Man

Key Points:

Step 1:  A-Man positioned at the patient’s head, positions their arms in anticipation of the full rotation that will occur as described above.  A-Man positions at a 45º angle to the patient, with arms placed so that the elbow to the side the patient will be rolled onto is in line with the patient’s inner shoulder to roll.  B-Man kneels at the patient’s mid-torso, on the other side to which the patient is to be rolled, and extends the patient’s arms down the patients torso. B-Man places their upper hand under the patient’s shoulder and the lower hand under the patient’s abdominal region level with lower ribs. C-Man kneels on the same side as B-Man at the patient’s thigh, slides their upper hand under the patient’s pelvic region, and lower hand under patient’s upper leg.  C-Man also places a rolled up towel against the patient’s leg just below the knees for the lower legs to roll onto during the log roll to prevent pelvic drooping.  D- and E-Man kneel on the side to which the patient is to be rolled. D-Man kneels at the patient’s mid torso grasping the patient’s opposite side shoulders and opposite lower chest. E-Man kneels at the patient’s thigh grasping the patient’s opposite pelvis and opposite mid femur.  A LSB is rested on the knees of D- and E-Man so that the side of the LSB furthest from the patient is elevated at an angle of 45º.  The LSB’s shoulder marking is aligned with the patient’s shoulders.

Step 2:  The patient is carefully log rolled until the patient’s back is placed on the LSB. A-Man at the patient’s head is in charge and sets the pace.  A-Man watches the patient’s torso turn and maintains the current position of the head, rotating it exactly with the patient’s torso. Only after the patient is completely log rolled onto the their back is the patient’s head then slowly re-aligned to the neutral in-line position unless contra-indicated. B- and D Man both assist with rotation of the patient’s torso. C- and E Man both assist with rotation of the patient’s pelvis, ensuring the patient’s pelvis rotates in-line with the patient’s torso.

Step 3:  While rotating the patient, D- and E-Man steadily shuffle backwards until the LSB and patient are flat on the ground. Keeping the patient in the neutral in-line position, use the v-slide technique to gently adjust the patient’s position sideways until centered on the LSB.

Step 4:  A-Man now re-aligns the patients head into the neutral in-line position unless contra-indicated.

Step 5:  Apply appropriate pack-n-fill padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column.   In the absence of protective athletic equipment, A cervical collar is now applied, and the patient immobilized to the LSB for transport.

References:

  1. National Registry of Emergency Medical Technicians.  National Registry of EMT’s Resource Document on Spinal Motion Restriction/Immobilization.  Accessed 9/2/19.
  2. Hoffman J, Mower W, Wolfson A, Todd K, Zucker M. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. The New England Journal of Medicine. July 13, 2000;343(2):94-99.